Home Drug Guide Flurazepam Hydrochloride

Drug Guide

Generic Name

Flurazepam Hydrochloride

Brand Names Dalmane

Classification

Therapeutic: Sedative-Hypnotic, Anxiolytic

Pharmacological: Benzodiazepine

FDA Approved Indications

Short-term management of insomnia characterized by difficulty with sleep initiation, duration, or both

Mechanism of Action

Enhances the effect of gamma-aminobutyric acid (GABA) at the GABA-A receptor, producing sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant properties.

Dosage and Administration

Adult: Initially, 30 mg at bedtime. Dose may be increased gradually up to 60 mg.

Pediatric: Not recommended for pediatric use.

Geriatric: Start at lower dose, typically 15 mg, with caution due to increased sensitivity and risk of side effects.

Renal Impairment: Use with caution; consult labeling for specific adjustments.

Hepatic Impairment: Use with caution; dose adjustment may be necessary.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed; crosses the blood-brain barrier.

Metabolism: Metabolized in the liver mainly by CYP3A4 enzyme to active and inactive metabolites.

Excretion: Excreted primarily in urine as metabolites.

Half Life: Approximately 40-100 hours, contributing to its long duration of action.

Contraindications

Hypersensitivity to benzodiazepines or any component of the formulation.
Acute narrow-angle glaucoma.

Precautions

Use with caution in elderly patients, patients with a history of substance abuse, respiratory impairment, hepatic impairment, or psychiatric disorders.

Adverse Reactions - Common

Drowsiness (Common)
Dizziness (Common)
Gastrointestinal disturbances (Less common)

Adverse Reactions - Serious

Respiratory depression (Rare)
Dependence or abuse potential (Potential with prolonged use)
Anterograde amnesia (Reported but uncommon)

Drug-Drug Interactions

CNS depressants (alcohol, opioids, other sedatives) - increased sedative effects, risk of respiratory depression.
Rifampin - decreased sedative effect due to increased metabolism.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for effectiveness in improving sleep, assess for signs of dependence, and observe for adverse reactions.

Diagnoses:

Risk for falls due to sedation, dizziness, or impaired coordination.
Risk for dependence with prolonged use.

Implementation: Administer at bedtime, instruct patient on proper use, and evaluate sleep patterns.

Evaluation: Effective sleep induction and maintenance without significant adverse effects or dependence.

Patient/Family Teaching

Take medication exactly as prescribed, usually at bedtime.
Avoid alcohol and other CNS depressants.
Do not abruptly discontinue to prevent withdrawal symptoms.
Use caution when rising from bed to prevent falls.

Special Considerations

Black Box Warnings:

Potential for abuse and dependence.
Risks from concomitant use with opioids.

Genetic Factors: Genetic variations in CYP3A4 may affect metabolism.

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Excessive sedation, confusion, respiratory depression, coma.

Treatment: Supportive care, airway management, possible use of flumazenil as an antidote to reverse benzodiazepine effects under careful medical supervision.

Storage and Handling

Storage: Store at room temperature away from moisture, heat, and light.

Stability: Stable when stored properly, check expiration date.