Home Drug Guide Quazepam

Drug Guide

Generic Name

Quazepam

Brand Names Doral

Classification

Therapeutic: Sedative-Hypnotic, Anxiolytic

Pharmacological: Benzodiazepine

FDA Approved Indications

Short-term treatment of insomnia

Mechanism of Action

Enhances the activity of gamma-aminobutyric acid (GABA) at GABA-A receptors, resulting in sedative, anxiolytic, anticonvulsant, and muscle relaxant properties.

Dosage and Administration

Adult: Initial dose usually 7.5 mg at bedtime. Dose may be adjusted based on response and tolerability.

Pediatric: Not approved for pediatric use.

Geriatric: Start with lower doses, e.g., 3.75 mg at bedtime, due to increased sensitivity and risk of adverse effects.

Renal Impairment: Use caution; dosage adjustment may be necessary.

Hepatic Impairment: Use caution; monitor for increased sedation.

Pharmacokinetics

Absorption: Well absorbed orally.

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

Metabolism: Primarily hepatic by oxidation and conjugation.

Excretion: Primarily in urine as metabolites.

Half Life: Approximately 10-12 hours, extended in elderly.

Contraindications

Hypersensitivity to benzodiazepines or any component of the formulation.
Myasthenia gravis.
Severe respiratory insufficiency.
Sleep apnea syndromes.

Precautions

History of substance abuse.
Liver impairment.
Psychotic disorders.
Pregnancy and lactation: use only if clearly necessary; risk in pregnancy especially during the first trimester.

Adverse Reactions - Common

Drowsiness (Common)
Dizziness (Common)
Fatigue (Common)
Headache (Common)

Adverse Reactions - Serious

Respiratory depression (Rare)
Anterograde amnesia (Uncommon)
Tolerance, dependence, withdrawal symptoms (Possible with prolonged use)

Drug-Drug Interactions

CNS depressants (e.g., alcohol, opioids, other sedatives), may enhance sedative effects.
Hepatic enzyme inducers or inhibitors affecting metabolism.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor mental status, alertness state, respiratory status, and signs of dependence.

Diagnoses:

Risk for injury due to sedation or impaired coordination.
Risk for dependence.

Implementation: Administer dose at bedtime. Use the lowest effective dose for the shortest duration. Monitor for adverse reactions.

Evaluation: Assess sleep quality and duration, monitor for adverse effects and dependence signs.

Patient/Family Teaching

Take medication exactly as prescribed.
Avoid alcohol and other CNS depressants.
Be cautious when performing tasks requiring alertness.
Do not abruptly stop medication to prevent withdrawal symptoms.
Report any unusual side effects or worsening symptoms.

Special Considerations

Black Box Warnings:

Potential for severe respiratory depression, especially when combined with other CNS depressants or in certain populations.

Genetic Factors: CYP3A4 enzyme metabolizes quazepam; genetic variations may affect metabolism.

Lab Test Interference: Potential false positives for benzodiazepines on drug screens.

Overdose Management

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

Treatment: Supportive care, maintain airway, possibly administer flumazenil if appropriate and under supervision.

Storage and Handling

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

Stability: Stable under normal storage conditions.