Long-acting benzodiazepine hypnotic
Enhances GABA-A receptor-mediated chloride influx, potentiating inhibitory neurotransmission.
Insomnia characterized by difficulty with sleep onset and/or frequent nighttime awakenings.
None well established; generally reserved for short-term hypnotic use only.
Oral capsules
15 mg p.o. at bedtime.
15–30 mg nightly
Metabolized primarily by CYP3A4 to long-acting active metabolites with half-lives extending up to several days, causing prolonged sedation. Parent drug half-life is 2–3 hours. Metabolites accumulate with repeated dosing, especially in elderly or those with impaired metabolism.
Next-day sedation, dizziness, confusion, impaired coordination, risk of falls.
Excessive sedation, respiratory depression, paradoxical reactions (rare).
Assess sedation level, cognition, and fall risk regularly; avoid use beyond short-term.
Risk of profound sedation, respiratory depression, coma, and death when used with opioids. Risk of dependence, misuse, and withdrawal with prolonged use.
Use caution in older adults, dementia, traumatic brain injury (TBI), or cognitive disorders due to risk of prolonged sedation, confusion, and falls. Flurazepam is not recommended for chronic use in geriatric populations.