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Temazepam, sold under the brand name Restoril among others, is a medication of the benzodiazepine class which is generally used to treat severe or debilitating insomnia.

It is taken by mouth. Temazepam is rapidly absorbed, and significant hypnotic effects begin in less than 30 minutes and can last for up to eight hours.

Prescriptions for hypnotics such as temazepam have seen a dramatic decrease since 2010, while anxiolytics such as alprazolamclonazepam, and lorazepam have increased or remained stable.

Temazepam and similar hypnotics, such as triazolam (Halcion) are generally reserved for severe and debilitating insomnia.

They have largely been replaced by z-drugs (zopiclonezolpidem) and atypical antidepressants (trazodonemirtazapine) as first line treatment for insomnia.

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Common side effects include drowsiness, motor and cognitive impairment, lethargy, confusion, euphoria, and dizziness. Serious side effects may include hallucinationshypotension, respiratory depression, abuseanaphylaxis, and suicide.

Use is generally not recommended together with alcohol or opioids. If the dose is rapidly decreased withdrawal may occur. Use during pregnancy or breastfeeding is not recommended. Temazepam is a short-acting benzodiazepine and hypnotic.

It works by affecting GABA within the brain.

Temazepam was patented in 1962 and came into medical use in 1969. It is available as a generic medication. In 2021, it was the 208th most commonly prescribed medication in the United States, with more than 2 million prescriptions.

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Temazepam uses

In sleep laboratory studies, temazepam significantly decreased the number of nightly awakenings, but has the drawback of distorting the normal sleep pattern. It is officially indicated for severe insomnia and other severe or disabling sleep disorders.

The prescribing guidelines in the UK limit the prescribing of hypnotics to two to four weeks due to concerns of tolerance and dependence.

The American Academy of Sleep Medicine‘s 2017 clinical practice guidelines recommended the use of temazepam in the treatment of sleep-onset and sleep-maintenance insomnia.

It rated the recommendation as weak, the quality of evidence as moderate, and concluded that the potential benefits outweighed the potential harms.

The guidelines found that temazepam at a dose of 15 mg reduces sleep latency by 37 minutes (95% CITooltip confidence interval 21 to 53 minutes), increases total sleep time by 99 minutes (95% CI 63 to 135 minutes), and provides a small improvement to sleep quality.

The improvements in sleep latency and total sleep time were numerically much greater than any of the other included sleep medications, including eszopiclone, zopiclone, zolpidem, triazolam, estazolam, quazepam, flurazepam, trazodone, diphenhydramine, gabapentin, among others.

The United States Air Force uses temazepam as one of the hypnotics approved as a “no-go pill” to help aviators and special-duty personnel sleep in support of mission readiness.

“Ground tests” are necessary prior to required authorization being issued to use the medication in an operational situation, and a 12-hour restriction is imposed on subsequent flight operation.

The other hypnotics used as “no-go pills” are zaleplon and zolpidem, which have shorter mandatory recovery periods.

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Temazepam effects

Side effects are typical of hypnotic benzodiazepines, though temazepam has more pronounced CNS depressant effects, and include somnolence, sedation, dizzinessfatigueataxiaheadachelethargy, impairment of memory and learning.

longer reaction time and impairment of motor functions (including coordination problems), slurred speech, decreased physical performance, numbed emotions, reduced alertness, muscle weakness, blurred vision (especially in higher doses or in those with low tolerance), and inattention.

Euphoria was a reported side effect with its use, which is uncommon or not ever reported amongst benzodiazepines. According to the U.S. Food and Drug Administration, temazepam had an incidence of euphoria of 1.5%, which is considered rare.

Feelings of euphoria, pleasant sedation, and inner feelings of peace are reported by those who abuse drugs, particularly in those who use temazepam intravenously. It has the highest ratings reported among benzodiazepines by recreational drug users.

Drug users tend have a higher preference for temazepam over other benzodiazepines. The three most common reasons for temazepam preference were due to speed of onset, that a it was ‘strong’ and that it gave a good ‘high’.

Anterograde amnesia is also common, and respiratory depression in higher doses has proven to be fatal, even when temazepam is taken alone.

In medical literature from Australia, Irealnd, the UK, Canada, and the United States, temazepam is the only benzodiazepine which has been fatal in overdoses without combination with other CNS depresssants.

This unique feature is due to the toxicity of the drug, which numerous studies have ranked it as being most toxic.

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