Flurazepam
/api/v1/drug/flurazepamBoxed warning
RISKS FROM CONCOMITANT USE WITH OPIOIDS; ABUSE, MISUSE, AND ADDICTION; and DEPENDENCE AND WITHDRAWAL REACTIONS Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Follow patients for signs and symptoms of respiratory depression and sedation [see Warnings and Precautions ( 5.1 ) and Drug Interactions ( 7.1 ) ]. The use of benzodiazepines, including flurazepam hydrochloride capsules, exposes users to risks of abuse, misuse, and addiction, which can lead to overdose or death. Abuse and misuse of benzodiazepines commonly involve concomitant use of other medications, alcohol, and/or illicit substances, which is associated with an increased frequency of serious adverse outcomes. Before prescribing flurazepam hydrochloride capsules, and throughout treatment, assess each patient’s risk for abuse, misuse, and addiction [ see Warnings and Precautions ( 5.2 ) ]. The continued use of benzodiazepines, including flurazepam hydrochloride capsules, may lead to clinically significant physical dependence. The risks of dependence and withdrawal increase with longer treatment duration and higher daily dose.
Mechanism of action
Sourced from openFDAMechanism-of-action class: GABA A Modulators.
Indications
Sourced from openFDA- Flurazepam hydrochloride capsules are indicated for the treatment of insomnia characterized by difficulty in falling asleep, frequent nocturnal awakenings, and/or early morning awakenings [see Clinical Studies ( 14 ) ]. Since insomnia is often transient and intermittent, short-term use is usually sufficient.ICD-10: G47.00
Contraindications
Sourced from openFDA- Flurazepam hydrochloride capsules are contraindicated in patients with known hypersensitivity to flurazepam or other benzodiazepines. Rare cases of angioedema involving the tongue, glottis or larynx have been reported in patients after taking the first or subsequent doses of flurazepam.contraindicated
Dosage & administration
Sourced from openFDAUse the lowest dose effective for the patient. Recommended initial dose is 15 mg for women and 15 mg or 30 mg for men. ( 2.1 ) Elderly or debilitated patients: recommended dose is 15 mg. ( 2.2 ) 2.1 Dosage in Adults Use the lowest dose effective for the patient, as important adverse effects of flurazepam hydrochloride capsules are dose related. The recommended initial dose is 15 mg for women and either 15 mg or 30 mg for men. The 15 mg dose can be increased to 30 mg if necessary for efficacy. The recommended initial doses for women and men are different because flurazepam clearance is lower in women [see Pharmacokinetics ( 12.3 ) ]. 2.2 Dosage in Elderly or Debilitated Patients Elderly or debilitated patients may be especially sensitive to flurazepam. Since the risk of the development of oversedation, dizziness, confusion and/or ataxia increases substantially with larger doses in elderly or debilitated patients, it is recommended that in such patients the dosage be limited to 15 mg. Staggering and falling have also been reported, particularly in geriatric patients [see Warnings and Precautions ( 5.2 ) ]. 2.3 Discontinuation or Dosage Reduction of Flurazepam Hydrochloride Capsules To reduce the risk of withdrawal reactions, use a gradual taper to discontinue flurazepam hydrochloride capsules or reduce the dosage. If a patient develops withdrawal reactions, consider pausing the taper or increasing the dosage to the previous tapered dosage level. Subsequently decrease the dosage more slowly [ see Warnings and Precautions ( 5.3 ) and Drug Abuse and Dependence ( 9.3 ) ].
Warnings & precautions
Sourced from openFDACNS depressant effects: Impaired alertness and motor coordination, including risk of falling. Daytime impairment. Caution patients against driving and other activities requiring complete mental alertness. ( 5.4 ) The failure of insomnia to remit after 7 to 10 days of treatment may indicate the presence of a primary psychiatric and/or medical illness that should be evaluated. ( 5.5 ) Severe anaphylactic/anaphylactoid reactions: Angioedema and anaphylaxis have been reported. Do not rechallenge if such reactions occur. ( 5.6 ) Sleep driving and other complex behaviors while not fully awake: Risk increases with dose and concomitant CNS depressants and alcohol. Immediately evaluate any new onset behavioral changes. ( 5.7 ) Worsening of depression or suicidal thinking may occur: Prescribe the least number of capsules feasible to avoid intentional overdose. ( 5.8 ) Neonatal Sedation and Withdrawal Syndrome: Flurazepam use during pregnancy can result in neonatal sedation and/or neonatal withdrawal. ( 5.9 ) 5.1 Risks from Concomitant Use of Opioids Concomitant use of benzodiazepines, including flurazepam, and opioids may result in profound sedation, respiratory depression, coma, and death. Because of these risks, reserve concomitant prescribing of benzodiazepines and opioids in patients for whom alternative treatment options are inadequate. Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases the risk of drug-related mortality compared to use of opioids alone.
Adverse reactions
Sourced from openFDAThe following serious adverse reactions are discussed in greater detail in other sections of the label: Risks from Concomitant Use with Opioids [see Warnings and Precautions ( 5.1 ) ] Abuse, Misuse, and Addiction [see Warnings and Precautions ( 5.2 )] Dependence and Withdrawal Reactions [see Warnings and Precautions ( 5.3 ) ] CNS-depressant effects and next-day impairment [see Warnings and Precautions ( 5.4 )] Severe Anaphylactic and Anaphylactoid Reactions [see Warnings and Precautions ( 5.6 )] Abnormal thinking and behavior changes, and complex behaviors [see Warnings and Precautions ( 5.7 )] Worsening of depression [see Warnings and Precautions ( 5.8 )] Neonatal Sedation and Withdrawal Syndrome [see Warnings and Precautions ( 5.9 )] Adverse reactions: dizziness, drowsiness, light-headedness, staggering, ataxia, falling. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Chartwell RX, LLC. at 1-845-232-1683 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch . 6.1 Clinical Trials Experience Reported were headache, heartburn, upset stomach, nausea, vomiting, diarrhea, constipation, gastrointestinal pain, nervousness, talkativeness, apprehension, irritability, weakness, palpitations, chest pains, body and joint pains, and genitourinary complaints.
Use in specific populations
Sourced from openFDALactation: Breastfeeding not recommended. ( 8.2 ) 8.1 Pregnancy Pregnancy Exposure Registry: There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to psychiatric medications, including flurazepam, during pregnancy. Healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Psychiatric Medications at 1-866-961-2388 or visiting online at https://womensmentalhealth.org/pregnancyregistry/ . Risk Summary Neonates born to mothers using benzodiazepines late in pregnancy have been reported to experience symptoms of sedation and/or neonatal withdrawal [ see Warnings and Precautions ( 5.9 ) and Clinical Considerations]. Available data from published observational studies of pregnant women exposed to benzodiazepines do not report a clear association with benzodiazepines and major birth defects (see Data) . The background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively.
Overdosage
Sourced from openFDAOverdosage of benzodiazepines is characterized by central nervous system depression ranging from drowsiness to coma. In mild to moderate cases, symptoms can include drowsiness, confusion, dysarthria, lethargy, hypnotic state, diminished reflexes, ataxia, and hypotonia. Rarely, paradoxical or disinhibitory reactions (including agitation, irritability, impulsivity, violent behavior, confusion, restlessness, excitement, and talkativeness) may occur. In severe overdosage cases, patients may develop respiratory depression and coma. Overdosage of benzodiazepines in combination with other CNS depressants (including alcohol and opioids) may be fatal [see Warnings and Precautions ( 5.2 )] . Markedly abnormal (lowered or elevated) blood pressure, heart rate, or respiratory rate raise the concern that additional drugs and/or alcohol are involved in the overdosage. In managing benzodiazepine overdosage, employ general supportive measures, including intravenous fluids and airway management.
Approval history
Sourced from openFDA- Mar 30, 1989ANDAANDA072368Chartwell Rx
- Mar 30, 1989ANDAANDA072369Chartwell Rx
FAERS reports
- 1Drug Abuse5715%
- 2Suicide Attempt5514%
- 3Toxicity To Various Agents4913%
- 4Sopor4512%
- 5Intentional Overdose4311%
- 6Somnolence348.9%
- 7Intentional Self-injury318.1%
- 8Drug Interaction277.0%
- 9Coma266.8%
- 10Fall236.0%
- 11Hypotension215.5%
- 12Confusional State205.2%
- 13Nausea194.9%
- 14Asthenia184.7%
- 15Insomnia184.7%
Literature
Recent PubMed references pinned to Flurazepam as a MeSH major topic. Citations link to pubmed.ncbi.nlm.nih.gov.
- Interventions to reduce bruxism in children and adolescents: a systematic scoping review and critical reflection.European journal of pediatrics · 2020 · Chisini LA, San Martin AS, Cademartori MG, et al.PMID 31858254DOI 10.1007/s00431-019-03549-8
- Characterization and in vitro phase I microsomal metabolism of designer benzodiazepines: An update comprising flunitrazolam, norflurazepam, and 4'-chlorodiazepam (Ro5-4864).Drug testing and analysis · 2019 · Moosmann B, Bisel P, Westphal F, et al.PMID 30578721DOI 10.1002/dta.2561
- Desalkylflurazepam found in patients' samples after high-dose midazolam treatment.Drug testing and analysis · 2013 · Vogt S, Kempf J, Buttler J, et al.PMID 23713025DOI 10.1002/dta.1484
- Regulation of Ca²⁺/calmodulin-dependent protein kinase II signaling within hippocampal glutamatergic postsynapses during flurazepam withdrawal.Neural plasticity · 2012 · Earl DE, Das P, Gunning WT 3rd, et al.PMID 22830051DOI 10.1155/2012/405926
- Disulphide trapping of the GABA(A) receptor reveals the importance of the coupling interface in the action of benzodiazepines.British journal of pharmacology · 2011 · Hanson SM, Czajkowski CPMID 20942818DOI 10.1111/j.1476-5381.2010.01073.x
- [Drugs and the mechanism for reversing the tolerance of flurazepan in rats].Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics · 2010 · Bian FZ, Wang L, Wang YX, et al.PMID 20113637
- Effects of discontinuing benzodiazepine-derivative hypnotics on postural sway and cognitive functions in the elderly.International journal of geriatric psychiatry · 2010 · Tsunoda K, Uchida H, Suzuki T, et al.PMID 20054834DOI 10.1002/gps.2465
- Mice lacking Gad2 show altered behavioral effects of ethanol, flurazepam and gabaxadol.Addiction biology · 2010 · Blednov YA, Walker DL, Iyer SV, et al.PMID 20002022DOI 10.1111/j.1369-1600.2009.00186.x
Clinical trials
The 4 most recently updated of 4 ClinicalTrials.gov registrations naming Flurazepam as an intervention. Registration is not evidence of efficacy or safety — reference crosswalk only.
- Sunitinib or Cediranib for Alveolar Soft Part SarcomaCompleted · Phase 2 · Interventional · 34 enrolled · National Cancer Institute (NCI)NCT01391962updated 2026-02-02
- Study to Evaluate the Effect of 2 Dosage Strengths of Lemborexant (E2006) on a Multiple Sleep Latency Test in Participants With Insomnia DisorderCompleted · Phase 1 · Interventional · 69 enrolled · Eisai Inc.NCT02350309updated 2020-01-18
- Pharmacovigilance in Gerontopsychiatric PatientsTerminated · Phase 3 · Interventional · 407 enrolled · Hannover Medical SchoolNCT02374567updated 2018-02-28
- Effects of Discontinuation of Benzodiazepine-derivative Hypnotics on Cognitive and Motor Functions in Elderly PersonsCompleted · Phase 4 · Interventional · 30 enrolled · Minamihanno HospitalNCT00707915updated 2012-03-27
Frequently asked questions
- How does Flurazepam work?
- Mechanism-of-action class: GABA A Modulators.
- What is Flurazepam used for?
- According to FDA labeling, Flurazepam carries indications including: Flurazepam hydrochloride capsules are indicated for the treatment of insomnia characterized by difficulty in falling asleep, frequent nocturnal awakenings, and/or early morning awakenings [see Clinical Studies ( 14 ) ]. Since insomnia is often transient and intermittent, short-term use is usually sufficient.. This is a reference summary of labeled uses, not medical advice or a treatment recommendation.
- What class of drug is Flurazepam?
- Flurazepam is classified as Benzodiazepine derivatives, Benzodiazepine, GABA A Modulators, Increased Central Nervous System GABA Activity.
- What are the contraindications for Flurazepam?
- Flurazepam labeling lists contraindications including: Flurazepam hydrochloride capsules are contraindicated in patients with known hypersensitivity to flurazepam or other benzodiazepines. Rare cases of angioedema involving the tongue, glottis or larynx have been reported in patients after taking the first or subsequent doses of flurazepam.. Always consult the full prescribing information and a clinician.
flurazepam is illustrative MVP content compiled from public sources. pharmacopeia is for educational and informational use only and is not a substitute for professional medical advice.