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(tem-AZE-uh-pam)
Restoril,  Apo-Temazepam, Dom-Temazepam, Gen-Temazepam, Novo-Temazepam, Nu-Temazepam, PMS-Temazepam
Class: Sedative Hypnotic/Benzodiazepine

 Action Potentiates action of GABA (gamma-aminobutyric acid), an inhibitory neurotransmitter, resulting in increased neuronal inhibition and CNS depression, especially in limbic system and reticular formation.

 Indications Short-term management of insomnia.

 Contraindications Hypersensitivity to benzodiazepines; pregnancy.

 Route/Dosage

ADULTS: PO 7.5–30 mg at bedtime; individualize. ELDERLY OR DEBILITATED PATIENTS: PO 15 mg until individual response is determined.

 Interactions

Alcohol, other CNS depressants: Additive CNS depressant effects. Digoxin: Serum digoxin concentrations may increase. Theophylline: May antagonize sedative effects.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Palpitations; tachycardia. CNS: Drowsiness; dizziness; lethargy; confusion; euphoria; weakness; falling; ataxia; hallucinations; paradoxical reactions (eg, excitement, agitation); headache; memory impairment. EENT: Blurred vision; difficulty focusing. GI: Anorexia; diarrhea; abdominal cramping; constipation; nausea; vomiting. HEMA; Leukopenia; agranulocytopenia. OTHER: Tolerance; physical and psychological dependence; slurred speech; elevated AST, ALT, bilirubin.

 Precautions

Pregnancy: Category X. Lactation: Similar drugs excreted in breast milk. Children: Not for use in children < 18 yr. Elderly/debilitated: Increased side effects; start with lowest dose. Anterograde amnesia: Has occurred with similar drugs. Alcohol may increase risk. Dependence/withdrawal: Prolonged use can lead to psychological or physical dependence. Withdrawal syndrome may occur; dose must be tapered gradually. Renal or hepatic impairment: Observe caution. Abnormal liver function test results and blood dyscrasias have occurred.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Administer ½ hr before bedtime with full glass of water.
  • If GI upset occurs, administer with food.
  • Store in tightly closed container at cool temperature.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies. Note drug dependence and potential for suicide.
  • Assess type of sleep difficulty (eg, falling asleep, remaining asleep, etc.).
  • Provide safety measures (siderails up, nightlight, call bell accessible) and assist with ambulation.
  • Carefully document response to initial dose; dose may be increased to 30 mg.
  • Assess results of baseline liver and kidney function test and complete blood count with differential. Periodically reevaluate these values throughout long-term therapy.
  • Assess and document mental and psychological parameters such as hallucinations, dreaming and nightmares, depression, euphoria, apprehension affect, mood and memory. Report potential problems to physician.
  • Notify physician if any of these symptoms occur: palpitations, increased heart rate, visual disturbances along with nausea and vomiting or headache, excitation, dermatitis, sweating, flushing, pruritus, body or joint pain, tinnitus and nasal congestion.
OVERDOSAGE: SIGNS & SYMPTOMS
  Symptoms of decreased CNS function: somnolence, confusion, respiratory depression; decreased blood pressure; seizures, coma, impaired coordination, slurred speech

 Patient/Family Education

  • Caution patient that this medication must not be taken during pregnancy or when pregnancy is possible. Advise patient to use reliable form of birth control while taking this drug.
  • Discuss with patient ways to facilitate sleep: quiet, avoidance of caffeine and nicotine, warm baths, deep breathing, relaxation techniques.
  • Explain that disturbed nocturnal sleep may occur for first or second night after discontinuing use.
  • Tell patient not to discontinue medication abruptly after prolonged therapy (> 2 wk).
  • Explain safety precautions with regard to falls, especially for elderly and debilitated patients.
  • Instruct patient to report these symptoms to physician: visual disturbances, abdominal pain or palpitations, fever, sore throat, bruising, rash, jaundice, unusual bleeding.
  • Advise patient to avoid intake of alcoholic beverages or other CNS depressants.
  • Caution patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.

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