How temazepam works
Temazepam has a calming and relaxing effect, relieves anxiety and makes it easier to fall asleep. The effects are based on the fact that temazepam increases the effect of the body’s own messenger GABA (gamma-aminobutyric acid).
To this end, it binds to those docking sites of nerve cells in the brain to which GABA also binds. GABA, in turn, makes nerve cells difficult to excite. Nerve signals therefore no longer travel as easily from one nerve cell to the next. Since temazepam increases the GABA effect, it thus reduces the excitability of the nerve cells even further.
Temazepam has an anxiety-relieving effect by specifically inhibiting nerve cells in the limbic system. The limbic system is a functional unit of the brain that processes emotions. The inhibition of nerve cells in the brainstem mediates the sleep-inducing and calming (sedative) effect.
By binding to additional GABA receptors, temazepam also has anticonvulsant and muscle relaxant effects.
The active ingredient is a medium-long-acting benzodiazepine. It takes about eight to twelve hours for the body to excrete half of the active ingredient (so-called half-life). Temazepam therefore not only helps you to fall asleep. It also ensures that you don’t wake up as often at night and can sleep better through the night.
How to take temazepam
Temazepam is only available in capsule form and not as tablets or drops. Patients take the sleeping pill unchewed with sufficient liquid about 30 minutes before bedtime.
Do not take temazepam on a full stomach right after eating. This will prevent the effect from being delayed.
The usual dosage of temazepam is usually between 10 and 20 milligrams. If this amount is not sufficient, the doctor increases the daily dose to a maximum of 30 to 40 milligrams.
To calm patients before surgery or examinations, they take 20 to 30 milligrams of temazepam the evening before or the day of the procedure.
Older or weakened patients often react more strongly to the active substance. In addition, the body breaks down temazepam more slowly. To avoid overdoses and undesirable side effects, the doctor reduces the dose in these cases.
When do doctors use temazepam?
Doctors prescribe temazepam to treat sleep disorders in adults over a short period of time. Therapy with temazepam (or comparable agents) is usually given only when other measures have previously failed to help and the sufferer is still having difficulty sleeping.
In addition, physicians use the active ingredient to calm very agitated patients before examinations or minor operations.
What are the side effects of temazepam?
Most side effects are due to the sedative and sleep-inducing effects of temazepam. Patients often experience muscle weakness, fatigue, drowsiness or dizziness.
In addition, they report coordination or movement disorders called ataxia. Headaches and reduced attention or concentration are also among the side effects of temazepam. Occasionally, patients suffer from dampened emotions or reduced sexual desire (libido).
When taking temazepam, so-called paradoxical reactions are possible, which usually occur in older patients. Those affected then tend to hallucinations and sleep disturbances, are aggressive, restless or irritable.
In the first hours after ingestion, patients sometimes suffer from anterograde amnesia. In this memory impairment, patients can no longer remember the actions performed during this period. The risk of amnesia decreases if attention is paid to adequate sleep duration of at least seven to eight hours after taking temazepam.
Temazepam has an antianxiety effect and can thus increase depressive symptoms that were masked by anxiety. This also increases the risk of suicidal (thoughts). Patients with depression therefore only use temazepam if their depression is being treated at the same time.
Contact your doctor or pharmacist if you experience or suspect any unwanted side effects. You can read which ones are known besides the ones above in the package leaflet of your temazepam medicine.
When should temazepam not be taken?
You must not take temazepam under some circumstances. These include:
- Hypersensitivity to the active substance, other benzodiazepines, or any of the other ingredients of the drug in question.
- Myasthenia gravis, a disease in which the transmission of nerve signals is impaired, which temazepam would exacerbate
- severe disorders of respiratory function, such as COPD or sleep apnea syndrome, because temazepam can decrease breathing (so-called respiratory depression, especially in combination with other agents such as opioids)
- severe liver dysfunction, as the liver then breaks down the active substance only very slowly
- Spinal and cerebellar ataxias, as they are exacerbated by temazepam
- acute intoxication with alcohol or drugs from the group of sedatives, painkillers or psychotropic drugs
- Children and adolescents under 18 years of age: Safety and efficacy data are lacking, therefore temazepam is also not approved for this age group.
These drug interactions may occur with temazepam
If patients take temazepam and other depressant medications at the same time, the effects may reinforce each other. These include, for example:
- Painkillers from the opioid group
- Tranquilizers (sedatives)
- Medicines used to treat psychosis (antipsychotics), such as haloperidol.
- Medicines for the treatment of depression (antidepressants)
- Medicines for the treatment of epilepsy (antiepileptic drugs)
- antihistamines (medicines for allergies) such as cetirizine
Alcohol also has a central depressant effect and increases the effect of temazepam. Therefore, do not drink alcohol while taking temazepam.
In particular, if someone uses temazepam and opioids (such as the painkiller morphine) at the same time, there is a risk of reduced respiratory drive (respiratory depression) and coma. This can assume life-threatening proportions.
In some cases, treatment with temazepam and opioids is still necessary. Doctors then choose the smallest possible dosage over a short period of time. It is also important to recognize adverse reactions quickly: Affected individuals are typically tired, sleepy, confused and breathing slows. They react more slowly and show fewer reflexes; blood pressure may also drop and the heartbeat decrease.
Talk to your doctor about how you and your caregivers can quickly recognize the first signs of serious interactions and react correctly!
Temazepam is broken down by an enzyme system (CYP-3A4 system) in the liver. Some active substances inhibit this system and thus slow down the breakdown of temazepam. These include, for example, macrolide antibiotics, drugs against fungal infections or grapefruit (juice). Such so-called enzyme inhibitors increase the amount of the active ingredient in the blood, and the effects and side effects increase.
There are also some active ingredients that accelerate these liver enzymes and thus ensure faster breakdown of temazepam. These enzyme inducers include rifampicin (active ingredient for the treatment of tuberculosis, for example) or the herbal antidepressant St. John’s wort.
Muscle relaxants such as tolperisone, for example, can in turn enhance the muscle-relaxing effect of temazepam. In particular, older people or those who are unsteady on their feet fall more quickly as a result.
Always tell your doctor about all medications they are taking. This includes those they were able to buy at a pharmacy without a prescription. And likewise herbal or dietary supplements. Apart from that, you can ask your pharmacy if temazepam can interact with any of your existing medications.
Temazepam during pregnancy and breastfeeding
Pregnant women should not take temazepam, especially in the last trimester of pregnancy or immediately before delivery. It is possible that newborn children may suffer from adjustment disorders, low blood pressure or drink very weakly.
In addition, the occurrence of the “floppy infant syndrome” is possible. In this case, the children’s muscles are very weak, arms and legs hang limply.
In addition, the infant may also suffer withdrawal symptoms such as seizures if the mother has taken temazepam for a long time during pregnancy. Nevertheless, the therapy should not be stopped abruptly in order to avoid withdrawal symptoms such as anxiety, restlessness and seizures in the mother.
If you are taking medicines containing temazepam and are planning to become pregnant or may already be pregnant, contact your doctor immediately. He or she will discuss the next steps with you.
The doctor decides on a case-by-case basis whether temazepam is possible during breastfeeding. If a nursing mother has taken temazepam once, no break from breastfeeding is necessary, according to doctors. However, in the case of long-term use, it is advisable to stop breastfeeding.
How to get medication with temazepam
In principle, benzodiazepines such as temazepam are considered narcotics in Germany and so-called psychotropic substances in Switzerland. However, these drugs are classified as “excepted preparations”. They can therefore be obtained from pharmacies with a normal prescription. However, the maximum dose per capsule of temazepam is limited to a maximum of 20 milligrams.
If doctors in Germany prescribe temazepam for patients addicted to alcohol or narcotics, no exceptions apply. The drug must then be prescribed on a narcotic prescription.
No drugs containing temazepam are currently available in Austria.
Other important notes on temazepam
If patients take temazepam daily, tolerance to the active substance develops after just a few weeks. This means that the body gets used to temazepam. Higher doses are then needed to achieve a full effect.
If patients stop taking temazepam abruptly, the body in turn reacts with withdrawal symptoms such as trembling, sweating or headaches and muscle pain. In addition, those affected feel restless, are irritable and more sensitive to noise or light. Sensitivity disorders such as tingling or numbness of the skin are also possible.
Therefore, the doctor usually recommends gradually reducing the temazepam dose to wean yourself off of it.
Withdrawal symptoms may also occur when switching from long-acting benzodiazepines (e.g., nitrazepam) to temazepam. Inform your doctor if you are already taking another benzodiazepine and he does not know about it.
Temazepam dependence and drug abuse.
Temazepam is physically and emotionally (psychologically) addictive. The longer and the higher the dosage, the greater the risk of dependence. But even normal amounts as prescribed by a doctor can be addictive if used for a long time.
People who are or have been dependent on alcohol, drugs or medication are particularly at risk. The same applies to people with other mental illnesses.
Take medicines containing temazepam only for a short time and in the lowest possible dosage. Always discuss your therapy with your doctor and use the medication as agreed.
The risk of addiction is explained by the processes described above:
Sufferers crave the anxiety-relieving and calming effect that makes them feel as if they are wrapped in absorbent cotton. As the body becomes accustomed to the active ingredient, sufferers need more and more temazepam for this. Conversely, without an appropriate dose, they become increasingly restless, anxious and irritable – in other words, they become withdrawn. This increases the craving for the active ingredient even more.
It is not uncommon for sufferers to abuse temazepam as a drug together with other substances such as opioids. This is supposed to intensify the desired effect. At the same time, however, the danger to life increases: breathing is dangerously inhibited, consciousness is severely clouded (see also next section).
Overdose
An overdose with temazepam alone is usually not life-threatening. However, the risk increases if patients take other centrally depressant drugs or alcohol at the same time. Possible consequences are respiratory depression, coma or death.
In mild overdoses, affected persons are tired, dizzy and suffer from visual disturbances. They also have coordination and balance problems (ataxia) or speak more slowly and slurredly. More severely overdosed patients are very sleepy and difficult to wake up, their blood pressure drops and they may become unconscious.
Always consult a doctor immediately in case of (suspected) overdose.
Those affected are monitored in a hospital. There, at the latest, they are often given activated charcoal, which prevents temazepam from entering the systemic circulation. If necessary, doctors rinse out the stomach.
In addition, there is an “antagonist” of benzodiazepines: Flumazenil. This active ingredient binds to the docking sites of benzodiazepines, thus displacing them from their target and cancelling the effect of temazepam. Because seizures can occur with flumazenil, for example, doctors give it only in severe cases.