estazolam

Adjunctive therapy

Brands: PROSOM

Last reviewed 2025-12-30

Reviewed by PsychMed Editorial Team.

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Quick answers

What is estazolam?
Estazolam (brand ProSom) is a benzodiazepine hypnotic indicated for the short-term treatment of insomnia (label; product-dependent). It can improve sleep onset and maintenance, but dependence, withdrawal, and next-day impairment make it a poor default long-term strategy.
What is PROSOM?
PROSOM is a brand name for estazolam.
What is PROSOM (estazolam) used for?
Label indications include: Short-term treatment of insomnia (label; product-dependent).
What drug class is PROSOM (estazolam)?
Benzodiazepine hypnotic; GABA-A receptor positive allosteric modulator.
What strengths does PROSOM (estazolam) come in?
Scored tablets: 1 mg, 2 mg.

Snapshot

Class: Adjunctive therapy
Common US brands: PROSOM
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-30

Label indications

Short-term treatment of insomnia (label; product-dependent).

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Clinical Highlights

Estazolam (brand ProSom) is a benzodiazepine hypnotic indicated for the short-term treatment of insomnia (label; product-dependent). It can improve sleep onset and maintenance, but dependence, withdrawal, and next-day impairment make it a poor default long-term strategy. Estazolam has a relatively long elimination half-life for a hypnotic (10–24 hours; longer in some older adults). That longer duration can reduce early-morning rebound but increases “carryover” effects such as morning grogginess, falls, and impaired driving—especially with polypharmacy (label).

Benzodiazepine safety is not only sedation: abuse, misuse, and addiction risk and withdrawal reactions are key reasons to pair any prescription with a time-limited plan and a reassessment date (label / safety guidance).
Boxed warning: Concomitant use with opioids can cause profound sedation, respiratory depression, coma, and death; co-prescribing is generally avoided when possible (label).
The compare view, estazolam evidence feed, and estazolam print page can help contextualize alternatives and support safety counseling.
Best fit is usually a time-limited, severe insomnia episode where a controlled hypnotic is warranted and the team can provide close follow-up and an exit/taper plan rather than open-ended nightly use.

Dosing & Formulations

Scored tablets: 1 mg, 2 mg (label). The recommended initial dose for adults is 1 mg at bedtime; some patients may need 2 mg (label).

Older adults: 1 mg is a typical starting dose, but dose increases are approached cautiously; a lower starting dose (0.5 mg) is sometimes used in small or debilitated older patients to reduce falls and confusion (label).
Take only when a full sleep window is possible; avoid “catch-up” dosing during the night because next-day impairment risk rises with higher total nightly dose.
If use extends beyond a short course, gradual tapering is commonly used to reduce rebound insomnia and withdrawal symptoms (label / class).

Monitoring & Risks

Next-day impairment: assess driving risk, falls, and cognitive slowing, especially in older adults and after dose increases. Behavioral and cognitive effects: confusion, anterograde amnesia, and paradoxical agitation can occur; reassess if symptoms worsen rather than “dose chasing.”.

Dependence and withdrawal: monitor for tolerance and rebound insomnia; avoid abrupt discontinuation after repeated nightly use (label).
Respiratory risk rises with alcohol, opioids, untreated sleep apnea, and other sedatives; avoid stacking CNS depressants.

Drug Interactions

Estazolam is metabolized via CYP3A; strong CYP3A inhibitors can increase exposure and adverse effects (label). Review common inhibitors (e.g., many azole antifungals and macrolides) before prescribing. Additive CNS/respiratory depression occurs with alcohol, opioids, antihistamines, and sedating antipsychotics—total sedative burden is a major driver of harm (label/class).

Grapefruit products and other moderate CYP3A inhibitors can still increase exposure; if morning impairment emerges, clinicians often reduce dose or switch hypnotics (label/class).

Practice Notes

If insomnia persists beyond a short course, guidelines typically favor CBT-I and non-benzodiazepine options (e.g., DORAs, ramelteon, low-dose doxepin) rather than chronic nightly benzodiazepine use. Document indication, duration, and a stop/taper plan to prevent inadvertent long-term use, especially when multiple clinicians are involved.

Reassess for treatable drivers (mood episode, substance use, pain, circadian disruption, sleep apnea) before escalating dose or adding additional sedatives.
Avoid combining with opioids when possible and review fall risk, cognitive vulnerability, and substance use risk before renewing.

References

Estazolam tablets prescribing information — DailyMed (2025)
Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline — Journal of Clinical Sleep Medicine (2017)
ASAM guideline on benzodiazepines — Journal of Addiction Medicine (2020)
Efficacy and Acceptability of Pharmacological Interventions for Insomnia in Patients With Severe Mental Illness — Acta Psychiatrica Scandinavica (2025)
Residual effects of medications for sleep disorders on driving performance — European Neuropsychopharmacology (2024)