flurazepam

General Information

Flurazepam is a benzodiazepine hypnotic indicated for the short-term treatment of insomnia (label; product-dependent). It can improve sleep onset and maintenance but is not a long-term insomnia strategy.

Flurazepam is “long acting” mainly due to a long-lived active metabolite (desalkyl-flurazepam). Accumulation over days is a key reason for next-day impairment and is one reason flurazepam is often avoided in older adults (label).

Long half-life can reduce late-night rebound but increases morning grogginess, falls, and impaired driving risk; total sedative burden and alcohol use amplify harm (label/class).

Boxed warning: Concomitant use with opioids can cause profound sedation, respiratory depression, coma, and death; avoid co-prescribing when possible (label).

The flurazepam compare view, flurazepam evidence feed, and flurazepam print page can support counseling about safer alternatives and carryover impairment.

Flurazepam’s major safety limiter is accumulation: the active metabolite can persist for days, producing daytime impairment even when night-time sleep improves. When used, teams often pair it with quantity limits, a follow-up date, and a taper/stop plan, and avoid it in patients with high fall risk or cognitive vulnerability.

Mechanism of Action

Refer to the Glossary entry on Neurotransmitters for background on receptor systems involved in serious mental illness.

Positive allosteric modulator of GABA-A receptors, producing hypnotic effects via increased inhibitory neurotransmission.

Sedation scales with dose and co-administered CNS depressants; “stacking” sedatives is a major driver of harm.

Tolerance can develop with repeated nightly use, and abrupt discontinuation can trigger rebound insomnia and withdrawal symptoms.

• GABA-A receptor positive allosteric modulation.

Metabolism and Pharmacokinetics

• Flurazepam is rapidly absorbed and rapidly metabolized; the parent drug has an apparent half-life of ~2.3 hours (label).
• The major active metabolite (desalkyl-flurazepam) reaches steady state after ~7–10 days of daily dosing and has a long elimination half-life (47–100 hours) (label).
• In older adults, desalkyl-flurazepam half-life and washout can be longer (e.g., ~120–160 hours reported), increasing next-day impairment and falls (label).
• Flurazepam is excreted primarily in urine as metabolites (label).

Dosing and Administration

• Recommended initial dose: 15 mg for women and 15 mg or 30 mg for men; the 15 mg dose can be increased to 30 mg if necessary for efficacy (label).
• Elderly or debilitated patients: recommended dose is 15 mg due to higher oversedation, confusion, and ataxia risk at larger doses (label).
• Because active metabolite levels accumulate over 1–2 weeks, reassess daytime function and avoid rapid dose escalation.
• If used beyond a short course, tapering is commonly used to reduce withdrawal and rebound insomnia (label/class).

Monitoring & Labs

• Reassess within 1–2 weeks, including falls, driving safety, and daytime cognition as metabolite levels rise.
• Screen for opioid co-prescribing, alcohol use, sleep apnea, and fall risk before renewing.
• Review concurrent sedatives and advise against alcohol co-use; adjust total sedative burden when impairment emerges.
• If used beyond a short course, document a taper plan and monitor for withdrawal symptoms.

Sources: FDA/DailyMed label; insomnia guideline context; benzodiazepine safety guidance.

Adverse Effects

Interactions

• Additive CNS/respiratory depression occurs with alcohol, opioids, antihistamines, and other sedatives; total sedative burden drives harm.
• Long metabolite half-life increases the impact of sedative co-prescribing because interaction effects can persist for days.
• If daytime impairment emerges, clinicians commonly reduce dose and review other sedating medications rather than escalating hypnotics.

Other Useful Information

• For chronic insomnia, guidelines typically prioritize CBT-I and non-benzodiazepine options (e.g., DORAs, ramelteon, low-dose doxepin) rather than chronic benzodiazepine use.
• If insomnia is driven by mood episodes, substance use, pain syndromes, or sleep apnea, addressing the driver usually improves outcomes more than escalating hypnotic dose.
• If a long-acting hypnotic is used, documenting duration and follow-up is especially important because accumulation can produce delayed impairment.

References

1. Flurazepam hydrochloride capsules prescribing information — DailyMed (2024)
2. 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)
3. ASAM guideline on benzodiazepines — Journal of Addiction Medicine (2020)
4. Efficacy and Acceptability of Pharmacological Interventions for Insomnia in Patients With Severe Mental Illness — Acta Psychiatrica Scandinavica (2025)
5. Residual effects of medications for sleep disorders on driving performance — European Neuropsychopharmacology (2024)