flurazepam
Brands: DALMANE
Last reviewed 2025-12-30
Reviewed by PsychMed Editorial Team.
Quick answers
What is flurazepam?
Flurazepam (brand Dalmane) is a benzodiazepine hypnotic indicated for the short-term treatment of insomnia (label; product-dependent). It can improve sleep, but dependence/withdrawal risk and marked next-day impairment potential make it a poor long-term strategy.
What is DALMANE?
DALMANE is a brand name for flurazepam.
What is DALMANE (flurazepam) used for?
Label indications include: Short-term treatment of insomnia (label; product-dependent).
What drug class is DALMANE (flurazepam)?
Long-acting benzodiazepine hypnotic; GABA-A receptor positive allosteric modulator.
What strengths does DALMANE (flurazepam) come in?
Capsules: 15 mg, 30 mg.
Snapshot
- Class: Adjunctive therapy
- Common US brands: DALMANE
- Therapeutic drug monitoring not routinely recommended.
- Last reviewed: 2025-12-30
Clinical Highlights
Flurazepam (brand Dalmane) is a benzodiazepine hypnotic indicated for the short-term treatment of insomnia (label; product-dependent). It can improve sleep, but dependence/withdrawal risk and marked next-day impairment potential make it a poor long-term strategy. Flurazepam is “long acting” mainly because its major active metabolite has a very long half-life (47–100 hours; longer in some older adults) (label). Accumulation over days is a key reason it is often avoided in older adults and in patients at fall or delirium risk.
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- Long half-life can reduce late-night rebound but increases morning grogginess, slowed reaction time, and impaired driving risk; harm is amplified by polypharmacy and alcohol (label/class).
- 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, flurazepam evidence feed, and flurazepam print page can help contextualize alternatives and support counseling on next-day impairment.
- Best fit is usually a short course in carefully selected patients where a long-acting hypnotic is specifically desired and the team can monitor daytime impairment and taper planning.
Dosing & Formulations
Capsules: 15 mg, 30 mg (label). Recommended initial dose is 15 mg for women and 15 mg or 30 mg for men; 15 mg may be increased to 30 mg if needed for efficacy (label).
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- Elderly or debilitated patients: recommended dose is 15 mg; higher doses substantially increase oversedation, dizziness, confusion, and ataxia risk (label).
- Because the active metabolite accumulates, “one bad night” is not a safe reason to escalate dose; dose changes are usually approached cautiously with follow-up for next-day impairment.
- If discontinuing after repeated use, gradual tapering is commonly used to reduce rebound insomnia and withdrawal symptoms (label/class).
Monitoring & Risks
Next-day impairment: monitor falls, driving risk, and daytime function; risk increases over the first 1–2 weeks as metabolite levels rise. Cognitive effects: confusion and slowed processing are more likely with long-acting benzodiazepines, especially in older adults (label).
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- Dependence and withdrawal: monitor tolerance and rebound insomnia; avoid abrupt discontinuation after prolonged use (label).
- Respiratory depression risk rises with alcohol, opioids, untreated sleep apnea, and other sedatives; avoid stacking CNS depressants.
Drug Interactions
Additive CNS/respiratory depression occurs with alcohol, opioids, antihistamines, sedating antipsychotics, and other hypnotics; total sedative burden drives harm (label/class). Long metabolite half-life increases the impact of “small” interaction changes (new sedatives, alcohol, dose timing changes) because effects can persist for days.
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- If morning impairment emerges, clinicians often reduce dose, avoid additional sedatives, or switch to non-controlled options rather than escalating.
Practice Notes
When insomnia is chronic, guidelines typically favor CBT-I and non-benzodiazepine options rather than chronic benzodiazepine use. Document indication, duration, and an exit plan; long-acting hypnotics can produce “silent” accumulation and impairment if follow-up is not scheduled.
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- Avoid in patients with high fall risk, cognitive vulnerability, or substantial polypharmacy when safer alternatives are available.
- If insomnia is driven by untreated depression, mania, substances, pain, or sleep apnea, address the driver rather than escalating hypnotics.
References
- Flurazepam hydrochloride capsules prescribing information — DailyMed (2024)
- 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)