quazepam

Adjunctive therapy

Brands: DORAL

Last reviewed 2025-12-30

Reviewed by PsychMed Editorial Team.

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Quick answers

What is quazepam?
Quazepam (brand Doral) is a benzodiazepine hypnotic indicated for the treatment of insomnia characterized by difficulty falling asleep, frequent awakenings, and/or early morning awakenings (label). It can improve sleep onset and maintenance but is usually time-limited due to dependence/withdrawal risk.
What is DORAL?
DORAL is a brand name for quazepam.
What is DORAL (quazepam) used for?
Label indications include: Treatment of insomnia (sleep-onset and/or maintenance) (label; product-dependent).
What drug class is DORAL (quazepam)?
Benzodiazepine hypnotic; GABA-A receptor positive allosteric modulator.
What strengths does DORAL (quazepam) come in?
Functionally scored tablets: 15 mg (split to 7.5 mg).

Snapshot

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

Label indications

Treatment of insomnia (sleep-onset and/or maintenance) (label; product-dependent).

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Clinical Highlights

Quazepam (brand Doral) is a benzodiazepine hypnotic indicated for the treatment of insomnia characterized by difficulty falling asleep, frequent awakenings, and/or early morning awakenings (label). It can improve sleep onset and maintenance but is usually time-limited due to dependence/withdrawal risk. Quazepam has a long duration because of active metabolites (mean half-life ~39 hours for quazepam/2-oxoquazepam and ~73 hours for the desalkyl metabolite) (label). Accumulation over 1–2 weeks is a major driver of morning impairment, falls, and impaired driving risk.

Benzodiazepine risks include abuse/misuse, addiction, and clinically significant physical dependence with withdrawal reactions; these risks support a defined duration with follow-up rather than open-ended nightly use (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, quazepam evidence feed, and quazepam print page can help weigh alternatives and support counseling on tapering and next-day impairment.
Best fit is usually a brief, severe insomnia episode where a longer maintenance effect is desired and the team can monitor impairment and taper planning.

Dosing & Formulations

Functionally scored tablets: 15 mg (split to 7.5 mg) (label). Recommended initial dose is 7.5 mg at bedtime (split the 15 mg tablet); may increase to 15 mg if needed for efficacy (label).

Use the lowest effective dose; prolonged administration is generally not necessary or recommended because insomnia is often transient and may reflect another treatable condition (label).
Older adults can be more sensitive to confusion and oversedation; lower doses and close follow-up are commonly used when prescribing in late life (label/class).
If discontinuing after repeated use, gradual tapering is commonly used to reduce rebound insomnia and withdrawal symptoms (label).

Monitoring & Risks

Carryover impairment: monitor daytime sedation, driving risk, and falls; risk can increase over the first 1–2 weeks as metabolites reach steady state (label). Cognitive effects: confusion and over-sedation can occur in older adults; reassess promptly if delirium-like symptoms emerge (label).

Dependence and withdrawal: monitor tolerance, rebound insomnia, and withdrawal symptoms; avoid abrupt discontinuation (label).
Respiratory depression risk rises with alcohol, opioids, untreated sleep apnea/COPD, and other sedatives; avoid stacking CNS depressants.

Drug Interactions

Additive CNS depression occurs with alcohol and other CNS depressants; dose adjustments and minimizing polypharmacy are common strategies (label). Because effects can persist for days, adding a new sedative (or increasing opioid dose) can change risk meaningfully even without changing quazepam dose.

If morning impairment emerges, clinicians often reduce dose or switch to shorter-acting or non-controlled options rather than escalating.

Practice Notes

If insomnia persists, guidelines generally favor CBT-I and non-benzodiazepine options rather than chronic benzodiazepine use. Reassess for treatable drivers (mood episode, anxiety flare, pain, substance use, circadian disruption, sleep apnea) before continuing beyond a short course.

Document indication, duration, and a taper plan; long-acting hypnotics can cause delayed impairment when follow-up is not scheduled.
Avoid combining with opioids when possible and review fall risk and cognitive vulnerability before renewing.

References

Quazepam 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)