temazepam

General Information

Temazepam is a benzodiazepine hypnotic indicated for the short-term treatment of insomnia (generally 7 to 10 days on label).

It can help with sleep onset and nighttime awakenings, but tolerance, dependence, and next-day impairment make it a poor default long-term strategy; plan a defined endpoint and avoid automatic refills.

Compared with very short-acting hypnotics, temazepam’s longer terminal half-life may reduce late-night rebound but increases morning grogginess and fall risk, especially in older adults and with polypharmacy.

Benzodiazepine harm is driven by total sedative burden: avoid combining with opioids, alcohol, antihistamines, or multiple sedative hypnotics.

The temazepam compare view, temazepam evidence feed, and temazepam print page can support counseling about safe, time-limited hypnotic use.

Temazepam can be effective for short courses but is not a maintenance plan for chronic insomnia. Use a clear reassessment date, avoid co-prescribing sedatives, and treat underlying causes (mood episodes, substances, pain, sleep apnea). Document indication and duration explicitly to prevent inadvertent long-term use.

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, increasing inhibitory neurotransmission and producing anxiolytic and hypnotic effects.

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

Benzodiazepines can produce tolerance with repeated nightly use, and abrupt discontinuation can trigger rebound insomnia and withdrawal.

• GABA-A receptor positive allosteric modulation.

Metabolism and Pharmacokinetics

• Biphasic elimination: short half-life ~0.4–0.6 hours and terminal half-life 3.5–18.4 hours (mean 8.8 hours) (label).
• Minimal first-pass metabolism (~8%); no active metabolites. The major metabolite is an O-conjugate (label).
• Longer terminal half-life increases next-day impairment risk compared with very short-acting hypnotics, especially in older adults (label).

Dosing and Administration

• Usual adult dose: 15 mg at bedtime; some may require 30 mg (label).
• Older or debilitated patients: start 7.5 mg to reduce confusion, ataxia, and falls (label).
• Confine activities to those needed to prepare for bed after dosing and avoid “middle-of-the-night” redosing.
• If use extends beyond a short course, taper gradually rather than stopping abruptly to reduce withdrawal and rebound insomnia.

Monitoring & Labs

• Reassess insomnia diagnosis and daytime function within 1–2 weeks; discontinue if no meaningful benefit.
• Screen for opioid co-prescribing, sleep apnea/COPD, substance use risk, and fall risk before renewing.
• Monitor for next-day impairment (driving, falls), confusion, and paradoxical agitation after dose changes.
• If used beyond a short course, create and document a gradual taper plan and monitor for withdrawal.

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

Adverse Effects

Interactions

• Additive CNS and respiratory depression with opioids, alcohol, and other sedatives.
• Temazepam is largely cleared by conjugation rather than CYP metabolism, but interaction risk remains clinically driven by combined sedative load.
• Diphenhydramine can potentiate sedation; avoid combining OTC sleep aids with temazepam (label).

Other Useful Information

• Pair hypnotic use with behavioral insomnia treatment (CBT-I, stimulus control, sleep restriction) and treat underlying drivers rather than escalating medication count.
• Avoid using temazepam as a nightly long-term plan; use a short trial with a defined stop date and reassess benefit vs harm.
• If insomnia persists, consider non-controlled options (ramelteon, low-dose doxepin) or orexin antagonists rather than chronic benzodiazepine therapy.
• Only take when a full night in bed is possible (e.g., 7–8 hours) and avoid dosing in the middle of the night; residual sedation is a common reason for falls and driving impairment after hypnotic use.

References

1. Restoril (temazepam) 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)