Dosing & Uses
Dosage Forms & Strengths
capsule: Schedule IV
- 15mg
- 30mg
Insomnia
15-30 mg PO qHS
<15 years old: not recommended
Not drug of choice in elderly because of long-acting metabolite; associated with increased falls
Insomnia
15 mg PO qHS
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (2)
- calcium/magnesium/potassium/sodium oxybates
flurazepam, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration with alcohol or sedative hypnotics are contraindicated because of additive CNS depression.
- sodium oxybate
flurazepam, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration with alcohol or sedative hypnotics are contraindicated because of additive CNS depression.
Serious - Use Alternative (26)
- apalutamide
apalutamide will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, flurazepam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
benzhydrocodone/acetaminophen and flurazepam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - buprenorphine subdermal implant
buprenorphine subdermal implant and flurazepam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- buprenorphine transdermal
buprenorphine transdermal and flurazepam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- buprenorphine, long-acting injection
buprenorphine, long-acting injection and flurazepam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- conivaptan
conivaptan will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- enzalutamide
enzalutamide will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- fentanyl
fentanyl, flurazepam. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
- fentanyl intranasal
fentanyl intranasal, flurazepam. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
- fentanyl transdermal
fentanyl transdermal, flurazepam. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
- fentanyl transmucosal
fentanyl transmucosal, flurazepam. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
- fexinidazole
fexinidazole will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.
- hydrocodone
hydrocodone, flurazepam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- idelalisib
idelalisib will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates
- ivosidenib
ivosidenib will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.
- lemborexant
lemborexant, flurazepam. Either increases effects of the other by sedation. Avoid or Use Alternate Drug. Use of lemborexant with other drugs to treat insomnia is not recommended.
- metoclopramide intranasal
flurazepam, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
- mifepristone
mifepristone will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- olopatadine intranasal
flurazepam and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- phenobarbital
phenobarbital will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- primidone
primidone will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- selinexor
selinexor, flurazepam. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.
- sufentanil SL
sufentanil SL, flurazepam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- tucatinib
tucatinib will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.
- valerian
valerian and flurazepam both increase sedation. Avoid or Use Alternate Drug.
- voxelotor
voxelotor will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.
Monitor Closely (240)
- acrivastine
acrivastine and flurazepam both increase sedation. Use Caution/Monitor.
- albuterol
flurazepam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alfentanil
flurazepam and alfentanil both increase sedation. Use Caution/Monitor.
- alprazolam
alprazolam and flurazepam both increase sedation. Use Caution/Monitor.
- amisulpride
amisulpride and flurazepam both increase sedation. Use Caution/Monitor.
- amitriptyline
flurazepam and amitriptyline both increase sedation. Use Caution/Monitor.
- amobarbital
amobarbital and flurazepam both increase sedation. Use Caution/Monitor.
- amoxapine
flurazepam and amoxapine both increase sedation. Use Caution/Monitor.
- apomorphine
flurazepam and apomorphine both increase sedation. Use Caution/Monitor.
- arformoterol
flurazepam increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- aripiprazole
flurazepam and aripiprazole both increase sedation. Use Caution/Monitor.
- armodafinil
flurazepam increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- asenapine
asenapine and flurazepam both increase sedation. Use Caution/Monitor.
- asenapine transdermal
asenapine transdermal and flurazepam both increase sedation. Use Caution/Monitor.
- atazanavir
atazanavir increases levels of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Consider lowering benzodiazepine dose.
- avapritinib
avapritinib and flurazepam both increase sedation. Use Caution/Monitor.
- azelastine
azelastine and flurazepam both increase sedation. Use Caution/Monitor.
- baclofen
flurazepam and baclofen both increase sedation. Use Caution/Monitor.
- belladonna and opium
flurazepam and belladonna and opium both increase sedation. Use Caution/Monitor.
- belzutifan
belzutifan will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.
- benperidol
flurazepam and benperidol both increase sedation. Use Caution/Monitor.
- benzphetamine
flurazepam increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- bosentan
bosentan will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- brexanolone
brexanolone, flurazepam. Either increases toxicity of the other by sedation. Use Caution/Monitor.
- brexpiprazole
brexpiprazole and flurazepam both increase sedation. Use Caution/Monitor.
- brimonidine
brimonidine and flurazepam both increase sedation. Use Caution/Monitor.
- brivaracetam
brivaracetam and flurazepam both increase sedation. Use Caution/Monitor.
- brompheniramine
brompheniramine and flurazepam both increase sedation. Use Caution/Monitor.
- buprenorphine
flurazepam and buprenorphine both increase sedation. Use Caution/Monitor.
- buprenorphine buccal
flurazepam and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- buprenorphine subdermal implant
flurazepam increases toxicity of buprenorphine subdermal implant by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Studies have shown that the combination of benzodiazepines and buprenorphine altered the usual ceiling effect on buprenorphine-induced respiratory depression, making the respiratory effects of buprenorphine appear similar to those of full opioid agonists. There have been postmarketing reports of coma and death with coadministration of buprenorphine and benzodiazepines. In many, but not all of these cases, buprenorphine was misused by self-injection. If a benzodiazepine must be used for an indication other than seizures, lower the benzodiazepine initial dose and cautiously titrate to clinical response.
- buprenorphine, long-acting injection
flurazepam increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.
- butabarbital
butabarbital and flurazepam both increase sedation. Use Caution/Monitor.
- butalbital
butalbital and flurazepam both increase sedation. Use Caution/Monitor.
- butorphanol
flurazepam and butorphanol both increase sedation. Use Caution/Monitor.
- caffeine
flurazepam increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbamazepine
carbamazepine will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- carbinoxamine
carbinoxamine and flurazepam both increase sedation. Use Caution/Monitor.
- carisoprodol
flurazepam and carisoprodol both increase sedation. Use Caution/Monitor.
- cenobamate
cenobamate will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
- ceritinib
ceritinib will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- chloral hydrate
flurazepam and chloral hydrate both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide and flurazepam both increase sedation. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine and flurazepam both increase sedation. Use Caution/Monitor.
- chlorpromazine
flurazepam and chlorpromazine both increase sedation. Use Caution/Monitor.
- chlorzoxazone
flurazepam and chlorzoxazone both increase sedation. Use Caution/Monitor.
- cinnarizine
cinnarizine and flurazepam both increase sedation. Use Caution/Monitor.
- clarithromycin
clarithromycin will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- clemastine
clemastine and flurazepam both increase sedation. Use Caution/Monitor.
- clomipramine
flurazepam and clomipramine both increase sedation. Use Caution/Monitor.
- clonazepam
clonazepam and flurazepam both increase sedation. Use Caution/Monitor.
- clonidine
clonidine, flurazepam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration enhances CNS depressant effects.
- clorazepate
clorazepate and flurazepam both increase sedation. Use Caution/Monitor.
- clozapine
flurazepam and clozapine both increase sedation. Use Caution/Monitor.
- cobicistat
cobicistat will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- codeine
flurazepam and codeine both increase sedation. Use Caution/Monitor.
- crizotinib
crizotinib increases levels of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.
- crofelemer
crofelemer increases levels of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.
- cyclizine
cyclizine and flurazepam both increase sedation. Use Caution/Monitor.
- cyclobenzaprine
flurazepam and cyclobenzaprine both increase sedation. Use Caution/Monitor.
- cyproheptadine
cyproheptadine and flurazepam both increase sedation. Use Caution/Monitor.
- dabrafenib
dabrafenib will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- dantrolene
flurazepam and dantrolene both increase sedation. Use Caution/Monitor.
- daridorexant
flurazepam and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- darunavir
darunavir increases levels of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available. Consider lowering benzodiazepine dose.
- desflurane
desflurane and flurazepam both increase sedation. Use Caution/Monitor.
- desipramine
flurazepam and desipramine both increase sedation. Use Caution/Monitor.
- deutetrabenazine
flurazepam and deutetrabenazine both increase sedation. Use Caution/Monitor.
- dexchlorpheniramine
dexchlorpheniramine and flurazepam both increase sedation. Use Caution/Monitor.
- dexfenfluramine
flurazepam increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexmedetomidine
flurazepam and dexmedetomidine both increase sedation. Use Caution/Monitor.
- dexmethylphenidate
flurazepam increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextroamphetamine
flurazepam increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextromoramide
flurazepam and dextromoramide both increase sedation. Use Caution/Monitor.
- diamorphine
flurazepam and diamorphine both increase sedation. Use Caution/Monitor.
- diazepam
diazepam and flurazepam both increase sedation. Use Caution/Monitor.
- diazepam intranasal
diazepam intranasal, flurazepam. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.
- diethylpropion
flurazepam increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- difelikefalin
difelikefalin and flurazepam both increase sedation. Use Caution/Monitor.
- difenoxin hcl
flurazepam and difenoxin hcl both increase sedation. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate and flurazepam both increase sedation. Use Caution/Monitor.
- diphenhydramine
diphenhydramine and flurazepam both increase sedation. Use Caution/Monitor.
- diphenoxylate hcl
flurazepam and diphenoxylate hcl both increase sedation. Use Caution/Monitor.
- dipipanone
flurazepam and dipipanone both increase sedation. Use Caution/Monitor.
- dobutamine
flurazepam increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopamine
flurazepam increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopexamine
flurazepam increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dosulepin
flurazepam and dosulepin both increase sedation. Use Caution/Monitor.
- doxepin
flurazepam and doxepin both increase sedation. Use Caution/Monitor.
- doxylamine
flurazepam and doxylamine both increase sedation. Use Caution/Monitor.
- droperidol
flurazepam and droperidol both increase sedation. Use Caution/Monitor.
- duvelisib
duvelisib will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.
- efavirenz
efavirenz will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- elagolix
elagolix decreases levels of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; consider benzodiazepine dose reduction.
- encorafenib
encorafenib, flurazepam. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.
- ephedrine
flurazepam increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine
flurazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine racemic
flurazepam increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- esketamine intranasal
esketamine intranasal, flurazepam. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.
- estazolam
estazolam and flurazepam both increase sedation. Use Caution/Monitor.
- ethanol
flurazepam and ethanol both increase sedation. Use Caution/Monitor.
- etomidate
etomidate and flurazepam both increase sedation. Use Caution/Monitor.
- etravirine
etravirine will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- fedratinib
fedratinib will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.
- fenfluramine
flurazepam increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- flibanserin
flurazepam and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.
- fluphenazine
flurazepam and fluphenazine both increase sedation. Use Caution/Monitor.
- formoterol
flurazepam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fosamprenavir
fosamprenavir increases levels of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available. Consider lowering benzodiazepine dose.
- fosphenytoin
fosphenytoin will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- gabapentin
gabapentin, flurazepam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- gabapentin enacarbil
gabapentin enacarbil, flurazepam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- ganaxolone
flurazepam and ganaxolone both increase sedation. Use Caution/Monitor.
- haloperidol
flurazepam and haloperidol both increase sedation. Use Caution/Monitor.
- hydromorphone
flurazepam and hydromorphone both increase sedation. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and flurazepam both increase sedation. Use Caution/Monitor.
- iloperidone
flurazepam and iloperidone both increase sedation. Use Caution/Monitor.
iloperidone increases levels of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4. - imipramine
flurazepam and imipramine both increase sedation. Use Caution/Monitor.
- indinavir
indinavir increases levels of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Consider lowering benzodiazepine dose.
- isoproterenol
flurazepam increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- istradefylline
istradefylline will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
- itraconazole
itraconazole will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ketamine
ketamine and flurazepam both increase sedation. Use Caution/Monitor.
- ketoconazole
ketoconazole will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ketotifen, ophthalmic
flurazepam and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.
- lasmiditan
lasmiditan, flurazepam. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
- lenacapavir
lenacapavir will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.
- letermovir
letermovir increases levels of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- levalbuterol
flurazepam increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levoketoconazole
levoketoconazole will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- levorphanol
flurazepam and levorphanol both increase sedation. Use Caution/Monitor.
- lisdexamfetamine
flurazepam increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lofepramine
flurazepam and lofepramine both increase sedation. Use Caution/Monitor.
- lofexidine
flurazepam and lofexidine both increase sedation. Use Caution/Monitor.
- lopinavir
lopinavir increases levels of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available. Consider lowering benzodiazepine dose.
- loprazolam
flurazepam and loprazolam both increase sedation. Use Caution/Monitor.
- lorazepam
flurazepam and lorazepam both increase sedation. Use Caution/Monitor.
- lorlatinib
lorlatinib will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lormetazepam
flurazepam and lormetazepam both increase sedation. Use Caution/Monitor.
- loxapine
flurazepam and loxapine both increase sedation. Use Caution/Monitor.
- loxapine inhaled
flurazepam and loxapine inhaled both increase sedation. Use Caution/Monitor.
- lurasidone
lurasidone, flurazepam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.
- maprotiline
flurazepam and maprotiline both increase sedation. Use Caution/Monitor.
- marijuana
flurazepam and marijuana both increase sedation. Use Caution/Monitor.
- melatonin
flurazepam and melatonin both increase sedation. Use Caution/Monitor.
- meperidine
flurazepam and meperidine both increase sedation. Use Caution/Monitor.
- meprobamate
flurazepam and meprobamate both increase sedation. Use Caution/Monitor.
- metaproterenol
flurazepam increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaxalone
flurazepam and metaxalone both increase sedation. Use Caution/Monitor.
- methadone
flurazepam and methadone both increase sedation. Use Caution/Monitor.
- methamphetamine
flurazepam increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methocarbamol
flurazepam and methocarbamol both increase sedation. Use Caution/Monitor.
- methylenedioxymethamphetamine
flurazepam increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- midazolam
flurazepam and midazolam both increase sedation. Use Caution/Monitor.
- midazolam intranasal
midazolam intranasal, flurazepam. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.
- midodrine
flurazepam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mirtazapine
flurazepam and mirtazapine both increase sedation. Use Caution/Monitor.
- mitotane
mitotane decreases levels of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.
- modafinil
flurazepam increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- morphine
flurazepam and morphine both increase sedation. Use Caution/Monitor.
- motherwort
flurazepam and motherwort both increase sedation. Use Caution/Monitor.
- moxonidine
flurazepam and moxonidine both increase sedation. Use Caution/Monitor.
- nabilone
flurazepam and nabilone both increase sedation. Use Caution/Monitor.
- nafcillin
nafcillin will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nalbuphine
flurazepam and nalbuphine both increase sedation. Use Caution/Monitor.
- nefazodone
nefazodone will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nelfinavir
nelfinavir increases levels of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available. Consider lowering benzodiazepine dose.
- norepinephrine
flurazepam increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nortriptyline
flurazepam and nortriptyline both increase sedation. Use Caution/Monitor.
- olanzapine
flurazepam and olanzapine both increase sedation. Use Caution/Monitor.
- oliceridine
oliceridine, flurazepam. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- opium tincture
flurazepam and opium tincture both increase sedation. Use Caution/Monitor.
- orphenadrine
flurazepam and orphenadrine both increase sedation. Use Caution/Monitor.
- oxazepam
flurazepam and oxazepam both increase sedation. Use Caution/Monitor.
- oxycodone
flurazepam and oxycodone both increase sedation. Use Caution/Monitor.
- oxymorphone
flurazepam and oxymorphone both increase sedation. Use Caution/Monitor.
- paliperidone
flurazepam and paliperidone both increase sedation. Use Caution/Monitor.
- papaveretum
flurazepam and papaveretum both increase sedation. Use Caution/Monitor.
- papaverine
flurazepam and papaverine both increase sedation. Use Caution/Monitor.
- pentazocine
flurazepam and pentazocine both increase sedation. Use Caution/Monitor.
- pentobarbital
pentobarbital and flurazepam both increase sedation. Use Caution/Monitor.
- perphenazine
flurazepam and perphenazine both increase sedation. Use Caution/Monitor.
- phendimetrazine
flurazepam increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenobarbital
phenobarbital and flurazepam both increase sedation. Use Caution/Monitor.
- phentermine
flurazepam increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine
flurazepam increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine PO
flurazepam increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- phenytoin
phenytoin will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- pholcodine
flurazepam and pholcodine both increase sedation. Use Caution/Monitor.
- pimozide
flurazepam and pimozide both increase sedation. Use Caution/Monitor.
- pirbuterol
flurazepam increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- posaconazole
posaconazole will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- pregabalin
pregabalin, flurazepam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- primidone
primidone and flurazepam both increase sedation. Use Caution/Monitor.
- prochlorperazine
flurazepam and prochlorperazine both increase sedation. Use Caution/Monitor.
- promethazine
promethazine and flurazepam both increase sedation. Use Caution/Monitor.
- propofol
propofol and flurazepam both increase sedation. Use Caution/Monitor.
- propylhexedrine
flurazepam increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- protriptyline
flurazepam and protriptyline both increase sedation. Use Caution/Monitor.
- quazepam
flurazepam and quazepam both increase sedation. Use Caution/Monitor.
- quetiapine
flurazepam and quetiapine both increase sedation. Use Caution/Monitor.
- ramelteon
flurazepam and ramelteon both increase sedation. Use Caution/Monitor.
- remimazolam
remimazolam, flurazepam. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.
- ribociclib
ribociclib will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifabutin
rifabutin will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifampin
rifampin will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- risperidone
flurazepam and risperidone both increase sedation. Use Caution/Monitor.
- ritonavir
ritonavir increases levels of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available. Consider lowering benzodiazepine dose.
- rucaparib
rucaparib will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.
- salmeterol
flurazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- saquinavir
saquinavir increases levels of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available. Consider lowering benzodiazepine dose.
- scullcap
flurazepam and scullcap both increase sedation. Use Caution/Monitor.
- secobarbital
secobarbital and flurazepam both increase sedation. Use Caution/Monitor.
- sevoflurane
sevoflurane and flurazepam both increase sedation. Use Caution/Monitor.
- shepherd's purse
flurazepam and shepherd's purse both increase sedation. Use Caution/Monitor.
- stiripentol
stiripentol, flurazepam. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
stiripentol, flurazepam. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence. - sufentanil
flurazepam and sufentanil both increase sedation. Use Caution/Monitor.
- tapentadol
flurazepam and tapentadol both increase sedation. Use Caution/Monitor.
- tazemetostat
tazemetostat will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tecovirimat
tecovirimat will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.
- temazepam
flurazepam and temazepam both increase sedation. Use Caution/Monitor.
- terbutaline
flurazepam increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- thioridazine
flurazepam and thioridazine both increase sedation. Use Caution/Monitor.
- thiothixene
flurazepam and thiothixene both increase sedation. Use Caution/Monitor.
- tipranavir
tipranavir increases levels of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available. Consider lowering benzodiazepine dose.
- topiramate
flurazepam and topiramate both increase sedation. Modify Therapy/Monitor Closely.
- tramadol
flurazepam and tramadol both increase sedation. Use Caution/Monitor.
- trazodone
flurazepam and trazodone both increase sedation. Use Caution/Monitor.
- triazolam
flurazepam and triazolam both increase sedation. Use Caution/Monitor.
- triclofos
flurazepam and triclofos both increase sedation. Use Caution/Monitor.
- trifluoperazine
flurazepam and trifluoperazine both increase sedation. Use Caution/Monitor.
- trimipramine
flurazepam and trimipramine both increase sedation. Use Caution/Monitor.
- triprolidine
triprolidine and flurazepam both increase sedation. Use Caution/Monitor.
- voriconazole
voriconazole will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- xylometazoline
flurazepam increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- yohimbine
flurazepam increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziconotide
flurazepam and ziconotide both increase sedation. Use Caution/Monitor.
- ziprasidone
flurazepam and ziprasidone both increase sedation. Use Caution/Monitor.
- zotepine
flurazepam and zotepine both increase sedation. Use Caution/Monitor.
Minor (19)
- acetazolamide
acetazolamide will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- anastrozole
anastrozole will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- brimonidine
brimonidine increases effects of flurazepam by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.
- ciprofloxacin
ciprofloxacin increases levels of flurazepam by decreasing metabolism. Minor/Significance Unknown.
- cyclophosphamide
cyclophosphamide will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- esomeprazole
esomeprazole increases levels of flurazepam by decreasing metabolism. Minor/Significance Unknown.
- eucalyptus
flurazepam and eucalyptus both increase sedation. Minor/Significance Unknown.
- fleroxacin
fleroxacin increases levels of flurazepam by decreasing metabolism. Minor/Significance Unknown.
- gemifloxacin
gemifloxacin increases levels of flurazepam by decreasing metabolism. Minor/Significance Unknown.
- larotrectinib
larotrectinib will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- levofloxacin
levofloxacin increases levels of flurazepam by decreasing metabolism. Minor/Significance Unknown.
- moxifloxacin
moxifloxacin increases levels of flurazepam by decreasing metabolism. Minor/Significance Unknown.
- ofloxacin
ofloxacin increases levels of flurazepam by decreasing metabolism. Minor/Significance Unknown.
- omeprazole
omeprazole increases levels of flurazepam by decreasing metabolism. Minor/Significance Unknown.
- rifabutin
rifabutin decreases levels of flurazepam by increasing metabolism. Minor/Significance Unknown.
- rifapentine
rifapentine will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- sage
flurazepam and sage both increase sedation. Minor/Significance Unknown.
- vinpocetine
flurazepam increases effects of vinpocetine by unspecified interaction mechanism. Minor/Significance Unknown. Desirable interaction enhanced memory improvement (based on preliminary trial).
- zolpidem
zolpidem, flurazepam. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.
Adverse Effects
Frequency Not Defined
Common
- Ataxia
- Dizziness
- Drowsiness
- Lethargy
- Light-headedness
Less Common
- Chest pain, palpitations
- Headache, irritability, nervousness, weakness
- GI complaints
- Myalgia
- GU complaints
Rare
- Elevations of AST, ALT, bilirubin (T&D), alk phos
Warnings
Black Box Warnings
Concomitant use of benzodiazepines and opioids may result in profound respiratory depression, coma, and death; administer concomitantly when there are no alternative options; limit dosages and durations to minimum required; monitor for signs and symptoms of respiratory depression and sedation
Addiction, abuse, and misuse
- On September 2020, FDA addressed serious risks of benzodiazepine addiction, abuse, and misuse, which can lead to overdose and death
- Physical dependence can occur when taken steadily for several days to weeks, even as prescribed
- Stopping abruptly or reducing dosage too quickly can result in withdrawal reactions, including seizures, which can be life-threatening
- Assess each patient’s risk prior to prescribing and monitor regularly for the development of these behaviors or conditions
Contraindications
Documented hypersensitivity
Cautions
May impair ability to perform hazardous tasks
Benzodiazepines may worsen depression; consequently, appropriate precautions (eg, limiting the total prescription size and increased monitoring for suicidal ideation) should be considered
To reduce risk of withdrawal reactions, use a gradual taper to discontinue therapy or reduce dosage (a patient-specific plan should be used to taper the dose); patients at an increased risk of withdrawal adverse reactions after benzodiazepine discontinuation or rapid dosage reduction include those who take higher dosages and those who have had longer durations of use
Continued use of this medication may lead to clinically significant physical dependence; abrupt discontinuation or rapid dosage reduction after continued use, or administration of this medication may precipitate acute withdrawal reactions, which can be life-threatening (eg, seizures)
In some cases, benzodiazepine users have developed a protracted withdrawal syndrome with withdrawal symptoms lasting weeks to more than 12 months
Risks from concomitant use with opioids
- Concomitant use with opioids may result in profound sedation, respiratory depression, coma, and death; because of these risks, reserve concomitant prescribing of benzodiazepines and opioids in patients for whom alternative treatment options are inadequate
- Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases risk of drug-related mortality compared to use of opioids alone; if a decision is made to prescribe this drug concomitantly with opioids, prescribe lowest effective dosages and minimum durations of concomitant use, and follow patients closely for signs and symptoms of respiratory depression and sedation
- Advise both patients and caregivers about risks of respiratory depression and sedation when this drug is used with opioids
Abuse, misuse, and addiction
- The use of benzodiazepines, including Flurazepam hydrochloride capsules, exposes users to risks of abuse, misuse, and addiction, which can lead to overdose or death
- Abuse and misuse of benzodiazepines often (but not always) involve use of doses greater than maximum recommended dosage and commonly involve concomitant use of other medications, alcohol, and/or illicit substances, which is associated with an increased frequency of serious adverse outcomes, including respiratory depression, overdose, or death
- Before prescribing medication and throughout treatment, assess each patient’s risk for abuse, misuse, and addiction (eg, using a standardized screening tool); use particularly in patients at elevated risk, necessitates counseling about risks and proper use of this medication along with monitoring for signs and symptoms of abuse, misuse, and addiction
- Prescribe lowest effective dosage; avoid or minimize concomitant use of CNS depressants and other substances associated with abuse, misuse, and addiction (eg, opioid analgesics, stimulants); and advise patients on proper disposal of unused drug
- If a substance use disorder is suspected, evaluate patient and institute (or refer them for) early treatment, as appropriate
CNS-depressant effects and next-day impairment
- Dizziness, drowsiness, light-headedness, staggering, ataxia and falling can occur, particularly in elderly or debilitated persons; severe sedation, lethargy, disorientation and coma, probably indicative of drug intolerance or overdosage, reported
- This drug is a central nervous system (CNS) depressant and can impair daytime function even when used as prescribed; prescribers should monitor for excess depressant effects, but impairment can occur in the absence of subjective symptoms, and may not be reliably detected by ordinary clinical exam (eg, less than formal psychomotor testing)
- While pharmacodynamic tolerance or adaptation to some adverse depressant effects of this drug may develop, patients receiving therapy should be cautioned against driving or engaging in other hazardous activities or activities requiring complete mental alertness
- Additive effects occur with concomitant use of other CNS depressants (eg, other benzodiazepines, opioids, tricyclic antidepressants, alcohol)
- Downward dose adjustment of this drug and concomitant CNS depressants should be considered; the potential for adverse drug interactions continues for several days following discontinuation of therapy, until serum levels of psychoactive metabolites decline
- Use with other sedative-hypnotics is not recommended; alcohol generally should not be used during treatment; the risk of next-day psychomotor impairment is increased if this drug is taken with less than a full night of sleep remaining (7 to 8 hours); if higher than recommended dose taken; if coadministered with other CNS depressants
- Because this drug can cause drowsiness and a decreased level of consciousness, patients, particularly the elderly, are at higher risk of falls
Need to evaluate for comorbid behavior
- Because sleep disturbances may be presenting manifestation of a physical and/or psychiatric disorder, symptomatic treatment of insomnia should be initiated only after a careful evaluation of the patient
- The failure of insomnia to remit after 7 to 10 days of treatment may indicate the presence of a primary psychiatric and/or medical illness that should be evaluated
- Worsening of insomnia or emergence of new thinking or behavior abnormalities may be the consequence of an unrecognized psychiatric or physical disorder; such findings have emerged during the course of treatment with sedative-hypnotic drugs
Severe anaphylactic or anaphylactoid reactions
- Rare cases of angioedema involving tongue, glottis, or larynx reported in patients after taking first or subsequent doses of sedative-hypnotics; some patients have had additional symptoms such as dyspnea, throat closing, or nausea and vomiting that suggest anaphylaxis
- Some patients have required medical therapy in emergency department; if angioedema involves tongue, glottis, or larynx, airway obstruction may occur and be fatal; patients who develop angioedema after treatment should not be rechallenged with the drug
Abnormal thinking and behavior changes
- Abnormal thinking and behavior changes have been reported in patients treated with sedative-hypnotics including this medication; some of these changes include decreased inhibition (eg, aggressiveness and extroversion that seemed out of character), bizarre behavior, and depersonalization; visual and auditory hallucinations also reported; amnesia, and other neuro-psychiatric symptoms, may occur
- Paradoxical reactions such as stimulation, agitation, increased muscle spasticity, and sleep disturbances may occur unpredictably
- Complex behaviors such as "sleep-driving" (eg, driving while not fully awake, with amnesia for the event) have been reported with use of sedative-hypnotics; these behaviors can occur with initial treatment or in patients previously tolerant of this medicaiton or other sedative-hypnotics
- Although these behaviors can occur with use at therapeutic doses, risk is increased by higher doses or concomitant use of alcohol or other CNS depressants; due to risk to patient and community, this drug should be discontinued if “sleep-driving” occurs
- Other complex behaviors (eg, preparing and eating food, making phone calls, or having sex) reported in patients who are not fully awake after taking a sedative-hypnotic; as with sleep-driving, patients usually do not remember these events
Drug interaction overview
- Concomitant use of benzodiazepines and opioids increases risk of respiratory depression because of actions at different receptor sites in the CNS that control respiration; benzodiazepines interact at GABAA sites, and opioids interact primarily at mu receptors; when benzodiazepines and opioids are combined, potential for benzodiazepines to significantly worsen opioid-related respiratory depression exists; limit dosage and duration of concomitant use of benzodiazepines and opioids, and follow patients closely for respiratory depression and sedation
- Benzodiazepines, including this medication, produce additive CNS depressant effects when co-administered with ethanol or other CNS depressants (eg, psychotropic medications, anticonvulsants, antihistamines); downward dose adjustment of flurazepam and/or concomitant CNS depressants may be necessary because of additive effects
Pregnancy & Lactation
Pregnancy
To provide information regarding effects of in-utero exposure to this drug, physicians are advised to recommend that pregnant patients taking flurazepam enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry; this can be done by calling the toll-free number 1-888-233-2334, and must be done by patients themselves or their caregiver; information on the registry can also be found at website http://www.aedpregnancyregistry.org/
There are no adequate and well-controlled studies in pregnant women; available human data on risk of teratogenicity for benzodiazepines are inconclusive; there is insufficient evidence in humans to assess effect of benzodiazepine exposure during pregnancy or neurodevelopment
Administration of benzodiazepines immediately prior to or during childbirth can result in syndrome of hypothermia, hypotonia, respiratory depression, and difficulty feeding
In addition, infants born to mothers who have taken benzodiazepines during later stages of pregnancy can develop dependence, and subsequently withdrawal, during postnatal period
This drug should be used during pregnancy only if potential benefit justifies the potential risk to fetus
Animal data
- Administration of this medication to pregnant animals did not indicate a risk for adverse effects on morphological development at clinically relevant doses; however, animal data for other benzodiazepines suggest the possibility of adverse developmental effects (including long-term effects on neurobehavioral and immunological function) following prenatal exposure
Lactation
Manufacturer makes no recommendation regarding use during lactation
Unknown if drug excreted into human milk; unknown if drug excreted into animal milk; data not available; effects in nursing infant are unknown
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Long-acting benzodiazepine that depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA.
Pharmacokinetics
Metabolism: Glucuronic acid conjugation
Metabolites: Desalkylflurazepam, N-1-hydroxyethylflurazepam
Excretion: Urine
Half-life elimination: 48-120 h
Peak plasma time: 0.5-3 hr
Peak plasma concentration: 0.5-4 ng/mL
Images
Formulary
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