Intermediate-acting benzodiazepine
Potentiates GABA-A receptor-mediated inhibitory neurotransmission, facilitating sleep induction and maintenance.
Short-term treatment of insomnia.
Occasionally used for other sleep disturbances but limited by tolerance risk.
Oral capsules.
7.5–15 mg p.o. at bedtime, titrated as needed. Lower doses preferred for older adults.
7.5–30 mg p.o. nightly.
Metabolized primarily via hepatic CYP3A4 with inactive metabolites. Half-life approximately 8–20 hours, shorter than longer-acting benzodiazepines, resulting in less next-day sedation compared to them.
Next-day drowsiness, dizziness, confusion, impaired coordination.
Tolerance, dependence, withdrawal symptoms with prolonged use; paradoxical reactions (rare).
Monitor for sedation, cognitive impairment, fall risk, and signs of dependence, especially with extended use.
Risk of concomitant opioid use increasing sedation and respiratory depression; use with caution.
Use caution in elderly, traumatic brain injury (TBI), dementia, or cognitively impaired patients due to increased risk of falls, sedation, and delirium. Non-pharmacologic sleep interventions should be prioritized prior to pharmacotherapy.