Quazepam

A to Z Drug Facts

 Action Potentiates action of GABA, an inhibitory neurotransmitter, resulting in increased neuronal inhibition and CNS depression, especially in limbic system and reticular formation.

 Indications Short-term management of insomnia.

 Contraindications Hypersensitivity to benzodiazepines; pregnancy; sleep apnea.

 Route/Dosage

ADULTS: PO 15 mg at bedtime initially; may reduce to 7.5 mg once individual response is determined. ELDERLY OR DEBILITATED PATIENT: Attempt dosage reduction after 1 to 2 nights.

 Interactions

Alcohol, CNS depressants: May cause additive CNS depressant effects. Cimetidine, disulfiram, omeprazole: May increase quazepam effects. Digoxin: May increase serum digoxin concentrations. Theophylline: May antagonize sedative effects.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV:Palpitations, tachycardia. CNS: Daytime drowsiness; dizziness; lethargy; confusion; memory impairment; euphoria; relaxed feeling; falling; ataxia; hallucinations; paradoxical reactions (eg, anger, hostility, mania); headache. DERM: Rash. EENT: Blurred vision; difficulty focusing. GI: Anorexia; diarrhea; abdominal cramping; constipation; nausea and vomiting. HEPA: Hepatic dysfunction. HEMA: Leukopenia; agranulocytopenia. OTHER: Tolerance; physical and psychological dependence; weakness; slurred speech.

 Precautions

Pregnancy: Category X. Lactation: Excreted in breast milk. Children: Contraindicated in children < 18 yr. Special risk patients: Use drug with caution in patients with renal or hepatic impairment, depression or suicidal tendencies, drug abuse and dependence, chronic pulmonary insufficiency, seizure disorders. Dependence/Withdrawal: Prolonged use can lead to psychologic or physical dependence. Withdrawal syndrome may occur; dose must be tapered gradually.

 Administration/Storage

• Administer ½ to 1 hr before bedtime with full glass of water. If GI upset occurs, administer with snack.
• Check to see that medication is swallowed.
• After long-term use, drug must be discontinued gradually. When drug is discontinued, expect nighttime sleep to be disturbed briefly (a few days).
• Store in tight container in cool area.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note potential for suicide or drug dependence.
• Assess type of sleep difficulty: Falling asleep, remaining asleep.
• Assess sleep pattern prior to and during therapy.
• Assess mental status: Sensorium, affect, mood, and long-term and short-term memory.
• Provide safety measures (removal of cigarettes, side rails up, night light, easily accessible call bell) and assistance with ambulation.

 Patient/Family Education

• Caution patient that this medication must not be taken during pregnancy or when pregnancy is possible. Advise patient to use reliable form of birth control while taking this drug.
• Discuss with patient ways to facilitate sleep (quiet, darkened room; avoidance of caffeine and nicotine; warm bath; warm milk; deep breathing; relaxation, self-hypnosis).
• Instruct patient not to increase dose.
• Emphasize importance of follow-up evaluation with health care provider to monitor progress of therapy. Instruct patient to inform health care provider if drug does not seem to be working.
• Instruct patient not to discontinue medication abruptly after prolonged therapy (eg, > 2 wk).
• Advise patient that disturbed nocturnal sleep may be experienced for 1 to 2 nights after discontinuing drug.
• Instruct patient to report these symptoms to health care provider: Sudden onset of vision changes, irregular heart beat, fever, sore throat, bruising, rash, jaundice, unusual bleeding (eg, epistaxis), or if pregnancy is detected.
• Advise patient to avoid intake of alcoholic beverages or other CNS depressants.
• Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts