Drugs in this Class
Estazolam Tablets ()
Quazepam (Doral)
Flurazepam Capsules (Dalmane Capsules, Flurazepam Hydrochloride Capsules)
Temazepam (Restoril)
Triazolam (Halcion)

Summarizing the Evidence

• All drugs in this class are effective for treating insomnia. However, it is difficult to directly compare effectiveness between the drugs in this class. The reason for this is because the key to deciding which benzodiazepine to use is based mainly upon the drug's onset of action (how fast the drug begins working) and duration of activity (how long the drug continues to work). Based on these features, the drugs in this class can be further categorized as short-acting, intermediate-acting, and long-acting benzodiazepines. Short-acting benzodiazepines (triazolam) are best for patients who have difficulty initiating sleep and those who require daytime alertness. Intermediate-acting benzodiazepines (estazolam and temazepam) are best for patients who have difficulty maintaining sleep or those who experience early morning awakenings. Long-acting benzodiazepines (flurazepam and quazepam) may also be useful for patients who have difficulty maintaining sleep and those who experience early morning awakenings; however, long-acting benzodiazepines can cause daytime drowsiness or sluggishness.

• The choice of which benzodiazepine to use will typically depend upon the specific symptoms of insomnia that you experience: difficulty falling asleep, difficulty maintaining sleep, or early morning awakenings. The choice may also depend on your doctor's preference and your prescription benefits formulary.

Dosing and Administration

• All of the benzodiazepines are available in oral dosage forms (as tablets or capsules) and should be taken before retiring for sleep.

Generic Availability

• Every drug in this class is available generically except for quazepam (brand name: Doral).

Drug Interactions

Some interactions between medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how the drugs interact and the severity of the interaction, please use our Drug Interactions Checker.

Side Effects

To view specific side effect information, please use our Side Effect Checker.

Additional Information

References

1. McEvoy GE, ed. American Hospital Formulary Service drug information 2006. Bethesda, MD: American Society of Health-System Pharmacists; 2006.

2. Drug Facts and Comparisons. Updated Monthly. St. Louis, MO: Facts and Comparisons, A Wolters Kluwer Company. 2006.

3. Drugdex Database. In: Gelman CJ, Rumack BH, editors. Denver: Micromedex Inc. 2006.

4. Jermain DM. Sleep Disorders. In: Pharmacotherapy: A Pathophysiologic Approach. 4th ed. Dipiro JT, Talbert RL, Yee GC, et al., eds. Stamford, CN: Appleton & Lange. 1999:1208-1218.

5. Scharf MB, Roth PB, Dominguez RA, Ware JC. Estazolam and flurazepam: a mulicenter, placebo-controlled comparative study in outpatients with insomnia. J Clin Pharmacol 1990;30(5):461-7.

6. Fillingim JM. Double-blind evaluation of temazepam, flurazepam, and placebo in geriatric insomniacs. Clin Ther 1982;4(5):369-80.

7. Dement WC. Comparative efficacy of triazolam, flurazepam and placebo in out-patient insomniacs. J Int Med Res 1978;64(4):334-42.

8. Sunshine A. Comparison of the hypnotic activity of triazolam, flurazepam hydrochloride, and placebo. Clin Pharmacol Ther 1975;17(5):573-7.
9. Mauri MC, Gianetti S, Pugnetti L, et al. Quazepam versus triazolam in patients with sleep disorders: a double-blind study. Int J Clin Pharmacol Res. 1993; 13(3):173-7.
10. Nakra BR, Gfeller JD, Hassan R. A double-blind comparison of the effects of temazepam and triazolam on residual, daytime performance in elderly insomniacs. Int Psychogeriatr. 1992; 4(1):45-53.
11. Dement WC. Objective measurements of daytime sleepiness and performance comparing quazepam with flurazepam in two adult populations using the multiple sleep latency test. J Clin Psychiatry. 1991; 52supp: 31-7.
12. Cohn JB, Wilcox CS, Bremner J, et al. Hypnotic efficacy of estazolam compared with flurazepam in outpatients with insomnia. J Clin Pharmacol. 1991; 31:747-50.
13. McClure DJ, Walsh J, Chang H, et al. Comparison of lorazepam and flurazepam as hypnotic agents in chronic insomniacs. J Clin Pharmacol. 1988; 28:52-63.

Last Updated: December 2007

Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It should not be construed to indicate that the use of the product is safe, appropriate, or effective for you. Consult your healthcare professional before taking any medication.

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