Dalmane

Action

Depresses CNS at limbic, thalamic, and hypothalamic levels by enhancing inhibitory neurotransmitter effect of gamma-aminobutyric acid on neuronal excitability

Availability

Capsules: 15 mg, 30 mg

Indications and dosages

➣ Short-term management of insomnia (less than 4 weeks)

Adults: 15 to 30 mg P.O. at bedtime

Dosage adjustment

• Elderly or debilitated patients

Contraindications

• Hypersensitivity to drug or other benzodiazepines

• Preexisting CNS depression

• Angle-closure glaucoma

• Pregnancy or breastfeeding

Precautions

Use cautiously in:

• hepatic dysfunction

• history of suicide attempt or drug dependence

• elderly patients

• children younger than age 15 (safety not established).

Administration

• Before starting therapy, evaluate patient's mental status and check kidney and liver function tests and CBC.

Adverse reactions

CNS: dizziness, daytime drowsiness, headache, lethargy, confusion, poor concentration, depression, paradoxical excitation, ataxia

EENT: blurred vision

GI: nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain

Respiratory: sleep apnea

Skin: rash

Other: abnormal taste, hangover, physical or psychological drug dependence, drug tolerance

Interactions

Drug-drug. Antidepressants, antihistamines, opioids: additive CNS depression

Barbiturates, rifampin: increased flurazepam metabolism, decreased efficacy

Cimetidine, disulfiram, fluoxetine, hormonal contraceptives, isoniazid, ketoconazole, metoprolol, propoxyphene, propranolol, valproic acid: decreased flurazepam metabolism, enhanced efficacy

Levodopa: decreased levodopa efficacy

Theophylline: decreased sedative effects of flurazepam

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, total and direct bilirubin: increased levels

Drug-herbs. Chamomile, hops, kava, skullcap, valerian: additive CNS depression

Drug-behaviors. Alcohol use: additive CNS depression

Smoking: increased drug metabolism and clearance

Patient monitoring

• With long-term use, watch for signs and symptoms of physical or psychological dependence.

• Monitor patient's mental status, especially for depression and suicidal ideation.

• Watch for signs of drug hoarding or overuse.

• Monitor CBC and liver and kidney function tests.

Patient teaching

☞ Urge patient (and significant other as appropriate) to report signs and symptoms of depression or suicidal thoughts or actions.

☞ Advise female patient to immediately tell prescriber if she is pregnant. Caution her not to breastfeed.

• Inform patient that drug may cause physical or psychological dependence.

• Advise patient to minimize GI upset by eating frequent, small servings of food and drinking adequate fluids.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.