Posted by Larry Hoover on April 18, 2005, at 12:25:09
In reply to Temazepam, posted by ed_uk on April 18, 2005, at 10:41:48
> Hi!
>
> Long-term use of temazepam is likely to result in physical dependence ie. withdrawal symptoms will occur if the medication is stopped abruptly. A gradual taper may be necessary in order to minimise withdrawal symptoms.
>
> In the treatment of insomnia, the long-term effectiveness of temazepam is not reliable, many people find that it 'poops out' relatively quickly- sometimes within a matter of days or weeks.
>
> Ideally, temazepam is best used on a short-term basis (eg. for a few days at a time), intermittently (eg. a couple of times a week) or 'as required' when insomnia is particularly bad.
>
> Kind regards,
> Ed.Sorry, Ed, but temazepam often gets a bad rap, just because it's a benzo. When they actually look at temazepam users, many people (certainly not all, but many) do not ever develop tolerance to it.
I saw one study of long-term temazepam users, (average 6 years, longest 17 years of continuous use), and all had responses to the drug similar to naive first-time users. I don't have that reference handy, though.
Lar
Br J Clin Pharmacol. 1997 Sep;44(3):267-75.
A study of the effects of long-term use on individual sensitivity to temazepam and lorazepam in a clinical population.
van Steveninck AL, Wallnofer AE, Schoemaker RC, Pieters MS, Danhof M, van Gerven JM, Cohen AF.
Centre for Human Drug Research, Leiden University Hospital, The Netherlands.
AIMS: The central effects of benzodiazepines may be attenuated after chronic use by changes in pharmacokinetics, pharmacodynamics or both. This attenuation may be influenced by the dosing pattern and the characteristics of the user population. The objectives of this study were to evaluate drug sensitivity in long-term users of temazepam and lorazepam in a clinical population. METHODS: The sensitivity to benzodiazepine effects in chronic users (1-20 years) of lorazepam (n = 14) or temazepam (n = 13) was evaluated in comparison with age and sex matched controls. Drug sensitivity was evaluated by plasma concentration in relation to saccadic eye movement parameters, postural stability and visual analogue scales. RESULTS: Pharmacokinetics of lorazepam and temazepam did not differ between patients and control subjects. Chronic users of lorazepam showed clear evidence of reduced sensitivity, indicated by lack of any pharmacodynamic difference between patients and controls at baseline, when drug concentrations were similar to the peak values attained in the control subjects after administration of 1-2.5 mg of lorazepam. In addition, there was a two- to four fold reduction in the slopes of concentration-effect plots for measures of saccadic eye movements and body sway (all; P < or = 0.01). By contrast, sensitivity in chronic users of temazepam was not different from controls. The difference between the temazepam and the lorazepam group appears to be associated with a more continuous drug exposure in the latter, due to the longer half-life and a more frequent intake of lorazepam. This pattern of use may be partly related to the more anxious personality traits that were observed in the chronic users of lorazepam. CONCLUSIONS: Chronic users of lorazepam show evidence of tolerance to sedative effects in comparison with healthy controls. Tolerance does not occur in chronic users of temazepam. The difference may be related to pharmacological properties, in addition to different patterns of use, associated with psychological factors.
Br J Clin Pharmacol. 1979;8(1):63S-68S.
Hypnotic efficacy of temazepam: a long-term sleep laboratory evaluation.
Mitler MM, Carskadon MA, Phillips RL, Sterling WR, Zarcone VP Jr, Spiegel R, Guilleminault C, Dement WC.
1 Temazepam was evaluated in a strictly defined insomniac patient population under sleep laboratory conditions. Two protocols were used: a short-term (26-night) and a long-term (54-night) protocol evaluated the efficacy of the drug administered at night at 15 mg (short-term study) and 30 mg (long-term study), respectively. 2 Temazepam seemed to be both safe and effective at doses of 15 and 30 mg with up to 5 weeks of ingestion. 3 Suppression of slow wave sleep was observed at the high dose, but no suppression of REM sleep, found in studies with other benzodiazepines, was noted. 4 No evidence was found for development of tolerance or rebound effects.
poster:Larry Hoover
thread:485696
URL: http://www.dr-bob.org/babble/20050418/msgs/485932.html