temazepam

In sleep laboratory studies, temazepam significantly decreased the number of nightly awakenings,{{cite journal | vauthors = Bixler EO, Kales A, Soldatos CR, Scharf MB, Kales JD | title = Effectiveness of temazepam with short-intermediate-, and long-term use: sleep laboratory evaluation | journal = Journal of Clinical Pharmacology | volume = 18 | issue = 2–3 | pages = 110–118 | year = 1978 | pmid = 342551 | doi = 10.1002/j.1552-4604.1978.tb02430.x | s2cid = 20850872 }} but has the drawback of distorting the normal sleep pattern.{{cite journal | vauthors = Ferrillo F, Balestra V, Carta F, Nuvoli G, Pintus C, Rosadini G | title = Comparison between the central effects of camazepam and temazepam. Computerized analysis of sleep recordings | journal = Neuropsychobiology | volume = 11 | issue = 1 | pages = 72–76 | year = 1984 | pmid = 6146112 | doi = 10.1159/000118055 | quote = The effects of acute administration per os of 30 mg camazepam and the same dose of temazepam, were compared with placebo in 8 young male volunteers.... }} It is officially indicated for severe insomnia and other severe or disabling sleep disorders. The prescribing guidelines in the UK limit the prescribing of hypnotics to two to four weeks due to concerns of tolerance and dependence.{{cite web|url= http://bnf.org/bnf/bnf/55/3152.htm|title= TEMAZEPAM|access-date= 17 August 2008|author= BNF|author-link= British National Formulary|year= 2008|publisher= British National Formulary|archive-date= 25 July 2020|archive-url= https://web.archive.org/web/20200725173757/https://about.medicinescomplete.com/|url-status= dead}}

The American Academy of Sleep Medicine's 2017 clinical practice guidelines recommended the use of temazepam in the treatment of sleep-onset and sleep-maintenance insomnia.{{cite journal | vauthors = Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL | title = Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline | journal = Journal of Clinical Sleep Medicine | volume = 13 | issue = 2 | pages = 307–349 | date = February 2017 | pmid = 27998379 | pmc = 5263087 | doi = 10.5664/jcsm.6470 }} It rated the recommendation as weak, the quality of evidence as moderate, and concluded that the potential benefits outweighed the potential harms. The guidelines found that temazepam at a dose of 15{{nbsp}}mg reduces sleep latency by 37{{nbsp}}minutes (95% {{Abbrlink|CI|confidence interval}} 21 to 53{{nbsp}}minutes), increases total sleep time by 99{{nbsp}}minutes (95% {{Abbr|CI|confidence interval}} 63 to 135{{nbsp}}minutes), and provides a small improvement to sleep quality. The improvements in sleep latency and total sleep time were numerically much greater than any of the other included sleep medications, including eszopiclone, zopiclone, zolpidem, triazolam, estazolam, quazepam, flurazepam, trazodone, diphenhydramine, gabapentin, among others.

The United States Air Force uses temazepam as one of the hypnotics approved as a "no-go pill" to help aviators and special-duty personnel sleep in support of mission readiness. "Ground tests"{{explain|date=January 2021}} are necessary prior to required authorization being issued to use the medication in an operational situation, and a 12-hour restriction is imposed on subsequent flight operation.{{cite journal | vauthors = Caldwell JA, Caldwell JL | title = Fatigue in military aviation: an overview of US military-approved pharmacological countermeasures | journal = Aviation, Space, and Environmental Medicine | volume = 76 | issue = 7 Suppl | pages = C39–C51 | date = July 2005 | pmid = 16018329 | url = http://docserver.ingentaconnect.com/deliver/connect/asma/00956562/v76n7x1/s10.pdf?expires=1335744234&id=68546495&titleid=8218&accname=Guest+User&checksum=D97BA65A8E7071CC3766CF365ED85FA3 | format = pdf }} The other hypnotics used as "no-go pills" are zaleplon and zolpidem, which have shorter mandatory recovery periods.

Use of temazepam should be avoided, when possible, in individuals with these conditions:

• Ataxia (gross lack of coordination of muscle movements)
• Severe hypoventilation
• Acute narrow-angle glaucoma
• Severe hepatic deficiencies (hepatitis and liver cirrhosis decrease elimination by a factor of two)
• Severe renal deficiencies (e.g. patients on dialysis)
• Sleep apnea{{cite web | url = http://www.medscape.com/druginfo/dosage?drugid=8715&drugname=Temazepam+Oral&monotype=default | title = Temazepam Oral | access-date = 22 August 2010 | work = Web MD Professional | publisher = Medscape}}
• Severe depression, particularly when accompanied by suicidal tendencies
• Acute intoxication with alcohol, narcotics, or other psychoactive substances
• Myasthenia gravis (autoimmune disorder causing muscle weakness)
• Hypersensitivity or allergy to any drug in the benzodiazepine class

Temazepam may cause harm to the fetus. The safety and effectiveness of temazepam has not been established in children. Benzodiazepines also require special caution if used in the elderly, alcohol- or drug-dependent individuals, and individuals with comorbid psychiatric disorders.{{cite journal | vauthors = Authier N, Balayssac D, Sautereau M, Zangarelli A, Courty P, Somogyi AA, Vennat B, Llorca PM, Eschalier A | title = Benzodiazepine dependence: focus on withdrawal syndrome | journal = Annales Pharmaceutiques Françaises | volume = 67 | issue = 6 | pages = 408–413 | date = November 2009 | pmid = 19900604 | doi = 10.1016/j.pharma.2009.07.001 }}

Temazepam, similar to other benzodiazepines and nonbenzodiazepine hypnotic drugs, causes impairments in body balance and standing steadiness in individuals who wake up at night or the next morning. Falls and hip fractures are frequently reported. The combination with alcohol increases these impairments. Partial but incomplete tolerance develops to these impairments.{{cite journal | vauthors = Mets MA, Volkerts ER, Olivier B, Verster JC | title = Effect of hypnotic drugs on body balance and standing steadiness | journal = Sleep Medicine Reviews | volume = 14 | issue = 4 | pages = 259–267 | date = August 2010 | pmid = 20171127 | doi = 10.1016/j.smrv.2009.10.008 }} The smallest possible effective dose should be used in elderly or very ill patients, as a risk of apnea and/or cardiac arrest exists. This risk is increased when temazepam is given concomitantly with other drugs that depress the central nervous system (CNS).

Because benzodiazepines can be abused and lead to dependence, their use should be avoided in people in certain particularly high-risk groups. These groups include people with a history of alcohol or drug dependence, people significantly struggling with their mood or people with longstanding mental health difficulties. If temazepam must be prescribed to people in these groups, they should generally be monitored very closely for signs of misuse and development of dependence.

{{See also|Benzodiazepine withdrawal syndrome}}

In September 2020, the U.S. Food and Drug Administration (FDA) required the boxed warning be updated for all benzodiazepine medicines to describe the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions consistently across all the medicines in the class.{{cite web | title=FDA expands Boxed Warning to improve safe use of benzodiazepine drug | website=U.S. Food and Drug Administration (FDA) | date=23 September 2020 | url=https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class | archive-url=https://web.archive.org/web/20200924002523/https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class | url-status=dead | archive-date=24 September 2020 | access-date=23 September 2020}} {{PD-notice}}

Side effects are typical of hypnotic benzodiazepines, though temazepam has more pronounced CNS depressant effects, and include somnolence, sedation, dizziness, fatigue, ataxia, headache, lethargy, impairment of memory and learning, longer reaction time and impairment of motor functions (including coordination problems),{{cite journal | vauthors = Liljequist R, Mattila MJ | title = Acute effects of temazepam and nitrazepam on psychomotor skills and memory | journal = Acta Pharmacologica et Toxicologica | volume = 44 | issue = 5 | pages = 364–369 | date = May 1979 | pmid = 38627 | pmc = 1429620 | doi = 10.1111/j.1600-0773.1979.tb02346.x }} slurred speech, decreased physical performance, numbed emotions, reduced alertness, muscle weakness, blurred vision (especially in higher doses or in those with low tolerance), and inattention. Euphoria was a reported side effect with its use, which is uncommon or not ever reported amongst benzodiazepines. According to the U.S. Food and Drug Administration, temazepam had an incidence of euphoria of 1.5%, which is considered rare.{{ cite web | title = Temazepam | url = https://www.drugs.com/pro/temazepam.html |date=October 2007 | publisher = Drugs.com | access-date = 25 November 2007 }} Feelings of euphoria, pleasant sedation, and inner feelings of peace are reported by those who abuse drugs, particularly in those who use temazepam intravenously. It has the highest ratings reported among benzodiazepines by recreational drug users. Drug users tend have a higher preference for temazepam over other benzodiazepines. The three most common reasons for temazepam preference were due to speed of onset, that a it was 'strong' and that it gave a good 'high'.{{cite web | url = https://www.legislation.act.gov.au/ni/2006-175/20060519-26368/pdf/2006-175.pdf | title = Health Professionals Approval 2006 (No 1) | access-date = 13 September 2011 | year = 2006 | publisher = Australian Capital Territory (ACT) medical board | archive-url = https://web.archive.org/web/20110404075747/http://www.legislation.act.gov.au/ni/2006-175/current/pdf/2006-175.pdf | archive-date = 4 April 2011 | url-status = live }}{{cite journal |vauthors = Griffiths RR, Lamb RJ, Ator NA, Roache JD, Brady JV |title=Relative Abuse Liability of Triazolam: Experimental Assessment in Animals and Humans |journal=Neuroscience and Biobehavioral Reviews |year=1985|volume=9|issue=1|pages=133–151|url=http://www.maps.org/dea-mdma/pdf/0059.PDF|doi=10.1016/0149-7634(85)90039-9|pmid=2858078|citeseerx=10.1.1.410.6027|s2cid=17366074|archive-date=12 March 2013|archive-url=https://web.archive.org/web/20130312194001/http://www.maps.org/dea-mdma/pdf/0059.PDF|url-status=dead }}{{cite journal | vauthors = Serfaty M, Masterton G | title = Fatal poisonings attributed to benzodiazepines in Britain during the 1980s | journal = The British Journal of Psychiatry | volume = 163 | issue = 3 | pages = 386–393 | date = September 1993 | pmid = 8104653 | doi = 10.1192/bjp.163.3.386 | s2cid = 46001278 }} Anterograde amnesia is also common, and respiratory depression in higher doses has proven to be fatal, even when temazepam is taken alone. In medical literature from Australia, Ireland, the UK, Canada, and the United States, temazepam is the only benzodiazepine which has been fatal in overdoses without combination with other CNS depresssants. This unique feature is due to the toxicity of the drug, which numerous studies have ranked it as being most toxic.

A 2009 meta-analysis found a 44% higher rate of mild infections, such as pharyngitis or sinusitis, in people taking Temazepam or other hypnotic drugs compared to those taking a placebo.{{cite journal | vauthors = Joya FL, Kripke DF, Loving RT, Dawson A, Kline LE | title = Meta-analyses of hypnotics and infections: eszopiclone, ramelteon, zaleplon, and zolpidem | journal = Journal of Clinical Sleep Medicine | volume = 5 | issue = 4 | pages = 377–383 | date = August 2009 | pmid = 19968019 | pmc = 2725260 | doi = 10.5664/jcsm.27552 }}

Hyperhydrosis, hypotension, burning eyes, increased appetite, changes in libido, hallucinations, faintness, nystagmus, vomiting, pruritus, gastrointestinal disturbances, nightmares, palpitation and paradoxical reactions including restlessness, aggression, violence, overstimulation and agitation have been reported, but are rare (less than 0.5%).

Before taking temazepam, one should ensure that at least 8 hours are available to dedicate to sleep. Failing to do so can increase the side effects of the drug.

Like all benzodiazepines, the use of this drug in combination with alcohol potentiates the side effects, and can lead to toxicity and death.

Though rare, residual "hangover" effects after night-time administration of temazepam occasionally occur. These include sleepiness, impaired psychomotor and cognitive functions which may persist into the next day, impaired driving ability, and possible increased risks of falls and hip fractures, especially in the elderly.{{cite journal | vauthors = Vermeeren A | title = Residual effects of hypnotics: epidemiology and clinical implications | journal = CNS Drugs | volume = 18 | issue = 5 | pages = 297–328 | year = 2004 | pmid = 15089115 | doi = 10.2165/00023210-200418050-00003 | s2cid = 25592318 }}

Chronic or excessive use of temazepam may cause drug tolerance, which can develop rapidly,{{cite journal | vauthors = Kales A | title = Quazepam: hypnotic efficacy and side effects | journal = Pharmacotherapy | volume = 10 | issue = 1 | pages = 1–10 | year = 1990 | pmid = 1969151 | doi = 10.1002/j.1875-9114.1990.tb02545.x | s2cid = 33505418 }} so this drug is not recommended for long-term use.{{cite web|url=https://medlineplus.gov/druginfo/meds/a684003.html|title=Temazepam: MedlinePlus Drug Information|website=medlineplus.gov}} In 1979, the Institute of Medicine (USA) and the National Institute on Drug Abuse stated that most hypnotics lose their sleep-inducing properties after about three to 14 days.{{cite journal | vauthors = | title = Systematic review of the benzodiazepines. Guidelines for data sheets on diazepam, chlordiazepoxide, medazepam, clorazepate, lorazepam, oxazepam, temazepam, triazolam, nitrazepam, and flurazepam. Committee on the Review of Medicines | journal = British Medical Journal | volume = 280 | issue = 6218 | pages = 910–912 | date = March 1980 | pmid = 7388368 | pmc = 1601049 | doi = 10.1136/bmj.280.6218.910 }} In use longer than one to two weeks, tolerance will rapidly develop towards the ability of temazepam to maintain sleep, resulting in a loss of effectiveness.{{cite journal | vauthors = Kales A, Bixler EO, Soldatos CR, Vela-Bueno A, Jacoby JA, Kales JD | title = Quazepam and temazepam: effects of short- and intermediate-term use and withdrawal | journal = Clinical Pharmacology and Therapeutics | volume = 39 | issue = 3 | pages = 345–352 | date = March 1986 | pmid = 2868823 | doi = 10.1038/clpt.1986.51 | s2cid = 23792142 }} Some studies have observed tolerance to temazepam after as little as one week's use.{{cite journal | vauthors = Roehrs T, Kribbs N, Zorick F, Roth T | title = Hypnotic residual effects of benzodiazepines with repeated administration | journal = Sleep | volume = 9 | issue = 2 | pages = 309–316 | date = June 1986 | pmid = 2905824 | doi = 10.1093/sleep/9.2.309 | doi-access = free }} Another study examined the short-term effects of the accumulation of temazepam over seven days in elderly inpatients, and found little tolerance developed during the accumulation of the drug.{{cite journal | vauthors = Cook PJ, Huggett A, Graham-Pole R, Savage IT, James IM | title = Hypnotic accumulation and hangover in elderly inpatients: a controlled double-blind study of temazepam and nitrazepam | journal = British Medical Journal | volume = 286 | issue = 6359 | pages = 100–102 | date = January 1983 | pmid = 6129914 | pmc = 1546430 | doi = 10.1136/bmj.286.6359.100 }} Other studies examined the use of temazepam over six days and saw no evidence of tolerance.{{cite journal | vauthors = Griffiths AN, Tedeschi G, Richens A | title = The effects of repeated doses of temazepam and nitrazepam on several measures of human performance | journal = Acta Psychiatrica Scandinavica. Supplementum | volume = 332 | pages = 119–126 | year = 1986 | pmid = 2883819 | doi = 10.1111/j.1600-0447.1986.tb08988.x | s2cid = 27441679 }}{{cite journal | vauthors = Tedeschi G, Griffiths AN, Smith AT, Richens A | title = The effect of repeated doses of temazepam and nitrazepam on human psychomotor performance | journal = British Journal of Clinical Pharmacology | volume = 20 | issue = 4 | pages = 361–367 | date = October 1985 | pmid = 2866784 | pmc = 1400899 | doi = 10.1111/j.1365-2125.1985.tb05078.x }} A study in 11 young male subjects showed significant tolerance occurs to temazepam's thermoregulatory effects and sleep inducing properties after one week of use of 30-mg temazepam. Body temperature is well correlated with the sleep-inducing or insomnia-promoting properties of drugs.{{cite journal | vauthors = Gilbert SS, Burgess HJ, Kennaway DJ, Dawson D | title = Attenuation of sleep propensity, core hypothermia, and peripheral heat loss after temazepam tolerance | journal = American Journal of Physiology. Regulatory, Integrative and Comparative Physiology | volume = 279 | issue = 6 | pages = R1980–R1987 | date = December 2000 | pmid = 11080060 | doi = 10.1152/ajpregu.2000.279.6.R1980 | s2cid = 2927653 }}

In one study, the drug sensitivity of people who had used temazepam for one to 20 years was no different from that of controls.{{cite journal | vauthors = van Steveninck AL, Wallnöfer AE, Schoemaker RC, Pieters MS, Danhof M, van Gerven JM, Cohen AF | title = A study of the effects of long-term use on individual sensitivity to temazepam and lorazepam in a clinical population | journal = British Journal of Clinical Pharmacology | volume = 44 | issue = 3 | pages = 267–275 | date = September 1997 | pmid = 9296321 | pmc = 2042835 | doi = 10.1046/j.1365-2125.1997.t01-1-00580.x }} An additional study, in which at least one of the authors is employed by multiple drug companies, examined the efficacy of temazepam treatment on chronic insomnia over three months, and saw no drug tolerance, with the authors even suggesting the drug might become more effective over time.{{cite journal | vauthors = Allen RP, Mendels J, Nevins DB, Chernik DA, Hoddes E | title = Efficacy without tolerance or rebound insomnia for midazolam and temazepam after use for one to three months | journal = Journal of Clinical Pharmacology | volume = 27 | issue = 10 | pages = 768–775 | date = October 1987 | pmid = 2892863 | doi = 10.1002/j.1552-4604.1987.tb02994.x | s2cid = 30011242 }}{{cite web|url= http://www.apss.org/pdf/COIDisclosures.pdf|title= Conflict of interest disclosures|access-date= 17 August 2008|publisher= American Academy of Sleep Medicine and the Sleep Research Society|archive-url= https://web.archive.org/web/20090708192745/http://www.apss.org/PDF/COIDisclosures.pdf|archive-date= 8 July 2009|url-status= dead}}{{cite web|url= http://www.jobsoneducation.com/cliniciansCME/index.asp?page=courses/10156/disclaimer.htm&lsn_id=10156|title= Management of Restless Legs Syndrome: Pathophysiology, Diagnosis, and Treatment|access-date= 17 August 2008| vauthors = Allen RP, Hening WA |date= March 2005|archive-url= https://web.archive.org/web/20081228003038/http://www.jobsoneducation.com/cliniciansCME/index.asp?page=courses%2F10156%2Fdisclaimer.htm&lsn_id=10156|archive-date= 28 December 2008|url-status= dead}}

Establishing continued efficacy beyond a few weeks can be complicated by the difficulty in distinguishing between the return of the original insomnia complaint and withdrawal or rebound related insomnia. Sleep EEG studies on hypnotic benzodiazepines show tolerance tends to occur completely after one to four weeks with sleep EEG returning to pretreatment levels. The paper concluded that due to concerns about long-term use involving toxicity, tolerance and dependence, as well as to controversy over long-term efficacy, wise prescribers should restrict benzodiazepines to a few weeks and avoid continuing prescriptions for months or years.{{cite journal | vauthors = Lader MH | title = Limitations on the use of benzodiazepines in anxiety and insomnia: are they justified? | journal = European Neuropsychopharmacology | volume = 9 | issue = Suppl 6 | pages = S399–S405 | date = December 1999 | pmid = 10622686 | doi = 10.1016/S0924-977X(99)00051-6 | s2cid = 43443180 }} A review of the literature found the nonpharmacological treatment options were a more effective treatment option for insomnia due to their sustained improvements in sleep quality.{{cite journal | vauthors = Kirkwood CK | title = Management of insomnia | journal = Journal of the American Pharmaceutical Association | volume = 39 | issue = 5 | pages = 688–96; quiz 713–4 | year = 1999 | pmid = 10533351 | doi = 10.1016/S1086-5802(15)30354-5 }}

Temazepam, like other benzodiazepine drugs, can cause physical dependence and addiction. Withdrawal from temazepam or other benzodiazepines after regular use often leads to benzodiazepine withdrawal syndrome, which resembles symptoms during alcohol and barbiturate withdrawal. The higher the dose and the longer the drug is taken, the greater the risk of experiencing unpleasant withdrawal symptoms. Withdrawal symptoms can also occur from standard dosages and after short-term use. Abrupt withdrawal from therapeutic doses of temazepam after long-term use may result in a severe benzodiazepine withdrawal syndrome. Gradual and careful reduction of the dosage, preferably with a long-acting benzodiazepine with long half-life active metabolites, such as chlordiazepoxide or diazepam, are recommended to prevent severe withdrawal syndromes from developing. Other hypnotic benzodiazepines are not recommended.{{cite journal | vauthors = MacKinnon GL, Parker WA | title = Benzodiazepine withdrawal syndrome: a literature review and evaluation | journal = The American Journal of Drug and Alcohol Abuse | volume = 9 | issue = 1 | pages = 19–33 | year = 1982 | pmid = 6133446 | doi = 10.3109/00952998209002608 }} A study in rats found temazepam is cross tolerant with barbiturates and is able to effectively substitute for barbiturates and suppress barbiturate withdrawal signs.{{cite journal | vauthors = Yutrzenka GJ, Patrick GA, Rosenberger W | title = Substitution of temazepam and midazolam in pentobarbital-dependent rats | journal = Physiology & Behavior | volume = 46 | issue = 1 | pages = 55–60 | date = July 1989 | pmid = 2573097 | doi = 10.1016/0031-9384(89)90321-1 | s2cid = 22621971 }}

Rare cases are reported in the medical literature of psychotic states developing after abrupt withdrawal from benzodiazepines, even from therapeutic doses.{{cite journal | vauthors = Terao T, Tani Y | title = [Two cases of psychotic state following normal-dose benzodiazepine withdrawal] | language = ja | journal = Journal of UOEH | volume = 10 | issue = 3 | pages = 337–340 | date = September 1988 | pmid = 2902678 | doi = 10.7888/juoeh.10.337 | doi-access = free }} Antipsychotics increase the severity of benzodiazepine withdrawal effects with an increase in the intensity and severity of convulsions.{{cite journal | vauthors = Tagashira E, Hiramori T, Urano T, Nakao K, Yanaura S | title = Enhancement of drug withdrawal convulsion by combinations of phenobarbital and antipsychotic agents | journal = Japanese Journal of Pharmacology | volume = 31 | issue = 5 | pages = 689–699 | date = October 1981 | pmid = 6118452 | doi = 10.1254/jjp.31.689 | doi-access = free }}

Patients who were treated in the hospital with temazepam or nitrazepam have continued taking these after leaving the hospital. Hypnotic uses in the hospital were recommended to be limited to five nights' use only, to avoid the development of withdrawal symptoms such as insomnia.{{cite journal | vauthors = Hecker R, Burr M, Newbury G | title = Risk of benzodiazepine dependence resulting from hospital admission | journal = Drug and Alcohol Review | volume = 11 | issue = 2 | pages = 131–135 | year = 1992 | pmid = 16840267 | doi = 10.1080/09595239200185601 }}

As with other benzodiazepines, temazepam produces additive CNS-depressant effects when coadministered with other medications which themselves produce CNS depression, such as barbiturates, alcohol,{{cite journal | vauthors = Liljequist R, Palva E, Linnoila M | title = Effects on learning and memory of 2-week treatments with chlordiazepoxide lactam, N-desmethyldiazepam, oxazepam and methyloxazepam, alone or in combination with alcohol | journal = International Pharmacopsychiatry | volume = 14 | issue = 4 | pages = 190–198 | year = 1979 | pmid = 42628 | doi = 10.1159/000468381 }} opioids, tricyclic antidepressants, nonselective MAO inhibitors, phenothiazines and other antipsychotics, skeletal muscle relaxants, antihistamines, and anaesthetics. Administration of theophylline or aminophylline has been shown to reduce the sedative effects of temazepam and other benzodiazepines.

Unlike many benzodiazepines, pharmacokinetic interactions involving the P450 system have not been observed with temazepam. Temazepam shows no significant interaction with CYP3A4 inhibitors (e.g. itraconazole, erythromycin).{{cite journal | vauthors = Ahonen J, Olkkola KT, Neuvonen PJ | title = Lack of effect of antimycotic itraconazole on the pharmacokinetics or pharmacodynamics of temazepam | journal = Therapeutic Drug Monitoring | volume = 18 | issue = 2 | pages = 124–127 | date = April 1996 | pmid = 8721273 | doi = 10.1097/00007691-199604000-00003 }} Oral contraceptives may decrease the effectiveness of temazepam and speed up its elimination half-life.{{cite journal | vauthors = Stoehr GP, Kroboth PD, Juhl RP, Wender DB, Phillips JP, Smith RB | title = Effect of oral contraceptives on triazolam, temazepam, alprazolam, and lorazepam kinetics | journal = Clinical Pharmacology and Therapeutics | volume = 36 | issue = 5 | pages = 683–690 | date = November 1984 | pmid = 6149030 | doi = 10.1038/clpt.1984.240 | s2cid = 44999891 }}

{{Main|Benzodiazepine overdose}}

Overdosage of temazepam results in increasing CNS effects, including:

• Somnolence (difficulty staying awake)
• Mental confusion
• Respiratory depression
• Hypotension
• Cyanosis
• Impaired motor functions
• Impaired or absent reflexes
• Impaired coordination
• Impaired balance
• Dizziness, sedation
• Coma
• Death

Temazepam had the highest rate of drug intoxication, including overdose, among common benzodiazepines in cases with and without combination with alcohol in a 1985 study.{{cite journal | vauthors = Buckley NA, Dawson AH, Whyte IM, O'Connell DL | title = Relative toxicity of benzodiazepines in overdose | journal = BMJ | volume = 310 | issue = 6974 | pages = 219–221 | date = January 1995 | pmid = 7866122 | pmc = 2548618 | doi = 10.1136/bmj.310.6974.219 }} Temazepam and nitrazepam were the two benzodiazepines most commonly detected in overdose-related deaths in an Australian study of drug deaths. Of the two, temazepam had higher number of deaths, and only temazepam was fatal as the lone drug in three cases, while all cases of nitrazepam deaths were due to mixes with other CNS depressants. Alcohol, heroin, and prescription opioids, with morphine being the opioid with the highest mortality rate.{{cite journal | vauthors = Drummer OH, Ranson DL | title = Sudden death and benzodiazepines | journal = The American Journal of Forensic Medicine and Pathology | volume = 17 | issue = 4 | pages = 336–342 | date = December 1996 | pmid = 8947361 | doi = 10.1097/00000433-199612000-00012 }} A 1993 British study found temazepam to have the highest number of deaths per million prescriptions among medications commonly prescribed in the 1980s (11.9, versus 5.9 for benzodiazepines overall, taken with or without alcohol).{{cite journal | vauthors = Serfaty M, Masterton G | title = Fatal poisonings attributed to benzodiazepines in Britain during the 1980s | journal = The British Journal of Psychiatry | volume = 163 | issue = 3 | pages = 386–393 | date = September 1993 | pmid = 8104653 | doi = 10.1192/bjp.163.3.386 | s2cid = 46001278 }}

A 1995 Australian study of patients admitted to hospital after benzodiazepine overdose corroborated these results, and found temazepam overdose much more likely to lead to coma than other benzodiazepines (odds ratio 1.86). The authors noted several factors, such as differences in potency, receptor affinity, and rate of absorption between benzodiazepines, could explain this higher toxicity. Although benzodiazepines have a high therapeutic index, temazepam is one of the more dangerous of this class of drugs. The combination of alcohol and temazepam makes death by alcohol poisoning more likely.{{cite journal | vauthors = Koski A, Ojanperä I, Vuori E | title = Interaction of alcohol and drugs in fatal poisonings | journal = Human & Experimental Toxicology | volume = 22 | issue = 5 | pages = 281–287 | date = May 2003 | pmid = 12774892 | doi = 10.1191/0960327103ht324oa | bibcode = 2003HETox..22..281K | s2cid = 37777007 }}

The main pharmacological action of temazepam is to increase the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABA_A receptor. This causes sedation, motor impairment, ataxia, anxiolysis, anticonvulsant effects, muscle relaxation, and a reinforcing effect.{{cite journal | vauthors = Oelschläger H | title = [Chemical and pharmacologic aspects of benzodiazepines] | journal = Schweizerische Rundschau für Medizin Praxis = Revue Suisse de Médecine Praxis | volume = 78 | issue = 27–28 | pages = 766–772 | date = July 1989 | pmid = 2570451 }}

As a medication before surgery, temazepam decreased cortisol in elderly patients.{{cite journal | vauthors = Salonen M, Kanto J, Hovi-Viander M, Irjala K, Viinamäki O | title = Oral temazepam as a premedicant in elderly general surgical patients | journal = Acta Anaesthesiologica Scandinavica | volume = 30 | issue = 8 | pages = 689–692 | date = November 1986 | pmid = 2880447 | doi = 10.1111/j.1399-6576.1986.tb02503.x | s2cid = 33526433 }} In rats, it triggered the release of vasopressin into paraventricular nucleus of the hypothalamus and decreased the release of ACTH under stress.{{cite journal | vauthors = Welt T, Engelmann M, Renner U, Erhardt A, Müller MB, Landgraf R, Holsboer F, Keck ME | title = Temazepam triggers the release of vasopressin into the rat hypothalamic paraventricular nucleus: novel insight into benzodiazepine action on hypothalamic-pituitary-adrenocortical system activity during stress | journal = Neuropsychopharmacology | volume = 31 | issue = 12 | pages = 2573–2579 | date = December 2006 | pmid = 16395302 | doi = 10.1038/sj.npp.1301006 | s2cid = 6197543 | doi-access = free }}

Oral administration of 15 to 45 mg of temazepam in humans resulted in rapid absorption with significant blood levels achieved in fewer than 30 minutes and peak levels at two to three hours.{{ cite web | url = http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20(General%20Monographs-%20R)/RESTORIL.html | title = RESTORIL® Novartis Temazepam Hypnotic | work = Pharmaceutical Information | publisher = RxMed }}

In a single- and multiple-dose absorption, distribution, metabolism, and excretion (ADME) study, using tritium-labelled drug, temazepam was well absorbed and found to have minimal (8%) first-pass drug metabolism. No active metabolites were formed and the only significant metabolite present in blood was the O-conjugate. The unchanged drug was 96% bound to plasma proteins. The blood-level decline of the parent drug was biphasic, with the short half-life ranging from 0.4 to 0.6 hours and the terminal half-life from 3.5 to 18.4 hours (mean 8.8 hours), depending on the study population and method of determination.{{cite journal | vauthors = Müller FO, Van Dyk M, Hundt HK, Joubert AL, Luus HG, Groenewoud G, Dunbar GC | title = Pharmacokinetics of temazepam after day-time and night-time oral administration | journal = European Journal of Clinical Pharmacology | volume = 33 | issue = 2 | pages = 211–214 | year = 1987 | pmid = 2891534 | doi = 10.1007/BF00544571 | s2cid = 22414521 }}

Temazepam has very good bioavailability, with almost 100% being absorbed following being taken by mouth. The drug is metabolized through conjugation and demethylation prior to excretion. Most of the drug is excreted in the urine, with about 20% appearing in the faeces. The major metabolite was the O-conjugate of temazepam (90%); the O-conjugate of N-desmethyl temazepam was a minor metabolite (7%).{{cite journal | vauthors = Schwarz HJ | title = Pharmacokinetics and metabolism of temazepam in man and several animal species | journal = British Journal of Clinical Pharmacology | volume = 8 | issue = 1 | pages = 23S–29S | date = 1 August 1979 | pmid = 41539 | pmc = 1429628 | doi = 10.1111/j.1365-2125.1979.tb00451.x }}

Temazepam is a benzodiazepine. It is a white, crystalline substance, very slightly soluble in water, and sparingly soluble in alcohol.

Pharmacologically active metabolite of diazepam, q.v.

File:Temazepam synthesis.svg).]]

N-oxides are prone to undergo the Polonovski rearrangement when treated with acetic anhydride, and this was illustrated by the synthesis of oxazepam. It is not surprising that the N-methyl analogue (1) also undergoes this process, and hydrolysis of the resulting acetate gives temazepam (2). Care must be exacted with the conditions, or the inactive rearrangement product (3) results.

Temazepam was synthesized in 1964, but it came into use in 1981 when its ability to counter insomnia was realized.{{cite journal | vauthors = Maggini C, Murri M, Sacchetti G | title = Evaluation of the effectiveness of temazepam on the insomnia of patients with neurosis and endogenous depression | journal = Arzneimittel-Forschung | volume = 19 | issue = 10 | pages = 1647–1652 | date = October 1969 | pmid = 4311716 }} By the late 1980s, temazepam was one of the most popular and widely prescribed{{citation needed|date=October 2016}} hypnotics on the market and it became one of the most widely prescribed drugs.{{citation needed|date=May 2023}}

{{See also|Benzodiazepine drug misuse}}

Temazepam is a drug with a high potential for misuse.{{cite journal | vauthors = Griffiths RR, Johnson MW | title = Relative abuse liability of hypnotic drugs: a conceptual framework and algorithm for differentiating among compounds | journal = The Journal of Clinical Psychiatry | volume = 66 | issue = Suppl 9 | pages = 31–41 | year = 2005 | pmid = 16336040 }}

Benzodiazepines have been abused orally and intravenously. Different benzodiazepines have different abuse potential; the more rapid the increase in the plasma level following ingestion, the greater the intoxicating effect and the more open to abuse the drug becomes. The speed of onset of action of a particular benzodiazepine correlates well with the 'popularity' of that drug for abuse. The two most common reasons for preference were that a benzodiazepine was 'strong' and that it gave a good 'high'.

A 1995 study found that temazepam is more rapidly absorbed and oxazepam is more slowly absorbed than most other benzodiazepines.

A 1985 study found that temazepam and triazolam maintained significantly higher rates of self-injection than a variety of other benzodiazepines. The study tested and compared the abuse liability of temazepam, triazolam, diazepam, lorazepam, oxazepam, flurazepam, alprazolam, chlordiazepoxide, clonazepam, nitrazepam, flunitrazepam, bromazepam, and clorazepate. The study tested self-injection rates on human, baboon, and rat subjects. All test subjects consistently showed a strong preference for temazepam and triazolam over all the rest of the benzodiazepines included in the study.

In North America, temazepam misuse is not widespread. Other benzodiazepines are more commonly prescribed for insomnia. In the United States, temazepam is the fifth-most prescribed benzodiazepine, however there is a major drop off from the top four most prescribed (alprazolam, lorazepam, diazepam, and clonazepam in that order). Individuals abusing benzodiazepines obtain the drug by getting prescriptions from several doctors, forging prescriptions, or buying diverted pharmaceutical products on the illicit market.{{cite web|url=https://www.deadiversion.usdoj.gov/|title=DEA Diversion Control Division|website=www.deadiversion.usdoj.gov}} North America has never had a serious problem with temazepam misuse, but is becoming increasingly vulnerable to the illicit trade of temazepam.Bureau for International Narcotics and Law Enforcement Affairs (BINLEA), 2006.

File:Temazepam Australia.jpg

Temazepam is a Schedule 4 drug and requires a prescription. The drug accounts for most benzodiazepine sought by forgery of prescriptions and through pharmacy burglary in Victoria.{{cite web |title= Injecting Temazepam: The facts — Temazepam Injection and Diversion |url= http://www.health.vic.gov.au/drugservices/pubs/temazepam/facts.htm |date= 29 March 2007 |publisher= Victorian Government Health Information |access-date= 25 November 2007 |url-status= dead |archive-url= https://web.archive.org/web/20080107121907/http://www.health.vic.gov.au/drugservices/pubs/temazepam/facts.htm |archive-date= 7 January 2008 }} Due to rife intravenous abuse, the Australian government decided to put it under a more restrictive schedule than it had been,{{cite web |title= Access to sedative drug restricted |url=http://www.encyclopedia.com/doc/1P1-49479424.html |date= 13 January 2002 |publisher=AAP General News (Australia) |access-date=18 February 2008}} and since March 2004 temazepam capsules have been withdrawn from the Australian market, leaving only 10 mg tablets available.{{cite journal | vauthors = Wilce H |title=Temazepam capsules: What was the problem? |date=June 2004 |journal=Australian Prescriber |volume=27 |pages=58–9 |issue=3 |doi=10.18773/austprescr.2004.053 |doi-access=free }}{{cite web |author=Australian Institute of Criminology |title=Benzodiazepine use and harms among police detainees in Australia |url=http://www.aic.gov.au/publications/tandi2/tandi336.pdf |publisher=Australian Government |date=May 2007 |access-date=20 November 2007 |archive-date=3 March 2016 |archive-url=https://web.archive.org/web/20160303230639/http://www.aic.gov.au/publications/tandi2/tandi336.pdf |url-status=dead }}

Benzodiazepines are commonly detected by customs at different ports and airports, arriving by mail, also found occasionally in the baggage of air passengers, mostly small or medium quantities (up to 200–300 tablets) for personal use. From 2003 to 2006, customs detected about 500 illegal importations of benzodiazepines per year, most frequently diazepam. Quantities varied from single tablets to 2,000 tablets.{{ cite journal | vauthors = Mouzos J, Smith L , Hind N | year = 2006 | title = Drug Use Monitoring in Australia (DUMA): 2005 annual report on drug use among police detainees | journal = Research and Public Policy Series | volume = 70 }}{{ cite book | vauthors = Stafford J, Degenhardt L, Black E, Bruno R, Buckingham K, Fetherston J, Jenkinson R, Kinner S, Newman J, Weekley J | year = 2006 | title = Australian drug trends 2005: Findings from the Illicit Drug Reporting System (IDRS) | publisher = National Drug and Alcohol Research Centre, Sydney }}

In 1987, temazepam was the most widely abused legal prescription drug in the United Kingdom. The use of benzodiazepines by street-drug abusers was part of a polydrug abuse pattern, but many of those entering treatment facilities were declaring temazepam as their main drug of abuse. Temazepam was the most commonly used benzodiazepine in a study, published 1994, of injecting drug users in seven cities, and had been injected from preparations of capsules, tablets, and syrup.{{cite book | vauthors = Ashton H |title=Drugs and Dependence |chapter= Benzodiazepine Abuse |chapter-url=http://www.benzo.org.uk/ashbzab.htm |year=2002 |publisher=Harwood Academic Publishers |location=London & New York }} The increase in use of heroin, often mixed with other drugs, which most often included temazepam, diazepam, and alcohol, was a major factor in the increase in drug-related deaths in Glasgow and Edinburgh in 1990–1992.{{cite journal | vauthors = Hammersley R, Cassidy MT, Oliver J | title = Drugs associated with drug-related deaths in Edinburgh and Glasgow, November 1990 to October 1992 | journal = Addiction | volume = 90 | issue = 7 | pages = 959–965 | date = July 1995 | pmid = 7663317 | doi = 10.1046/j.1360-0443.1995.9079598.x }} Temazepam use was particularly associated with violent or disorderly behaviours and contact with the police in a 1997 study of young single homeless people in Scotland.{{cite journal | vauthors = Hammersley R, Pearl S |title=Temazepam Misuse, Violence and Disorder |journal=Addict Res Theory |volume=5 |issue=3 |pages=213–22 |year=1997 |doi= 10.3109/16066359709005262 }} The BBC series Panorama featured an episode titled "Temazepam Wars", dealing with the epidemic of temazepam abuse and directly related crime in Paisley, Scotland. The trend was mocked in the 1995 Black Grape song "Temazi Party" (also called "Tramazi Party").{{cite web|url=https://www.nme.com/news/music/black-grape-5-1217283|title=Reunited Black Grape perform hits for Bez's election campaign in Manchester | NME|website=NME |date=12 April 2015}}{{cite book|url=https://books.google.com/books?id=6DXYAAAAMAAJ&q=%22Tramazi+Party%22|title=Manchester, England: The Story of the Pop Cult City| vauthors = Dave H |date=27 August 2000|publisher=Fourth Estate|isbn=9781841151465|via=Google Books}}{{cite book|url=https://books.google.com/books?id=DPONG6wSk_EC&q=%22Tramazi+Party%22|title=The Wee Rock Discography| vauthors = Strong M |date=27 August 1996|publisher=Canongate|isbn=9780862416218|via=Google Books}}

The Journal of Clinical Sleep Medicine published a paper expressing concerns about benzodiazepine receptor agonist drugs, the benzodiazepines and the Z-drugs used as hypnotics in humans. The paper cites a systematic review of the medical literature concerning insomnia medications and states almost all trials of sleep disorders and drugs are sponsored by the pharmaceutical industry, while this is not the case in general medicine or psychiatry. It cites another study that "found that the odds ratio for finding results favorable to industry in industry-sponsored trials was 3.6 times as high as in non–industry-sponsored studies". Issues discussed regarding industry-sponsored studies include: comparison of a drug to a placebo, but not to an alternative treatment; unpublished studies with unfavorable outcomes; and trials organized around a placebo baseline followed by drug treatment, but not counterbalanced with parallel-placebo-controlled studies. Quoting a 1979 report that too little research into hypnotics was independent of the drug manufacturers, the authors conclude, "the public desperately needs an equipoised assessment of hypnotic benefits and risks" and the NIH and VA should provide leadership to that end.{{cite journal | vauthors = Kripke DF | title = Who should sponsor sleep disorders pharmaceutical trials? | journal = Journal of Clinical Sleep Medicine | volume = 3 | issue = 7 | pages = 671–673 | date = December 2007 | pmid = 18198797 | pmc = 2556906 | doi = 10.5664/jcsm.27020 | quote = NIH or VA sponsorship of major hypnotic trials is needed to more carefully study potential adverse effects of hypnotics such as daytime impairment, infection, cancer, and death and the resultant balance of benefits and risks. }}

Street terms for temazepam include king kong pills (formerly referred to barbiturates, now more commonly refers to temazepam), jellies, jelly, Edinburgh {{Not a typo|eccies}}, tams, terms, {{Not a typo|mazzies}}, {{Not a typo|temazies}}, {{Not a typo|tammies}}, {{Not a typo|temmies}}, beans, eggs, green eggs, wobbly eggs, knockouts, hardball, {{Not a typo|norries}}, oranges (common term in Australia and New Zealand), rugby balls, {{Not a typo|ruggers}}, terminators, red and blue, no-gos, {{Not a typo|num nums}}, blackout, green devils, drunk pills, brainwash, mind erasers, {{Not a typo|neurotrashers}}, {{Not a typo|tem-tems}} (combined with buprenorphine), mommy's big helper, vitamin T, big T, TZ, the {{Not a typo|mazepam}}, {{Not a typo|resties}} (North America) and others.{{cite web|url=http://www.dan247.org.uk/Drug_Print.asp?Drug=Temazepam|title=DAN 24/7: Temazepam|website=www.dan247.org.uk|access-date=4 July 2018|archive-date=5 July 2018|archive-url=https://web.archive.org/web/20180705003249/http://www.dan247.org.uk/Drug_Print.asp?Drug=Temazepam|url-status=dead}}{{cite web |title=Erowid Drug Street Terms |url=http://www.erowid.org/psychoactives/slang/|work=Erowid}}

In Austria, temazepam is listed in UN71 Schedule III under the Psychotropic Substances Decree of 1997. The drug is considered to have a high potential for abuse and addiction, but has accepted medical use for the treatment of severe insomnia.

In Australia, temazepam is a Schedule 4 - Prescription Only medicine.{{cite web | url = http://www.comlaw.gov.au/Details/F2015L00128 | format = pdf | title = Poisons Standard 2015 | date = 5 February 2015 | publisher = Therapeutic Goods Administration | access-date = 13 May 2015 | page = 121 }} It is primarily used for the treatment of insomnia, and is also seen as pre-anaesthetic medication.

In Canada, temazepam is a Schedule IV controlled substance requiring a registered doctor's prescription.{{cite web|title=Controlled Drugs and Substance Act - Schedule IV|url=http://laws-lois.justice.gc.ca/eng/acts/C-38.8/page-27.html#h-31|publisher=Government of Canada|access-date=3 November 2013|archive-url=https://web.archive.org/web/20131104174934/http://laws-lois.justice.gc.ca/eng/acts/C-38.8/page-27.html#h-31|archive-date=4 November 2013|url-status=dead}}

In Denmark, temazepam is listed as a Class D substance under the Executive Order 698 of 1993 on Euphoric Substances which means it has a high potential for abuse, but is used for medical and scientific purposes.{{cite web|title=Classification of controlled drugs|url=http://www.emcdda.europa.eu/html.cfm/index146601EN.html|publisher=The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)|access-date=20 September 2012}}

In Finland, temazepam is more tightly controlled than other benzodiazepines. The temazepam product Normison was pulled out of shelves and banned because the liquid inside gelatin capsules had caused a large increase in intravenous temazepam use. The other temazepam product, Tenox, was not affected and remains as prescription medicine. Temazepam intravenous use has not decreased to the level before Normison came to the market.

In France, temazepam is listed as a psychotropic substance as are other similar drugs. It is prescribed with a nonrenewable prescription (a new doctor visit every time), available only in 7 or 14-pill packaging for one or two weeks.{{cite web|title=Classification of controlled drugs|url=http://www.emcdda.europa.eu/html.cfm/index146601EN.html|publisher=EMCDDA|access-date=3 November 2013}} One brand was withdrawn from the market in 2013 due to rampant abuse.{{cite web |url=https://eurekasante.vidal.fr/medicaments/vidal-famille/medicament-onormi01-NORMISON.html |title=NORMISON - EurekaSanté par VIDAL |access-date=25 May 2020 |archive-date=23 September 2020 |archive-url=https://web.archive.org/web/20200923010903/https://eurekasante.vidal.fr/medicaments/vidal-famille/medicament-onormi01-NORMISON.html |url-status=dead }}

In Hong Kong, temazepam is regulated under Schedule 1 of Hong Kong's Chapter 134 Dangerous Drugs Ordinance. Temazepam can only be used legally by health professionals and for university research purposes. The substance can be given by pharmacists under a prescription. Anyone who supplies the substance without prescription can be fined HKD$10,000. The penalty for trafficking or manufacturing the substance is a $5,000,000-fine and life imprisonment. Possession of the substance for consumption without license from the Department of Health is illegal with a $1,000,000-fine and/or seven years of jail time.{{cite web |title=Bilingual Laws Information System |url=http://www.legislation.gov.hk/eng/index.htm |format=English |publisher=The Government of the Hong Kong Special Administrative Region of the People's Republic of China}}

In Ireland, temazepam is a Schedule 3 controlled substance with strict restrictions.{{cite web |title=Misuse Of Drugs (Amendment) Regulations |year=1993 |url=http://www.irishstatutebook.ie/1993/en/si/0342.html |work=Irish Statute Book |publisher=Office of the Attorney General}}

In the Netherlands, temazepam is available for prescription as 10- or 20-mg tablets and capsules. Formulations of temazepam containing less than 20 mg are included in List 2 of the Opium Law, while formulations containing 20 mg or more of the drug (along with the gel-capsules) are a List 1 substance of the Opium Law, thus subject to more stringent regulation. Besides being used for insomnia, it is also occasionally used as a preanesthetic medication.

In Norway, temazepam is not available as a prescription drug. It is regulated as a Class A substance under Norway's Narcotics Act.

In Portugal, temazepam is a Schedule IV controlled drug under Decree-Law 15/93.{{cite web |url=http://www.infarmed.pt/portal/page/portal/INFARMED/LEGISLACAO/LEGISLACAO_FARMACEUTICA_COMPILADA/TITULO_III/TITULO_III_CAPITULO_III/068-DL_15_93_VF.pdf |title=Decreto-Lei n.º 15/93, de 22 de Janeiro: Regime jurídico do tráfico e consumo de estupefacientes e psicotrópicos |language=pt |publisher=Infarmed |access-date=29 September 2009}}

In Slovenia, it is regulated as a Group II (Schedule 2) controlled substance under the Production and Trade in Illicit Drugs Act.

In South Africa, temazepam is a Schedule 5 drug, requiring a special prescription, and is restricted to 10– to 30-mg doses.{{cite web |url=http://www.health24.com/Medical/Meds-and-you/Medication/Temazepam-Client-20120721 |title=Temazepam | Health24 |access-date=22 March 2015 |archive-url=https://web.archive.org/web/20170324222845/http://www.health24.com/Medical/Meds-and-you/Medication/Temazepam-Client-20120721 |archive-date=24 March 2017 |url-status=dead }}

In Sweden, temazepam is classed as a "narcotic" drug listed as both a List II (Schedule II) which denotes it is a drug with limited medicinal use and a high risk of addiction, and is also listed as a List V (Schedule V) substance which denotes the drug is prohibited in Sweden under the Narcotics Drugs Act (1968).{{cite web|url=https://lakemedelsverket.se/malgrupp/Halso---sjukvard/Forskrivning/Narkotikaklassade-lakemedel/|title=Narkotiska läkemedel - Läkemedelsverket / Swedish Medical Products Agency|website=lakemedelsverket.se|access-date=3 January 2019|archive-date=3 January 2019|archive-url=https://web.archive.org/web/20190103210937/https://lakemedelsverket.se/malgrupp/Halso---sjukvard/Forskrivning/Narkotikaklassade-lakemedel/|url-status=dead}} Temazepam is banned in Sweden and possession and distribution of even small amounts is punishable by a prison sentence and a fine. Temazepam found in Sweden is usually trafficked from Finland

In Switzerland, temazepam is a Class B controlled substance, like all other benzodiazepines. This means it is a prescription-only drug.{{cite web|url=http://www.swissmedic.ch/produktbereiche/00447/00536/index.html?lang=de&download=NHzLpZeg7t,lnp6I0NTU042l2Z6ln1acy4Zn4Z2qZpnO2Yuq2Z6gpJCDdH1,fWym162epYbg2c_JjKbNoKSn6A--|title=Verzeichnis aller zugelassenen betäubungsmittelhaltigen Präparate im Schweizer Handel Indice de tous les stupéfiants autorisés sur le marché suisse Stand/Etat 01.07.2011|access-date=27 July 2011|archive-url=https://web.archive.org/web/20120219232355/http://www.swissmedic.ch/produktbereiche/00447/00536/index.html?lang=de&download=NHzLpZeg7t,lnp6I0NTU042l2Z6ln1acy4Zn4Z2qZpnO2Yuq2Z6gpJCDdH1,fWym162epYbg2c_JjKbNoKSn6A--|archive-date=19 February 2012|url-status=dead}}

In the United Kingdom, temazepam is a Class C controlled drug under the Misuse of Drugs Act 1971 (Schedule 3 under the Misuse of Drugs Regulations 2001).{{cite web | author = Blackpool NHS Primary Care Trust | title = Medicines Management Update | url = http://www.blackpool.nhs.uk/images/uploads/CD-update-GP-v2-may08.pdf | publisher = National Health Service | location = United Kingdom | year = 2007 | url-status = dead | archive-url = https://web.archive.org/web/20101204070730/http://www.blackpool.nhs.uk/images/uploads/CD-update-GP-v2-may08.pdf | archive-date = 4 December 2010 }}{{cite web |url=http://www.homeoffice.gov.uk/documents/cdlist.pdf?view=Binary |format=PDF |title=List of drugs currently controlled under the misuse of drugs legislation |date=28 January 2009 |access-date=27 May 2009 |publisher=UK Government Home Office |url-status=dead |archive-url=https://web.archive.org/web/20070205105239/http://www.homeoffice.gov.uk/documents/cdlist.pdf?view=Binary |archive-date=5 February 2007 }} If prescribed privately (not on the NHS), temazepam is available only by a special controlled drug prescription form (FP10PCD) and pharmacies are obligated to follow special procedures for storage and dispensing.{{cite web|url=https://patient.info/doctor/controlled-drugs|archive-url=https://archive.today/20120909075750/http://www.patient.co.uk/print/234|url-status=dead|title=Controlled Drugs. Information about Controlled Drugs. Patient|website=patient.info|archive-date=9 September 2012|access-date=27 August 2020}}

In the United States, Temazepam is a Schedule IV drug under the international Convention on Psychotropic Substances of 1971 and is only available by prescription.{{cite web|url=http://www.incb.org/pdf/e/list/Green_list_ENG_2010_53991.pdf|title=Green List—List of psychotropic substances under international control|date=May 2010|publisher=International Narcotics Control Board|access-date=12 September 2011|edition=24th|archive-url=https://web.archive.org/web/20110813065659/http://www.incb.org/pdf/e/list/Green_list_ENG_2010_53991.pdf|archive-date=13 August 2011|url-status=dead}}

{{unreferenced section|date=January 2024}}

Temazepam is available in English-speaking countries under the brand names Euhypnos, Normison, Norkotral, Nortem, Remestan, Restoril, Temaze, and Temtabs.

In Hungary the drug is sold as Signopam.

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