277. Flurazepam Uses: 🔹 Insomnia (Short-Term Treatment): Reduces sleep latency and increases total sleep duration. 🔹 Nighttime Anxiety & Agitation: Occasionally used for severe nocturnal anxiety. 🔹 Preoperative Sedation: Used as a premedication before procedures. 🔹 Muscle Relaxation: Provides mild muscle relaxation due to CNS depressant effects. 🔹 Alcohol Withdrawal Management: Used in benzodiazepine tapering protocols (not first-line). 🔹 Adjunct in Psychiatric Disorders: Prescribed for severe anxiety-related sleep disturbances. Presentation: 🔹 Enteral (Oral): 15 mg and 30 mg capsules. Dose: 🔹 Adult Dose: 15-30 mg orally at bedtime, short-term use recommended (≤2-4 weeks). 🔹 Geriatric Dose: Start at 15 mg, use the lowest effective dose due to fall risk. 🔹 Pediatric Dose: Not recommended due to high risk of adverse effects. 🔹 Special Populations: • Hepatic Impairment: Start with 15 mg due to prolonged metabolism. • Renal Impairment: No specific adjustment, but caution advised. • Severe Respiratory Disease: Contraindicated due to respiratory depression risk. 🔹 Administration Considerations: Take at bedtime; avoid alcohol and CNS depressants. Notes: 🔹 Pharmacology & Mechanism: • Enhances GABA-A receptor activity, increasing chloride influx → neuronal inhibition. • Long half-life due to active metabolite (N-desalkylflurazepam, 40-250 hours). 🔹 Adverse Effects: • Common: Daytime drowsiness, cognitive impairment, dizziness, muscle weakness. • Severe: Respiratory depression (high-risk in COPD, sleep apnea, opioid co-use), paradoxical reactions, withdrawal symptoms. 🔹 Contraindications: • Absolute: Severe respiratory insufficiency, hepatic impairment, myasthenia gravis, pregnancy (Category X), breastfeeding. • Relative: Elderly, history of drug dependence, depression, renal impairment, CNS depressant use. 🔹 Drug Interactions: • Enhanced sedation with opioids, alcohol, antihistamines, and antipsychotics. • CYP3A4 inhibitors (ketoconazole, macrolides) prolong sedation; CYP3A4 inducers (rifampin, carbamazepine) reduce efficacy. 🔹 Monitoring: • Assess hepatic function before initiation. • Monitor for excessive sedation, cognitive decline, and dependence. • Taper gradually if discontinuing after prolonged use. 🔹 Reversal: Flumazenil reverses effects in overdose. References: 🔹 Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 13th Edition. 🔹 Stoelting RK, Pharmacology & Physiology in Anesthetic Practice, 5th Edition. 🔹 Miller’s Anesthesia, 9th Edition. 🔠🔠.🔠🔠🔠 🔠🔠🔠🔠_🔠🔠🔠🔠 Download ‘Dr. Med - Made Easy’ for comprehensive drug information and dose calculation😇 🔗 Android 🔗 iPhone
18
9
