Flurazepam

INTRODUCTION

Indications

Short-term management of insomnia (<4 wk).

Action

Depresses the CNS, probably by potentiating gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter. Therapeutic Effects: Relief of insomnia.

Adverse Reactions/Side Effects

CNS: abnormal thinking, behavior changes, confusion, daytime drowsiness, decreased concentration, dizziness, hallucinations, headache, lethargy, mental depression, paradoxical excitation, sleep-driving. EENT: blurred vision. GI: constipation, diarrhea, nausea, vomiting. Derm: rashes. Neuro: ataxia. Misc: physical dependence, psychologic dependence, tolerance.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor daytime drowsiness, short-term memory deficits, and "hangover" symptoms (headache, nausea, malaise, irritability, dysphoria). Repeated or excessive symptoms may require change in dose or medication.

• Assess dizziness or ataxia that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Report any behavioral or personality changes such as depression, confusion, decreased concentration, nervousness, excitation, hallucinations, or expression of abnormal thoughts.

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth). Implement fall- prevention strategies, especially in older adults or if drowsiness and dizziness carry over into the daytime (See Appendix E).

• Help patient explore nonpharmacologic methods to improve sleep, such as relaxation techniques, regular exercise, avoid caffeine, and so forth.

Patient/Client-Related Instruction

• Instruct patients on prolonged treatment not to discontinue medication without consulting their physician. Long-term use can cause tolerance and physical/psychologic dependence, and increased sleep problems (rebound insomnia) can occur when the drug is suddenly discontinued.

• Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

• Caution patient and family/caregivers to guard against complex motor behaviors that can occur while asleep, including driving a car.

• Instruct patient to report other bothersome side effects including severe or prolonged headache, blurred vision, skin rash, or GI problems (nausea, vomiting, constipation, diarrhea).

Pharmacokinetics

Absorption: Well absorbed after oral administration.

Distribution: Widely distributed; crosses blood-brain barrier. Probably crosses the placenta and enters breast milk. Accumulation of drug occurs with chronic dosing.

Protein Binding: 97% (one of the active metabolites).

Metabolism and Excretion: Metabolized by the liver; some metabolites have hypnotic activity.

Half-life: 2.3 hr (half-life of active metabolite may be 30–200 hr).

Contraindications/Precautions

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