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tranquilizer (trade name Dalmane) used to treat insomnia (同)flurazepam_hydrochloride, Dalmane

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/10/25 18:14:39」(JST)

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Flurazepam^[1] (marketed under the brand names Dalmane and Dalmadorm) is a drug which is a benzodiazepine derivative. It possesses anxiolytic, anticonvulsant, sedative and skeletal muscle relaxant properties. It produces a metabolite with a very long half-life (40–250 hours), which may stay in the bloodstream for up to four days.^[2]^{[unreliable source?]} Flurazepam is therefore unsuitable as a sleeping medication for some individuals due to next-day sedation; however, this same effect may also provide next-day anxiety relief. For this reason it is sometimes utilized to treat anxiety-induced insomnia on the night before dental visits and other medical procedures, patients are usually instructed to have someone to drive them to and from the appointment when using flurazepam in this context.

Flurazepam was initially patented in 1963 and went on sale in the United States in 1970.^[3]

Medical uses

Flurazepam is officially indicated for mild to moderate insomnia and as such it is used for short-term treatment of patients with mild to moderate insomnia such as difficulty falling asleep, frequent awakening, early awakenings or a combination of each. Flurazepam is a long-acting benzodiazepine and is sometimes used in patients who have difficulty in maintaining sleep. Intermediate half-life benzodiazepines are also useful for patients with difficulty in maintaining sleep (e.g. loprazolam, lormetazepam, temazepam). Hypnotics should only be used on a short term basis or in those with chronic insomnia on an occasional basis.^[4]

Side effects

The most common adverse effects are dizziness, drowsiness, light-headedness, and ataxia. Flurazepam has abuse potential and should never be used with alcoholic beverages or any other substance that can cause drowsiness. Addictive and possibly fatal results may occur. Flurazepam users should only take this drug strictly as prescribed, and should only be taken directly before the user plans on sleeping a full night. Next day drowsiness is common and may increase during the initial phase of treatment as accumulation occurs until steady-state plasma levels are attained.

Tolerance, dependence and withdrawal

A review paper found that long term use of flurazepam is associated with drug tolerance, drug dependence, rebound insomnia and CNS related adverse effects. Flurazepam is best used for a short time period and at the lowest possible dose to avoid complications associated with long term use. Non-pharmacological treatment options however, were found to have sustained improvements in sleep quality.^[5] Flurazepam and other benzodiazepines such as fosazepam, and nitrazepam lost some of their effect after seven days administration in psychogeriatric patients.^[6] Flurazepam shares cross tolerance with barbiturates and barbiturates can easily be substituted by flurazepam in those who are habituated to barbiturate sedative hypnotics.^[7]

After discontinuation of flurazepam a rebound effect or benzodiazepine withdrawal syndrome may occur about four days after discontinuation of medication.^[8]

Contraindications and special caution

Benzodiazepines require special precaution if used in the elderly, during pregnancy, in children, alcohol- or drug-dependent individuals and individuals with comorbid psychiatric disorders.^[9]

Elderly

Flurazepam, 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.^[10] An extensive review of the medical literature regarding the management of insomnia and the elderly found that there is considerable evidence of the effectiveness and durability of non-drug treatments for insomnia in adults of all ages and that these interventions are underutilized. Compared with the benzodiazepines including flurazepam, the nonbenzodiazepine sedative-hypnotics appeared to offer few, if any, significant clinical advantages in efficacy in elderly persons. Tolerability in elderly patients, however, is improved marginally in that benzodiazepines have moderately higher risks of falls, memory problems, and disinhibition ("Paradoxical agitation") when compared to non-benzodiazepine sedatives. It was found that newer agents with novel mechanisms of action and improved safety profiles, such as the melatonin agonists, hold promise for the management of chronic insomnia in elderly people. Chronic use of sedative-hypnotic drugs for the management of insomnia does not have an evidence base and has been discouraged due to concerns including potential adverse drug effects as cognitive impairment (anterograde amnesia), daytime sedation, motor incoordination, and increased risk of motor vehicle accidents and falls. In addition, the effectiveness and safety of long-term use of sedative hypnotics has been determined to be no better than placebo after 3 months of therapy and worse than placebo after 6 months of therapy. (NEJM, 1983, 1994, et seq.)^[11]

Pharmacology

Flurazepam is a "classical" benzodiazepine; some other classical benzodiazepines include diazepam, clonazepam, oxazepam, lorazepam, nitrazepam, bromazepam, and clorazepate.^[12] Flurazepam generates an active metabolite with a very long elimination half-life of 40–250 hours.^[2]^{[unreliable source?]} Residual 'hangover' effects after nighttime administration of flurazepam, such as sleepiness, impaired psychomotor and cognitive functions, may persist into the next day, which may impair the ability of users to drive safely and increase risks of falls and hip fractures.^[13]

Flurazepam is lipophilic, is metabolized hepatically via oxidative pathways. The main pharmacological effect of flurazepam is to increase the effect of GABA at the GABA_A receptor via binding to the benzodiazepine site on the GABA_A receptor causing an increase influx of chloride ions into the GABA_A neuron.^[14]^[15] Flurazepam is a unique benzodiazepine in that it is a partial agonist of benzodiazepine receptors whereas other benzodiazepines are full agonists of benzodiazepine receptors.^[16]

Flurazepam is contraindicated in pregnancy. It is recommended to withdraw flurazepam during breast feeding, as flurazepam is excreted in breast milk.^[17]

Society and culture

Drug misuse

Flurazepam is a drug with potential for misuse. Two types of drug misuse can occur, either recreational misuse where the drug is taken to achieve a high, or when the drug is continued long term against medical advice.^[18]

Legal status

Flurazepam is a Schedule IV drug under the Convention on Psychotropic Substances.^[19]

References

^ BE 629005
^ ^a ^b "Benzodiazepine Equivalents Table – A list of Equivalent Doses of Benzodiazepines". Non-benzodiazepines.org.uk. Retrieved 2015-05-05.
^ Shorter, Edward (2005). "B". A Historical Dictionary of Psychiatry. Oxford University Press. ISBN 978-0-19-029201-0.
^ Rickels K. (1986). "The clinical use of hypnotics: indications for use and the need for a variety of hypnotics". Acta Psychiatrica Scandinavica Suppl. 74 (S332): 132–41. doi:10.1111/j.1600-0447.1986.tb08990.x. PMID 2883820.
^ Kirkwood CK (1999). "Management of insomnia". J Am Pharm Assoc (Wash) 39 (5): 688–96; quiz 713–4. PMID 10533351.
^ Viukari M; Linnoila M; Aalto U. (January 1978). "Efficacy and side effects of flurazepam, fosazepam, and nitrazepam as sleeping aids in psychogeriatric patients". Acta Psychiatrica Scandinavica 57 (1): 27–35. doi:10.1111/j.1600-0447.1978.tb06871.x. PMID 24980.
^ Rooke KC. (1976). "The use of flurazepam (dalmane) as a substitute for barbiturates and methaqualone/diphenhydramine (mandrax) in general practice". J Int Med Res. 4 (5): 355–9. doi:10.1177/030006057600400510. PMID 18375.
^ Hindmarch I. (November 1977). "A repeated dose comparison of three benzodiazepine derivative (nitrazepam, flurazepam and flunitrazepam) on subjective appraisals of sleep and measures of psychomotor performance the morning following night-time medication". Acta Psychiatrica Scandinavica 56 (5): 373–81. doi:10.1111/j.1600-0447.1977.tb06678.x. PMID 22990.
^ Authier, N.; Balayssac, D.; Sautereau, M.; Zangarelli, A.; Courty, P.; Somogyi, AA.; Vennat, B.; Llorca, PM.; Eschalier, A. (November 2009). "Benzodiazepine dependence: focus on withdrawal syndrome". Ann Pharm Fr 67 (6): 408–13. doi:10.1016/j.pharma.2009.07.001. PMID 19900604.
^ Mets, MA.; Volkerts, ER.; Olivier, B.; Verster, JC. (Feb 2010). "Effect of hypnotic drugs on body balance and standing steadiness.". Sleep Med Rev 14 (4): 259–67. doi:10.1016/j.smrv.2009.10.008. PMID 20171127.
^ Bain KT (June 2006). "Management of chronic insomnia in elderly persons". Am J Geriatr Pharmacother 4 (2): 168–92. doi:10.1016/j.amjopharm.2006.06.006. PMID 16860264.
^ Braestrup C; Squires RF. (1 April 1978). "Pharmacological characterization of benzodiazepine receptors in the brain". Eur J Pharmacol 48 (3): 263–70. doi:10.1016/0014-2999(78)90085-7. PMID 639854.
^ Vermeeren A. (2004). "Residual effects of hypnotics: epidemiology and clinical implications". CNS Drugs. 18 (5): 297–328. doi:10.2165/00023210-200418050-00003. PMID 15089115.
^ Oelschläger H. (July 4, 1989). "[Chemical and pharmacologic aspects of benzodiazepines]". Schweiz Rundsch Med Prax. 78 (27–28): 766–72. PMID 2570451.
^ Lehoullier PF, Ticku MK (March 1987). "Benzodiazepine and beta-carboline modulation of GABA-stimulated 36Cl-influx in cultured spinal cord neurons". Eur. J. Pharmacol. 135 (2): 235–8. doi:10.1016/0014-2999(87)90617-0. PMID 3034628.
^ Chan CY; Farb DH (1 September 1985). "Modulation of neurotransmitter action: control of the gamma-aminobutyric acid response through the benzodiazepine receptor" (PDF). J Neurosci 5 (9): 2365–73. PMID 2863335.
^ Olive G; Dreux C. (January 1977). "Pharmacologic bases of use of benzodiazepines in peréinatal medicine". Arch Fr Pediatr. 34 (1): 74–89. PMID 851373.
^ Griffiths RR, Johnson MW (2005). "Relative abuse liability of hypnotic drugs: a conceptual framework and algorithm for differentiating among compounds". J Clin Psychiatry. 66 Suppl 9: 31–41. PMID 16336040.
^ [1]^{[dead link]}

External links

Rx-List – Flurazepam
Inchem – Flurazepam

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 不眠症の治療 treatment of insomnia
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English Journal

Comparison of LC-MS-MS and GC-MS Analysis of Benzodiazepine Compounds Included in the Drug Demand Reduction Urinalysis Program.

Perez ER1, Knapp JA1, Horn CK1, Stillman SL1, Evans JE1, Arfsten DP2.
Journal of analytical toxicology.J Anal Toxicol.2016 Apr;40(3):201-7. doi: 10.1093/jat/bkv140. Epub 2016 Jan 10.
Liquid chromatography-tandem mass spectrometry (LC-MS-MS) offers specific advantages over gas chromatography-mass spectrometry (GC-MS) such as the ability to identify and measure a broader range of compounds with minimal sample preparation. Comparative analysis of LC-MS-MS versus GC-MS was performed
PMID 26755538

Emerging role of orexin antagonists in insomnia therapeutics: An update on SORAs and DORAs.

Kumar A1, Chanana P2, Choudhary S2.
Pharmacological reports : PR.Pharmacol Rep.2016 Apr;68(2):231-42. doi: 10.1016/j.pharep.2015.09.002. Epub 2015 Sep 28.
The pharmacological management of insomnia has lately become a challenge for researchers worldwide. As per the third International Classification of Sleep disorders (ICSD-3) insomnia can be defined as a state with repeated difficulty in sleep initiation, duration, consolidation, or quality that occu
PMID 26922522

Activation-induced regulation of GABAA receptors: Is there a link with the molecular basis of benzodiazepine tolerance?

Gravielle MC1.
Pharmacological research.Pharmacol Res.2015 Dec 28. pii: S1043-6618(15)00295-9. doi: 10.1016/j.phrs.2015.12.030. [Epub ahead of print]
Benzodiazepines have been used clinically for more than 50 years to treat disorders such as insomnia, anxiety, and epilepsy, as well as to aid muscle relaxation and anesthesia. The therapeutic index for benzodiazepines if very high and the toxicity is low. However, their usefulness is limited by the
PMID 26733466

Japanese Journal

Effect of Phosphatidylserine Content on the Partition Coefficients of Diazepam and Flurazepam between Phosphatidylcholine-Phosphatidylserine Bilayer of Small Unilamellar Vesicles and Water Studied by Second Derivative Spectrophotometry

, , [他], , , ,
Chemical & pharmaceutical bulletin 50(3), 312-315, 2002-03-01
… The affinity of the psychotropic benzodiazepine drugs diazepam (DZ) and flurazepam (FZ) to phosphatidylserine (PS) was examined since PS is abundantly contained in brain membranes. …
NAID 110003616148

直浸固相ミクロ抽出/ガスクロマトグラフィーによる尿中ベンゾジアゼピン系薬剤の検出

Seno Hiroshi,Kumazawa Takeshi,Ishii Akira,Watanabe Kanako,Hattori Hideki,Suzuki Osamu
1997-01-31
… Medazepam, fludiazepam, diazepam, midazolam, flunitrazepam, prazepam, nimetazepam and flurazepam could be extracted under the present DI-SPME conditions, and their recoveries were 1.55-17.0%. … those for medazepam, fludiazepam, diazepam, midazolam, flunitrazepam, prazepam and flurazepam were 10-20 ng/ml.rights:日本法中毒学会rights:本文データは日本法中毒学会の許諾のもと掲載しています。 …
NAID 120005314025

Large-volume sample stacking of selected drugs of forensic significance by capillary electrophoresis

MCGRATH G.,SMYTH W. F.
Journal of chromatography. B, Biomedical applications 681(1), 125-131, 1996-05-31
NAID 10024555511

Related Pictures

★リンクテーブル★

リンク元	「フルラゼパム」
拡張検索	「flurazepam hydrochloride」

「フルラゼパム」

Flurazepam
Systematic (IUPAC) name
	7-Chloro-1-[2-(diethylamino)ethyl]-5-(2-fluorophenyl)-1,3-dihydro-2H-1,4-benzodiazepin-2-one
Clinical data
Trade names	Dalmane
AHFS/Drugs.com	monograph
MedlinePlus	a682051
Pregnancy; category	X (Contraindicated in pregnancy);
Legal status	DE: Anlage III; US: Schedule IV;
Routes of; administration	Oral
Pharmacokinetic data
Bioavailability	83%
Metabolism	Hepatic
Biological half-life	40–250 hours
Excretion	Renal
Identifiers
CAS Registry Number	17617-23-1
ATC code	N05CD01
PubChem	CID: 3393
IUPHAR/BPS	7188
DrugBank	DB00690
ChemSpider	3276
UNII	IHP475989U
KEGG	D00329
ChEMBL	CHEMBL968
PDB ligand ID	FL7 (PDBe, RCSB PDB)
Chemical data
Formula	C21H23ClFN3O
Molecular mass	387.88 g/mol
	SMILES FC1=CC=CC=C1C2=NCC(N(CCN(CC)CC)C3=C2C=C(C=C3)Cl)=O ;
	InChI InChI=1S/C21H23ClFN3O/c1-3-25(4-2)11-12-26-19-10-9-15(22)13-17(19)21(24-14-20(26)27)16-7-5-6-8-18(16)23/h5-10,13H,3-4,11-12,14H2,1-2H3 ; Key:SAADBVWGJQAEFS-UHFFFAOYSA-N ;
Physical data
Melting point	79.5 °C (175.1 °F)
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英: flurazepam
ラ: flurazepamum
化: 塩酸フルラゼパム flurazepam hydrochloride
商: ダルメート、ベノジール、インスミン
関: 睡眠薬

「flurazepam hydrochloride」

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塩酸フルラゼパム

関: flurazepam

[1] BE 629005

[non-benzodiazepines.org-2] "Benzodiazepine Equivalents Table – A list of Equivalent Doses of Benzodiazepines". Non-benzodiazepines.org.uk. Retrieved 2015-05-05.

[3] Shorter, Edward (2005). "B". A Historical Dictionary of Psychiatry. Oxford University Press. ISBN 978-0-19-029201-0.

[4] Rickels K. (1986). "The clinical use of hypnotics: indications for use and the need for a variety of hypnotics". Acta Psychiatrica Scandinavica Suppl. 74 (S332): 132–41. doi:10.1111/j.1600-0447.1986.tb08990.x. PMID 2883820.

[5] Kirkwood CK (1999). "Management of insomnia". J Am Pharm Assoc (Wash) 39 (5): 688–96; quiz 713–4. PMID 10533351.

[6] Viukari M; Linnoila M; Aalto U. (January 1978). "Efficacy and side effects of flurazepam, fosazepam, and nitrazepam as sleeping aids in psychogeriatric patients". Acta Psychiatrica Scandinavica 57 (1): 27–35. doi:10.1111/j.1600-0447.1978.tb06871.x. PMID 24980.

[7] Rooke KC. (1976). "The use of flurazepam (dalmane) as a substitute for barbiturates and methaqualone/diphenhydramine (mandrax) in general practice". J Int Med Res. 4 (5): 355–9. doi:10.1177/030006057600400510. PMID 18375.

[8] Hindmarch I. (November 1977). "A repeated dose comparison of three benzodiazepine derivative (nitrazepam, flurazepam and flunitrazepam) on subjective appraisals of sleep and measures of psychomotor performance the morning following night-time medication". Acta Psychiatrica Scandinavica 56 (5): 373–81. doi:10.1111/j.1600-0447.1977.tb06678.x. PMID 22990.

[9] Authier, N.; Balayssac, D.; Sautereau, M.; Zangarelli, A.; Courty, P.; Somogyi, AA.; Vennat, B.; Llorca, PM.; Eschalier, A. (November 2009). "Benzodiazepine dependence: focus on withdrawal syndrome". Ann Pharm Fr 67 (6): 408–13. doi:10.1016/j.pharma.2009.07.001. PMID 19900604.

[Mets-2010-10] Mets, MA.; Volkerts, ER.; Olivier, B.; Verster, JC. (Feb 2010). "Effect of hypnotic drugs on body balance and standing steadiness.". Sleep Med Rev 14 (4): 259–67. doi:10.1016/j.smrv.2009.10.008. PMID 20171127.

[11] Bain KT (June 2006). "Management of chronic insomnia in elderly persons". Am J Geriatr Pharmacother 4 (2): 168–92. doi:10.1016/j.amjopharm.2006.06.006. PMID 16860264.

[12] Braestrup C; Squires RF. (1 April 1978). "Pharmacological characterization of benzodiazepine receptors in the brain". Eur J Pharmacol 48 (3): 263–70. doi:10.1016/0014-2999(78)90085-7. PMID 639854.

[13] Vermeeren A. (2004). "Residual effects of hypnotics: epidemiology and clinical implications". CNS Drugs. 18 (5): 297–328. doi:10.2165/00023210-200418050-00003. PMID 15089115.

[14] Oelschläger H. (July 4, 1989). "[Chemical and pharmacologic aspects of benzodiazepines]". Schweiz Rundsch Med Prax. 78 (27–28): 766–72. PMID 2570451.

[15] Lehoullier PF, Ticku MK (March 1987). "Benzodiazepine and beta-carboline modulation of GABA-stimulated 36Cl-influx in cultured spinal cord neurons". Eur. J. Pharmacol. 135 (2): 235–8. doi:10.1016/0014-2999(87)90617-0. PMID 3034628.

[16] Chan CY; Farb DH (1 September 1985). "Modulation of neurotransmitter action: control of the gamma-aminobutyric acid response through the benzodiazepine receptor" (PDF). J Neurosci 5 (9): 2365–73. PMID 2863335.

[17] Olive G; Dreux C. (January 1977). "Pharmacologic bases of use of benzodiazepines in peréinatal medicine". Arch Fr Pediatr. 34 (1): 74–89. PMID 851373.

[18] Griffiths RR, Johnson MW (2005). "Relative abuse liability of hypnotic drugs: a conceptual framework and algorithm for differentiating among compounds". J Clin Psychiatry. 66 Suppl 9: 31–41. PMID 16336040.

[19] [1]^{[dead link]}

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flurazepam