Dosing and uses of Dalmane, Som Pam (flurazepam)
Adult dosage forms and strengths
capsule: Schedule IV
- 15mg
- 30mg
Insomnia
15-30 mg PO qHs
Pediatric dosage forms and strengths
<15 years old: not recommended
Geriatric dosage forms and strengths
Not drug of choice in elderly because of long-acting metabolite; associated with increased falls
Insomnia
15 mg PO qHs
Dalmane, Som Pam (flurazepam) adverse (side) effects
Frequency not defined
Common
- Ataxia
- Dizziness
- Drowsiness
- Lethargy
- Light-headedness
Less Common
- Chest pain, palpitations
- Headache, irritability, nervousness, weakness
- GI complaints
- Myalgia
- GU complaints
Rare
- Elevations of AST, ALT, bilirubin (T&D), alk phos
Warnings
Contraindications
Documented hypersensitivity
Acute alcohol intoxication
Myasthenia gravis (allowable in limited circumstances)
Narrow angle glaucoma (questionable)
Severe respiratory depression
Depressed neuroses, psychotic reactions
IV use in shock, coma, depressed respiration, patients who recently received other respiratory depressants
Lactation
Cautions
Use caution in COPD, sleep apnea, renal/hepatic disease, open-angle glaucoma (questionable), depression, suicide ideation
May impair ability to perform hazardous tasks
Use caution in patients with history of drug abuse or acute alcoholism; tolerance, psychological and physical dependence may occur with prolonged use
Pregnancy and lactation
Pregnancy category: X
Lactation: Excretion in milk unknown; not recommended
Minor tranquilizers should be avoided in 1st trimester of pregnancy due to increased risk of congenital malformations
Maternal use shortly before delivery is associated with floppy infant syndrome (good and consistent evidence)
Prenatal benzodiazepine exposure slightly increased oral cleft risk (limited or inconsistent evidence)
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Dalmane, Som Pam (flurazepam)
Mechanism of action
Long-acting benzodiazepine that depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA.
Pharmacokinetics
Metabolism: Glucuronic acid conjugation
Metabolites: Desalkylflurazepam, N-1-hydroxyethylflurazepam
Excretion: Urine
Half-life elimination: 48-120 h
Peak plasma time: 0.5-3 hr
Peak plasma concentration: 0.5-4 ng/mL
