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Depressant

Temazepam

Also called Restoril, Normison, Hydroxydiazepam, Methyloxazepam, Oxydiazepam

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Part of the metabolic pathway of Diazepam, Camazepam and Temazepam. See the timeline on the metabolic highway.

Common dose · Oral10–30 mg PW
Onset30–60 minutes[6] PW
Total7–8 hours[6] PW
After-effects3.5–18.4 hours[1] PW

Dosage

When sources disagree, both rows are shown as published. Nothing is averaged or merged.

Oral

SourceThresholdLightCommonStrongHeavy
PsychonautWiki2 mg PW5–10 mg PW10–30 mg PW30–40 mg PW40 mg+[6] PW
TripSit–5–10 mg TS10–20 mg TS20–40 mg+ TS–

Bioavailability: 96%[1] PW

TripSit dose text

TripSit's factsheet also states its doses as text.

Oral Light: 5-10mg's Common: 10-20mg Strong: 20-40mg+ TS

What dose are you on? (self-reported, unverified)
Read this first. These numbers come from anonymous visitors typing in a box. Nobody checks them. People misjudge, mistype, troll, or take untested products of unknown strength. They are not a dose guide and never override the sourced table above. They exist only so the sourced ranges can be compared with what people say they take. If you are deciding what to take, use the sourced table, start low, and read the risks section.
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Duration

Route · sourceOnsetCome-upPeakOffsetTotalAfter-effects
Oral · PsychonautWiki30–60 minutes[6] PW–––7–8 hours[6] PW3.5–18.4 hours[1] PW

TripSit factsheet

Onset
20-90 minutes TS
Duration
6-10 hours TS
Aftereffects
6-12 hours TS

Mixing

For best safety practice, don't mix this drug with other depressants.

Why: respiratory depression. PsychonautWiki says:

Quotes from PsychonautWiki, CC BY-SA 4.0.

Acute combinations: what happens when these are taken close together. Entries backed by a medical journal or agency are listed first.

Backed by medical journals

Awaiting sourcePeer-reviewed reports on acute combinations, from PubMed and the journals the harm reduction sites cite.

Other documented combinations

  • Depressants (1,4-Butanediol, 2-methyl-2-butanol, alcohol, barbiturates, GHB/GBL, methaqualone, opioids) - This combination can result in dangerous or even fatal levels of respiratory depression. These substances potentiate the muscle relaxation, sedation and amnesia caused by one another and can lead to unexpected loss of consciousness at high doses. There is also an increased risk of vomiting during unconsciousness and death from the resulting suffocation. If this occurs, users should attempt to fall asleep in the recovery position or have a friend move them into it. PW⚠ PsychonautWiki lists this combination without a danger rating.
  • Dissociatives - This combination can result in an increased risk of vomiting during unconsciousness and death from the resulting suffocation. If this occurs, users should attempt to fall asleep in the recovery position or have a friend move them into it. PW⚠ PsychonautWiki lists this combination without a danger rating.
  • Stimulants - It is dangerous to combine benzodiazepines with stimulants due to the risk of excessive intoxication. Stimulants decrease the sedative effect of benzodiazepines, which is the main factor most people consider when determining their level of intoxication. Once the stimulant wears off, the effects of benzodiazepines will be significantly increased, leading to intensified disinhibition as well as other effects. If combined, one should strictly limit themselves to only dosing a certain amount of benzodiazepines per hour. This combination can also potentially result in severe dehydration if hydration is not monitored. PW⚠ PsychonautWiki lists this combination without a danger rating.

TripSit combination chart

TripSit rates each pairing. Only pairings with a number carry a citation from TripSit. See the whole chart; TripSit's own notes are on combo.tripsit.me.

Dangerous

Unsafe

Low Risk & Decrease

Risks and toxicity

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. Temazepam and nitrazepam were the two benzodiazepines most commonly detected in overdose-related deaths in an Australian study of drug deaths. 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). Temazepam has a fatal toxicity index (FTI) that is higher than some tricyclic antidepressants, and has also caused overdose and death without combining it with other CNS depressants, which is almost unheard of amongst the benzodiazepine class of drugs.[13][14][15] PW

Another 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 or opioids and temazepam makes death by alcohol poisoning more likely. PW

Still, temazepam has a low toxicity relative to dose. However, it is potentially lethal when mixed with depressants like alcohol or opioids.[2] PW

It is strongly recommended that one use harm reduction practices when using this substances. These include volumetric liquid dosing. PW

Dependence and abuse potential

Temazepam is extremely physically and psychologically addictive. Temazepam is considered to be significantly more addictive than other benzodiazepines. PW

Tolerance will develop to the sedative-hypnotic effects within a couple of days of continuous use. After cessation, the tolerance returns to baseline in 7-14 days. However, in certain cases this may take significantly longer in a manner which is proportional to the duration and intensity of one's long-term usage.[16] PW

Withdrawal symptoms or rebound symptoms may occur after ceasing usage abruptly following a few weeks or longer of steady dosing, and may necessitate a gradual dose reduction. For more information on tapering from benzodiazepines in a controlled manner, please see this guide.[17][18] PW

Benzodiazepine discontinuation is notoriously difficult; it is potentially life-threatening for individuals using regularly to discontinue use without tapering their dose over a period of weeks. There is an increased risk of hypertension, seizures, and death. Drugs which lower the seizure threshold such as tramadol should be avoided during withdrawal.[19] PW

Temazepam presents cross-tolerance with all benzodiazepines, meaning that after its consumption all benzodiazepines will have a reduced effect. Temazepam also has cross-tolerance with all barbiturates, meaning that after consumption, all barbiturates will have a diminished effect. PW

Overdose

Benzodiazepine overdose may occur when a benzodiazepine is taken in extremely heavy quantities or concurrently with other depressants. This is particularly dangerous with other GABAergic depressants such as barbiturates and alcohol since they work in a similar fashion, but bind to distinct allosteric sites on the GABAA receptor, thus their effects potentiate one another. Benzodiazepines increase the frequency in which the chlorine ion pore opens on the GABAA receptor while barbiturates increase the duration in which they are open, meaning when both are consumed, the ion pore will open more frequently and stay open longer. Benzodiazepine overdose is a medical emergency that may lead to a coma, permanent brain injury or death if not treated promptly and properly.[20] PW

Symptoms of a benzodiazepine overdose may include severe thought deceleration, slurred speech, confusion, delusions, respiratory depression, coma or death. Benzodiazepine overdoses may be treated effectively in a hospital environment, with generally favorable outcomes. Benzodiazepine overdoses are sometimes treated with flumazenil, a GABAA antagonist, however care is primarily supportive in nature.[21] PW

Dangerous interactions

Although many drugs are safe on their own, they can become dangerous and even life-threatening when combined with other substances. The list below contains some common potentially dangerous combinations, but may not include all of them. Certain combinations may be safe in low doses of each but still increase the potential risk of death. Independent research should always be done to ensure that a combination of two or more substances is safe before consumption. PW

TripSit factsheet

Avoid
All other CNS depressants.[3] TS

Testing

Awaiting sourceReagent reactions and test kit guidance from a harm reduction testing service.

Effects

AnxiolyticSedativeMuscle RelaxantAmnesiaDystaxiaHypnotic TS

Overview

Temazepam (trade name Restoril) is a short-acting psychoactive substance of the benzodiazepine class which produces anxiolytic, sedative, hypnotic, muscle relaxant, anticonvulsant, and amnesic effects. Temazepam, like other benzodiazepines, binds to specific sites on the GABAA gamma-amino-butyric acid receptor.[1][2] PW

Temazepam's brand name is Restoril. It is a hypnotic benzodiazepine with effects similar to clonazepam, frequently prescribed as a sleep aid. Some users report mild euphoria alongside the hypnotic effects.[3] TS

Temazepam, sold under the brand name Restoril among others, is a medication of the benzodiazepine class which is generally used to treat severe or debilitating insomnia. It is taken by mouth. Temazepam is rapidly absorbed, and significant hypnotic and anxiolytic effects begin in less than 30 minutes and can last for up to eight hours. Prescriptions for hypnotics like temazepam have seen a dramatic decrease since 2010, while anxiolytics, such as alprazolam, clonazepam, and lorazepam, have increased or remained stable. Temazepam and similar hypnotics, such as triazolam (Halcion), are generally reserved for severe and debilitating insomnia. They have largely been replaced by z-drugs (zopiclone, zolpidem) and atypical antidepressants (trazodone, mirtazapine) as first line treatment for insomnia.[4–7] WP

Common side effects include drowsiness, motor and cognitive impairment, lethargy, confusion, euphoria, and dizziness. Serious side effects may include hallucinations, hypotension, respiratory depression, and anaphylaxis. It may lead to addiction, and it has a potential for abuse. Use is generally not recommended together with alcohol or opioids. If the dose is rapidly decreased withdrawal may occur. Use during pregnancy or breastfeeding is not recommended. Temazepam is a short-acting benzodiazepine and hypnotic. It works by affecting GABA within the brain.[4][6][8] WP

Temazepam was patented in 1962 and came into medical use in 1969. It is available as a generic medication. In 2021, it was the 208th most commonly prescribed medication in the United States, with more than 2 million prescriptions.[9–12] WP

History

History

Temazepam was synthesized in 1964, but it came into use in 1981 when its ability to counter insomnia was realized. By the late 1980s, temazepam was one of the most popular and widely prescribed hypnotics on the market and it became one of the most widely prescribed drugs.[22] WP⚠ Wikipedia itself has flagged this text: citation needed.

Pharmacology

Pharmacodynamics

The main pharmacological action of temazepam is to increase the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABAA receptor. This causes sedation, motor impairment, ataxia, anxiolysis, anticonvulsant effects, muscle relaxation, and a reinforcing effect.[49] WP

As a medication before surgery, temazepam decreased cortisol in elderly patients. In rats, it triggered the release of vasopressin into paraventricular nucleus of the hypothalamus and decreased the release of ACTH under stress.[50][51] WP

Pharmacokinetics

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.[5] WP

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.[1] WP

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%).[52] WP

Chemistry

Formula
C16H13ClN2O2 PC
CAS number
846-50-4 PC
Molar mass (g/mol)
300.74 PC
IUPAC name (computed by PubChem)
7-chloro-3-hydroxy-1-methyl-5-phenyl-3H-1,4-benzodiazepin-2-one PC
SMILES
CN1C2=C(C=C(C=C2)Cl)C(=NC(C1=O)O)C3=CC=CC=C3 PC
InChIKey
SEQDDYPDSLOBDC-UHFFFAOYSA-N PC
PubChem CID
5391

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Pop culture

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References

  1. Journal / agency Müller FO, Van Dyk M, Hundt HK, etal. Pharmacokinetics of temazepam after day-time and night-time oral administration. Eur. J. Clin. Pharmacol. 1987. doi:10.1007/BF00544571 · PMID 2891534
  2. Journal / agency Mandrioli, R., Mercolini, L., Raggi, M. A. Benzodiazepine metabolism: an analytical perspective. Current Drug Metabolism. October 2008. doi:10.2174/138920008786049258
  3. Journal / agency Alcohol and benzodiazepines in fatal poisonings
  4. Other Temazepam Monograph for Professionals
  5. Other RESTORIL® Novartis Temazepam Hypnotic
  6. Other Collins SR. Pharmacology and the Nursing Process. 2015
  7. Journal / agency Breen CL, Degenhardt LJ, Bruno RB, Roxburgh AD, Jenkinson R. The effects of restricting publicly subsidised temazepam capsules on benzodiazepine use among injecting drug users in Australia. The Medical Journal of Australia. September 2004. doi:10.5694/j.1326-5377.2004.tb06293.x · PMID 15377238
  8. Other Temazepam (Restoril) Use During Pregnancy
  9. Other Fischer J, Ganellin CR. Analogue-based Drug Discovery. 2006
  10. Other British national formulary: BNF 76. 2018
  11. Other The Top 300 of 2021
  12. Other Temazepam - Drug Usage Statistics
  13. Journal / agency Buckley N. A.; Dawson, A. H.; Whyte, I. M.; O'Connell, D. L. Relative toxicity of benzodiazepines in overdose. BMJ. 1995. doi:10.1136/bmj.310.6974.219 · PMID 7866122 · PMC2548618
  14. Journal / agency Drummer OH. Sudden death and benzodiazepines. Am J Forensic Med Pathol. December 1996. doi:10.1097/00000433-199612000-00012 · PMID 8947361
  15. Journal / agency Serfaty M, Masterton G. Fatal poisonings attributed to benzodiazepines in Britain during the 1980s. Br J Psychiatry. 1993. doi:10.1192/bjp.163.3.386 · PMID 8104653
  16. Other Janicak, P. G., Marder, S. R., Pavuluri, M. N. Principles and Practice of Psychopharmacotherapy. 25 October 2010
  17. Journal / agency Verster, J. C., Volkerts, E. R. Clinical Pharmacology, Clinical Efficacy, and Behavioral Toxicity of Alprazolam: A Review of the Literature. CNS Drug Reviews. 7 June 2006. doi:10.1111/j.1527-3458.2004.tb00003.x
  18. Other Galanter, M., Kleber, H. D. The American Psychiatric Publishing Textbook of Substance Abuse Treatment. 2008
  19. Journal / agency Lann, M. A., Molina, D. K. A fatal case of benzodiazepine withdrawal. The American Journal of Forensic Medicine and Pathology. June 2009. doi:10.1097/PAF.0b013e3181875aa0
  20. Journal / agency Twyman, R. E., Rogers, C. J., Macdonald, R. L. Differential regulation of gamma-aminobutyric acid receptor channels by diazepam and phenobarbital. Annals of Neurology. March 1989. doi:10.1002/ana.410250302
  21. Journal / agency Hoffman, E. J., Warren, E. W. Flumazenil: a benzodiazepine antagonist. Clinical Pharmacy. September 1993
  22. Journal / agency Maggini C, Murri M, Sacchetti G. Evaluation of the effectiveness of temazepam on the insomnia of patients with neurosis and endogenous depression. Arzneimittel-Forschung. October 1969. PMID 4311716
  23. Other List of Psychotropic Substances under International Control
  24. Other Controlled Drugs and Substances Act - SCHEDULE IV
  25. Other Anlage III BtMG
  26. Other Zweite Verordnung zur Änderung betäubungsmittelrechtlicher Vorschriften
  27. Other S.I. No. 342/1993 - Misuse of Drugs (Amendment) Regulations, 1993
  28. Other Decreto-Lei n.º 15/93, de 22 de Janeiro
  29. Other Постановление Правительства РФ от 04.02.2013 N 78 “О внесении изменений в некоторые акты Правительства Российской Федерации” - КонсультантПлюс
  30. Other Läkemedelsverkets föreskrifter (LVFS 2011:10) om förteckningar över narkotika" [Medical Products Agency on the lists of drugs]
  31. Other Verordnung des EDI über die Verzeichnisse der Betäubungsmittel, psychotropen Stoffe, Vorläuferstoffe und Hilfschemikalien
  32. Other Participation, E. Misuse of Drugs Act 1971
  33. Other DEA, Drug Scheduling
  34. Other DAN 24/7: Temazepam
  35. Harm reduction site Erowid Drug Street Terms
  36. Harm reduction site Classification of controlled drugs
  37. Other Poisons Standard 2015. 5 February 2015
  38. Other Controlled Drugs and Substance Act - Schedule IV
  39. Other NORMISON - EurekaSanté par VIDAL
  40. Other Bilingual Laws Information System
  41. Other Misuse Of Drugs (Amendment) Regulations. 1993
  42. Other Temazepam | Health24
  43. Other Narkotiska läkemedel - Läkemedelsverket / Swedish Medical Products Agency
  44. Other Verzeichnis aller zugelassenen betäubungsmittelhaltigen Präparate im Schweizer Handel Indice de tous les stupéfiants autorisés sur le marché suisse Stand/Etat 01.07.2011
  45. Other Blackpool NHS Primary Care Trust. Medicines Management Update. 2007
  46. Other List of drugs currently controlled under the misuse of drugs legislation. 28 January 2009
  47. Other Controlled Drugs. Information about Controlled Drugs. Patient
  48. Other Green List—List of psychotropic substances under international control. May 2010
  49. Journal / agency Oelschläger H. Chemical and pharmacologic aspects of benzodiazepines. Schweizerische Rundschau für Medizin Praxis = Revue Suisse de Médecine Praxis. July 1989. PMID 2570451
  50. Journal / agency Salonen M, Kanto J, Hovi-Viander M, Irjala K, Viinamäki O. Oral temazepam as a premedicant in elderly general surgical patients. Acta Anaesthesiologica Scandinavica. November 1986. doi:10.1111/j.1399-6576.1986.tb02503.x · PMID 2880447
  51. Journal / agency Welt T, Engelmann M, Renner U, Erhardt A, Müller MB, Landgraf R, Holsboer F, Keck ME. 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. Neuropsychopharmacology. December 2006. doi:10.1038/sj.npp.1301006 · PMID 16395302
  52. Journal / agency Schwarz HJ. Pharmacokinetics and metabolism of temazepam in man and several animal species. British Journal of Clinical Pharmacology. 1 August 1979. doi:10.1111/j.1365-2125.1979.tb00451.x · PMID 41539 · PMC1429628

Text and values on this page are quoted from PsychonautWiki (CC BY-SA 4.0), Wikipedia (CC BY-SA 4.0), TripSit factsheets, PubChem (public domain). Each value links to the exact revision it came from.