Benzodiazepines in the management of insomnia in adults

Benzodiazepine	Clinical use*	Adult dose (usual)^¶	Dose in older adults (≥65 years)	Half-life (hours)	Potential for drug interactions^Δ
Estazolam	Sleep onset or sleep maintenance insomnia	1 to 2 mg	0.5 mg	Intermediate (10 to 24)	CYP3A4 to minimally active metabolite.
Flurazepam	Sleep onset or sleep maintenance insomnia	15 to 30 mg	15 mg	Long (40 to 114; 120 to 160 older adults)	Non-CYP glucuronidation in liver. Active metabolite.
Temazepam	Sleep onset or sleep maintenance insomnia	7.5 to 30 mg	7.5 to 15 mg	Intermediate (8 to 15)	Primarily non-CYP glucuronidation in liver to inactive metabolites. CYP3A4 to active metabolite (minor pathway, clinically insignificant).
Triazolam	Sleep onset insomnia	0.125 to 0.25 mg	0.125 to 0.25 mg	Short (2 to 5)	CYP3A4. No active metabolite.
Quazepam	Sleep onset or sleep maintenance insomnia	7.5 to 15 mg	7.5 mg	Long (39)	CYP3A4, CYP2C9/19. Active metabolites.

* Appropriate clinical uses may differ from the US Food and Drug Administration (FDA)-approved indication(s) for a given drug.
¶ Initiate treatment using lowest dose shown for those with low body weight, debilitated patients, and those receiving treatment with opioid analgesics or other central nervous system or cardiorespiratory depressants.
Δ For specific drug interactions, including management recommendations and combinations that should be avoided, use Lexi-Interact drug interactions program included with UpToDate.

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Benzodiazepines in the management of insomnia in adults