Nitrazepam

Nitrazepam - Use | Dosage | Side Effects

Nitrazepam is a drug from the group of benzodiazepines and is used for short-term treatment of insomnia. It is desirable to determine the cause of insomnia before you start the therapy. Nitrazepam works like all other benzodiazepines.

Precautions

Contraindications to the use of Nitrazepam include:

  • Severe respiratory insufficiency. Nitrazepam may cause respiratory depression and therefore should not be used in such patients.1
  • Myasthenia gravis (muscle disease characterized by muscle weakness). Nitrazepam leads to muscle relaxation, which can exacerbate the symptoms of myasthenia gravis.
  • Sleep apnea syndrome
  • Liver damage/disorders. Studies have shown that use of this drug in patients who have liver damage can lead to encephalopathy.
  • Chronic psychosis
  • Manic-phobic disorders

Nitrazepam may cause difficulty swallowing (dysphagia)2, and is not recommended in patients who already have difficulty swallowing.

Cases of Nitrazepam dependence are also reported3, which is why this drug should be used as short as possible (not more than four weeks). Patients who have a history of addiction to alcohol or other substances, have a higher risk of developing Nitrazepam dependence.

Long-term use of this drug can lead to the occurrence of tolerance - effects of this drug become weakened over time.

Abrupt cessation of treatment may cause withdrawal symptoms, such as: anxiety, insomnia, psychosis, irritability and headache.

Nitrazepam, pregnancy and breastfeeding

Nitrazepam should be used during pregnancy only when clearly needed. Forty three cases of pregnant women who have unsuccessfully tried to attempt suicide by taking large doses of Nitrazepam, have been reported. Of the forty three babies who were exposed to the drug, thirteen had congenital malformations while other thirty were born healthy.4 Overall, long-term use of Nitrazepam during pregnancy can lead to the occurrence of dependence in newborns, and because of that they will experience withdrawal symptoms immediately after a birth. Use of this drug in the last trimester of pregnancy increases the risk of respiratory depression in the newborns.

Nitrazepam is excreted into breast milk, therefore breastfeeding should be avoided while taking this medicine.

Dosage

The usual dose in adult patients (18-65 years) is 5-10 mg half an hour before bedtime.

In patients older than 65 years and in patients who have a decreased creatinine clearance, it is necessary to reduce the dose by half, i.e. 2.5-5 mg thirty minutes before bedtime.

The treatment should not last longer than four weeks, because prolonged use increases the risk of tolerance, physical and psychological dependence and other undesirable effects.

Interactions

Nitrazepam may interact with the following medications:

  • Antipsychotics, such as:
    • clozapine
    • olanzapine
    • loxapine
    • fluphenazine
    • thioridazine
    • promethazine
    • prochlorperazine
    • chlorpromazine
    • aripiprazole
    • haloperidol
    • droperidol
    • clopenthixol
    • flupentixol and others
    Co-administration of these drugs with Nitrazepam boosts a depressing effect on the central nervous system (CNS).
  • Other benzodiazepines, such as:
  • Antidepressants, such as:
  • Anticonvulsant medications
  • Opioid analgesics, such as: morphine and fentanyl.
  • Muscle relaxants (e.g. tizanidine)
  • Drugs used to treat fungal infections (ketoconazole, fluconazole and itraconazole). These drugs inhibit the enzyme responsible for metabolism of Nitrazepam, thereby increase its concentration in the blood.
  • Rifampicin (an antibiotic which is used in the treatment of tuberculosis). Rifampicin reduces the concentration of Nitrazepam in the blood.
  • St. John's Wort. This plant reduces the efficiency of Nitrazepam.
  • Grapefruit. This fruit increases the risk of side effects.
  • Alcoholic beverages. These beverages increase the depressive effects of Nitrazepam on the CNS.

Undesirable effects

Undesirable effects of the Nitrazepam include:

  • Anterograde amnesia
  • Drowsiness
  • Reduction of attention
  • Emotional numbness
  • Ataxia
  • Dizziness
  • Diplopia
  • Blurred vision
  • Weakness
  • Fainting
  • Nightmares
  • Insomnia
  • Anxiety
  • Depression
  • Seizures
  • Hypotension
  • Impotence

References

  1. NCBI link 1
  2. NCBI link 2
  3. bjp rcpsych link
  4. NCBI link 3

Information on this website are provided for educational purposes only and are not intended for medical advice, diagnosis or treatment.

If you have any concerns or questions about your health, you should always consult with a physician or other health-care professional.