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Uses. Flurazepam has become one of the most common benzodiazepine class compounds in medical use around the globe. One reason for its popularity is flurazepam's high therapeutic index, meaning the dose needed for medical action is much smaller than a fatal dose, making accidental poisoning unlikely. Caregivers mainly use this long-acting drug to help people sleep, and it has been used experimentally to reduce sleepwalking.

Drawbacks. Flurazepam often leaves people groggy the next day, impairing their mental abilities (including memory and accuracy of perceptions). Such problems can decrease after weeks or months of using the drug, but in one experiment users never achieved normal performance while taking fluraze-pam. Researchers find that volunteers may be unaware of the trouble they are having. In contrast to those typical findings, experiments using healthy college students found no effect on performance the day after taking a nighttime dose of the drug.

Laboratory tests of users demonstrate impairment in reaction time, eye-hand coordination, making decisions, and maintaining attention. All those skills are relevant to operating an automobile. Twelve hours after taking a nighttime dose of flurazepam, volunteers drove a test vehicle. Researchers conducting the experiment concluded that such drivers were much more likely to have a road accident than controls who received a placebo. Bolder experimenters had drivers take a car into actual traffic the day after ingesting flur-azepam, and drivers had trouble keeping the car aligned in the proper lane. An experiment using a driving simulator also showed people to have trouble driving the morning after using flurazepam.

Users tend to be more accident prone in general, not just behind the steering wheel of a car. A case report tells of a person's muscular discoordination clearing up when he stopped taking flurazepam, and experimental work has documented the drug's tendency to interfere with movement. In elderly persons that unsteadiness is associated with falls causing broken hips, and caution is advised in prescribing flurazepam to older people. One factor with flurazepam problems experienced by the elderly is that, compared to younger persons, the elderly maintain higher levels of the drug in their bodies from a given dose.

Researchers find that the substance can help people shift their sleep schedules from night to daytime, while promoting good-quality rest, yet the drug still has hangover effects that degrade ability to function after awakening.

The drug can worsen verbal communication, causing voices to become indistinct and grammar to become garbled. Studies measuring sleep-time breathing find that the drug can exacerbate respiration problems; in some experiments researchers concluded that the change has no practical effect on health, but medical literature notes an instance in which the drug's influence on breathing did cause trouble for a sleeping person. In a mice experiment flurazepam lowered body temperature. In humans long-term use of the drug is suspected of causing hallucinations and confusion, and a case report exists of a single dose creating those symptoms along with euphoria. Investigators in the 1970s found mild euphoria to be a routine effect of flurazepam. Headache, low blood pressure, eyesight trouble, nausea, vomiting, and constipation can occur. A case report relates that a woman's interest in sexual activity increased when she stopped taking flurazepam and diazepam. Flurazepam is believed to interfere with women's ability to achieve a sexual orgasm.

Abuse factors. Tests with normal persons find that flurazepam has equal or less appeal compared to placebo. Medical authorities examining the drug in the 1970s concluded that it probably had little potential for abuse. Despite the drug's apparent low appeal, it can create a physical dependence with a person's body. Withdrawal symptoms can include peevishness, fidgeting, anxiety, sweating, tremors, high blood pressure, and intolerance to light and sounds. One longtime user of flurazepam and diazepam developed such a strong dependence with them that a severe withdrawal syndrome occurred when she suddenly halted dosage: cramps, stomach discomfort, nervous unease, sleep difficulty, and nightmares. Milder versions of such symptoms are reported if the original level of dependence is lighter. Symptoms can be avoided if flur-azepam usage is tapered off rather than stopped suddenly. Volunteers who received flurazepam in a long-term experiment consistently detected the difference between the drug and a placebo, an ability causing investigators to conclude that users of flurazepam do not develop tolerance to the drug (tolerance is a classic indicator of addictive potential). This conclusion is not accepted by all experts, however, and some believe tolerance does occur.

Drug interactions. A catalepsy effect from marijuana may become stronger in mice if they also receive flurazepam, but the reason is unclear. Alcohol and flurazepam boost some of each other's effects. Experimenters find that caffeine can lessen flurazepam's adverse next-day effects on performance. The heartburn medicine cimetidine lengthens the time that flurazepam's metabolite de-salkylflurazepam stays in the body. In a monkey experiment, that metabolite produced performance deficiencies reminiscent of those seen in humans with flurazepam and also lowered inhibitions.

Cancer. No indication of a cancer-causing potential has emerged.

Pregnancy. Experiments with rats and rabbits produced no birth defects. Researchers tracking assorted birth defects examined medical records of 50 to 99 women who took flurazepam during pregnancy and found no malformations in offspring. Nonetheless, birth defects are considered a serious risk from the drug, and pregnant women are advised to avoid it. Newborns from mothers using the drug may have "floppy infant syndrome" involving sedation, inferior muscle tone, breathing trouble, and poor feeding.

Additional scientific information may be found in:

Council on Drugs. "Evaluation of a New Hypnotic Agent—Flurazepam Hydrochloride

(Dalmane)." Journal of the American Medical Association 218 (1971): 246. De Wit, H., E.H. Uhlenhuth, and C.E. Johanson. "Lack of Preference for Flurazepam in Normal Volunteers." Pharmacology, Biochemistry, and Behavior 21 (1984): 865-69.

"Flurazepam (Dalmane)." Medical Letter on Drugs and Therapeutics 17 (1975): 29-30. Judd, L.L., E. Ellinwood, and L.A. McAdams. "Cognitive Performance and Mood in Patients with Chronic Insomnia during 14-Day Use of Flurazepam and Midazolam." Journal of Clinical Psychopharmacology 10 (1990, Suppl.): S56-S67. Juhl, R.P., V.M. Daugherty, and P.D. Kroboth. "Incidence of Next-Day Anterograde Amnesia Caused by Flurazepam Hydrochloride and Triazolam." Clinical Pharmacy 3 (1984): 622-25. Mendelson, W.B., et al. "A Clinical Study of Flurazepam." Sleep 5 (1982): 350-60. Wesnes, K., and D.M. Warburton. "A Comparison of Temazepam and Flurazepam in Terms of Sleep Quality and Residual Changes in Performance." Neuropsycho-biology 11 (1984): 255-59. Younus, M., and M.J. Labellarte. "Insomnia in Children: When Are Hypnotics Indicated?" Paediatric Drugs 4 (2002): 391-403.

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