Evaluation of Temazepam as a Hypnotic
Evaluation of Temazepam as a Hypnotic
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替马西泮作为催眠药的评价
作者：
M. Mitler
替马西潘是一种1，4-苯二氮卓类药物，最近在美国上市，用于对症治疗失眠主诉。制造商建议大多数成年人睡前服用30毫克，老年或虚弱患者服用15毫克。30毫克的剂量通常在口服后3小时内产生峰值血药浓度，平均半衰期为10至15小时。因此，替马西潘的吸收更慢，代谢更快，氟西潘是美国唯一销售的另一种专门治疗失眠的苯二氮卓类药物。关于替马西潘的8个睡眠实验室和21个临床研究表明，替马西潘减少了夜间的觉醒，延长了睡眠时间。然而，没有一致的证据表明替马西潘减少了睡眠潜伏期--可能是因为在睡前服用的替马西潘没有及时达到足够高的血液水平，从而影响睡眠开始。一项对8名失眠症患者进行的睡眠实验室研究发现，没有证据表明耐受性或反弹失眠。对耐受性、新陈代谢和残留效应的研究表明，替马西潘没有长效代谢物，也不会影响睡前服用后的唤醒功能。在适合服用催眠药的患者中，替马西潘应该是一种有效的药物，可以减轻大多数失眠症状。
Temazepam is a 1,4‐benzodiazepine, newly marketed in the United States for the symptomatic treatment of the complaint of insomnia. The manufacturer recommends a dose of 30 mg before bedtime for most adults and 15 mg for geriatric or debilitated patients. A dose of 30 mg usually produces peak plasma concentrations within 3 hours after oral ingestion and has a mean half‐life of 10 to 15 hours. Thus, temazepam is absorbed more slowly and metabolized more quickly than flurazepam, the only other benzodiazepine marketed in the United States specifically for insomnia. Eight sleep laboratory and 21 clinical studies on temazepam indicate that temazepam reduces awakening during the night and increases sleep duration. However, there was no consistent evidence that temazepam reduces sleep latency — probably because temazepam, taken at bedtime, does not reach sufficiently high blood levels in time to affect sleep onset. One sleep laboratory study on 8 insomniac patients given 35 consecutive nightly doses of 30 mg found no evidence of tolerance or rebound insomnia. Studies on tolerance, metabolism and carry‐over effects have shown that temazepam has no long‐acting metabolites and does not affect waking function following use at bedtime. In patients for whom hypnotic medication is appropriate, temazepam should be an effective drug for reducing most symptoms of insomnia.