Methylnaltrexone
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Drug reference
Flurazepam
Long-acting benzodiazepine hypnotic · Insomnia
Also known as Flurazepam hydrochloride, Dalmane
START
15 mg PO at bedtime; short-term use only
TYPICAL MAX
30 mg at bedtime (short-term)
STOP IF
Daytime impairment, falls, or signs of dependence
WATCH
Sedation/falls, cognition (elderly), respiratory status, dependence
CDSCO approvedATC N05CD01
KDIGO 2024 + manufacturer label
- ONSET
- 30min · absorption
- PEAK
- 1.5h · Tmax
- t½
- 2.9d · metabolite t½
- DURATION
- 8h · hypnosis
EXCRETION
Renal — metabolites
route + CYP
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
Contraindicated (esp. 1st trimester / near term).
FDA category + note
Top interactionssee all 12 →
- MethylnaltrexoneSevereTextbookG&G 14e
- NalmefeneSevereTextbookG&G 14e
- NaloxoneSevereTextbookG&G 14e
- NaltrexoneSevereTextbookG&G 14e
Mechanism
Allosteric agonist at GABA-A receptor benzodiazepine site, potentiating chloride influx and producing sedation/hypnosis; active metabolites (desalkylflurazepam) prolong action.
Indications
Short-term management of insomnia
Dosing
- Adult
- 15–30 mg PO at bedtime for short-term use (≤2–4 weeks).
- Pediatric
- Not recommended.
- Renal adjustment
- No specific adjustment; caution.
- Hepatic adjustment
- Reduce dose / extend interval (active metabolite accumulation).
- Geriatric
- Avoid (Beers criteria — fall/cognitive risk); if used 15 mg start.
- Max dose
- 30 mg at bedtime
Pharmacokinetics
Onset
15–45 min (oral)
Peak effect
~1–2 h
Duration
Hypnotic 7–8 h; residual sedation longer
Half-life
Parent ~2.3 h; active desalkyl ~47–100 h (accumulates)
Bioavailability
Well absorbed orally
Protein binding
Active metabolite high
Metabolism
Hepatic CYP3A4 (active metabolites)
Excretion
Renal (metabolites)
Contraindications
- Acute angle-closure glaucoma
- Severe respiratory insufficiency / sleep apnoea
- Myasthenia gravis
- Pregnancy/breastfeeding
- Hypersensitivity to benzodiazepines
Side effects
Common
Daytime drowsiness/hangoverDizzinessHeadacheAtaxia (elderly)
Serious
- Dependence/withdrawal
- Falls/fractures (elderly)
- Respiratory depression (with opioids/alcohol)
- Paradoxical agitation
Pregnancy & lactation
Pregnancy
Contraindicated (esp. 1st trimester / near term).
Lactation
Avoid breastfeeding (excreted, neonatal sedation).
Drug interactions
Nalmefene
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Naloxone
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Naltrexone
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Other Cns Depressants
Severe
Textbook
Typically fatal if combined in overdose.
Use with extreme caution; avoid if possible.
Source: G&G 14e
Alfentanil
Severe
Database
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: DDInter
Benzhydrocodone
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Buprenorphine
Severe
Database
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: DDInter
Butorphanol
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Clozapine
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Codeine
Severe
Database
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: DDInter
Dextropropoxyphene
Severe
Database
Clinical effect not specified
Source: DDInter
Related guidelines
Ask House about Flurazepam
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung, BNF·Verified: 2026-05-20 · House clinical team·Cockpit curated: 2026-05-20