Alfentanil
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
Nitrazepam
Benzodiazepine · Hypnotic
BenzodiazepineHypnotic
CDSCO approved
EXCRETION
—
not curated
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
—
not curated
Top interactionssee all 12 →
- AlfentanilSevereTextbookG&G 14e
- BuprenorphineSevereTextbookG&G 14e
- CodeineSevereTextbookG&G 14e
- FentanylSevereTextbookG&G 14e
Mechanism
Nitrazepam is a long-acting 7-nitro benzodiazepine that acts as a positive allosteric modulator of GABA-A receptors, with a half-life exceeding 30 hours contributing to sustained hypnotic effects. Like other nitrobenzodiazepines, it has relatively greater hypnotic and anticonvulsant activity compared to anxiolytic activity. Its long elimination half-life results in significant accumulation with repeated dosing, producing residual daytime sedation and impaired psychomotor performance ('hangover effect').
Indications
Insomniafrequent nocturnal awakenings (when some daytime sedation is acceptable)
Dosing
- Adult
- Hypnotic dose: 5–10 mg
- Geriatric
- Should be avoided in the elderly due to increased risk of ataxia, confusion, falls, and injury.
Pharmacokinetics
Duration
Prolonged action; repeated doses tend to be cumulative.
Half-life
30 hours
Metabolism
Metabolized by N-acetyltransferases.
Excretion
Crosses placenta
Contraindications
- Should be avoided in the elderly due to increased risk of ataxia, confusion, falls, and injury.
- obstructive sleep apnoea
Side effects
Common
DizzinessSomnolenceResidual effects on the following dayAtaxia (especially in elderly)Confusion (especially in elderly)Rebound insomnia (upon discontinuation from long-term use)Withdrawal syndrome (upon discontinuation from long-term use)vertigoataxiadisorientationamnesiaprolongation of reaction time (impairment of psychomotor skills)hangover (less common than with barbiturates)weaknessblurring of visiondry mouthurinary incontinence
Serious
- Potentially fatal respiratory depression
- increase in nightmares
- behavioural alterations
Pregnancy & lactation
Lactation
Secreted in milk
Drug interactions
Buprenorphine
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
Codeine
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
Fentanyl
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
Hydrocodone
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
Methadone
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
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
Morphine
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
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
Related guidelines
Other Benzodiazepine drugs
Ask House about Nitrazepam
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Sources: KD Tripathi 7e, Katzung·Verified: 2026-05-10 · House clinical team