Causes CNS depression (dose-related) resulting in sedation, dizziness, confusion, or ataxia which may impair physical and mental capabilities. Patients must be cautioned about performing tasks which require mental alertness (operating machinery or driving). Use with caution in patients receiving other CNS depressants or psychoactive agents. Effects with other sedative drugs or ethanol may be potentiated. Benzodiazepines have been associated with falls and traumatic injury and should be used with extreme caution in patients who are at risk of these events (especially the elderly).

Use caution in patients with depression, particularly if suicidal risk may be present. Use with caution in patients with a history of drug dependence. Benzodiazepines have been associated with dependence and acute withdrawal symptoms on discontinuation or reduction in dose. Acute withdrawal, including seizures, may be precipitated after administration of flumazenil to patients receiving long-term benzodiazepine therapy.

Benzodiazepines have been associated with anterograde amnesia. Paradoxical reactions, including hyperactive or aggressive behavior have been reported with benzodiazepines, particularly in adolescent/pediatric or psychiatric patients. Does not have analgesic, antidepressant, or antipsychotic properties.

Cardiovascular: Palpitations

Central nervous system: Drowsiness, fatigue, ataxia, memory impairment, anxiety, depression, headache, confusion, nervousness, dizziness, incoordination, hypo- and hyperkinesia, agitation, euphoria, paranoid reaction, nightmares, abnormal thinking

Dermatologic: Dermatitis, pruritus, rash

Endocrine & metabolic: Decreased libido, menstrual irregularities

Gastrointestinal: Xerostomia, constipation, diarrhea, dyspepsia, anorexia, abnormal taste perception, nausea, vomiting, increased or decreased appetite, abdominal pain

Genitourinary: Impotence, incontinence

Hematologic: Blood dyscrasias

Neuromuscular & skeletal: Dysarthria, rigidity, tremor, muscle cramps, reflex slowing

Ocular: Blurred vision

Miscellaneous: Drug dependence

CNS depressants: Sedative effects and/or respiratory depression may be additive with CNS depressants; includes ethanol, barbiturates, narcotic analgesics, and other sedative agents; monitor for increased effect

Levodopa: Therapeutic effects may be diminished in some patients following the addition of a benzodiazepine; limited/inconsistent data

Oral contraceptives: May decrease the clearance of some benzodiazepines (those which undergo oxidative metabolism); monitor for increased benzodiazepine effect

Theophylline: May partially antagonize some of the effects of benzodiazepines; monitor for decreased response; may require higher doses for sedation

Absorption: Rapid

Protein binding: 95%

Half-life elimination, serum: Parent drug: 25-41 hours; Active metabolite: 40-114 hours

Elderly: Dosing should be cautious; begin at lower end of dosing range (ie, 7.5 mg)

Dosing adjustment in hepatic impairment: Dose reduction may be necessary

Provide safety measures (ie, side rails, night light, call button); remove smoking materials from area; supervise ambulation

Monitor respiratory and cardiovascular status

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Winsauer HJ and O'Hair DE, "Quazepam: Short-Term Treatment of Insomnia in Geriatric Outpatients,"Curr Ther Res, 1984, 35(2):228-34.