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Teicoplanin is for gram-positive bacteria only. It does not treat E.coli.
Teicoplanin is not for intraventricular use. The manufacturer strongly discourage injecting Teicoplanin into the brain.

My daughter bled into the brain. She lived for another two years and ultimately died.

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Flurazepam (Dalmane) - Uses, Dose, Side effects, MOA, Brands

Flurazepam is a longer-acting benzodiazepine that is primarily used to treat patients with insomnia who have difficulty falling asleep or maintaining sleep.

Flurazepam Uses:

Insomnia:
- - It is used to treat patients who have difficulty falling asleep, maintaining sleep, and/ o those who complain of early morning awakenings.

Flurazepam dose in Adults

Flurazepam dose in the treatment of Insomnia in Adults:

The starting dose is 15 mg at bedtime for women and 15 to 30 mg at bedtime for males. If necessary and depending on the patient's response,
The dose may be increased to 30 mg at bedtime.

Flurazepam dose in Children

Flurazepam dose in the treatment of Insomnia in adolescents aged 15 years or more: Limited data available:

15 mg per oral at bedtime.

Pregnancy Risk Factor C

All benzodiazepines are capable of crossing the placental boundary. There have been adverse fetal outcomes reported with many of them.
A neonate may experience withdrawal symptoms as soon as they are born or the "floppy infant Syndrome" within days to weeks.
However, some benzodiazepines may also have teratogenic effects. Data are limited.
A maternal use of benzodiazepines in pregnancy has been linked to low birth weight, hypoglycemia, and respiratory depression among neonates.
The infant's serum levels of N desalkylflurazepam was measured in the first four days after its use.
Flurazepam is not recommended during pregnancy.
It has been shown to be associated with neonatal depressive disorder in pregnant women who have taken it for more than ten days before giving birth.

Use flurazepam while breastfeeding

Although information is scarce, it is possible that all benzodiazepines will be found in breastmilk.
Negative side effects like lethargy, drowsiness, difficulty eating, and weight loss could result from this.

Dose in Kidney Disease:

Use with caution in patients with kidney disease.
The manufacture has not provided any recommendations regarding dosage adjustment in kidney impairment.

Dose in Liver disease:

In patients with liver problems, use with caution.
The manufacture has not provided any recommendations regarding dosage adjustment in hepatic impairment.

Side effects of Flurazepam:

Cardiovascular:
- Chest Pain
- Syncope
- Flushing
- Hypotension
- Palpitations
Central Nervous System:
- Abnormal Reflexes (Slowing)
- Confusion
- Depression
- Dizziness
- Drowsiness
- Drug Dependence
- Dysarthria
- Euphoria
- Apprehension
- Ataxia
- Bitter Taste
- Body Pain
- Falling
- Hallucination
- Hangover Effect
- Headache
- Irritability
- Memory Impairment
- Nervousness
- Paradoxical Reaction
- Restlessness
- Slurred Speech
- Staggering
- Talkativeness
Dermatologic:
- Diaphoresis
- Pruritus
- Skin Rash
Endocrine & Metabolic:
- Weight Gain
- Weight Loss
Gastrointestinal:
- Constipation
- Gastric Distress
- Gastrointestinal Pain
- Heartburn
- Increased Appetite
- Nausea
- Sialorrhea
- Vomiting
- Decreased Appetite
- Diarrhea
- Xerostomia
Hematologic & Oncologic:
- Granulocytopenia
- Leukopenia
Hepatic:
- Cholestatic Jaundice
- Increased Serum Alkaline Phosphatase
- Increased Serum ALT
- Abnormal Bilirubin Levels (Total Bilirubin Increased)
- Increased Serum AST
Neuromuscular & Skeletal:
- Arthralgia
- Weakness
Ophthalmic:
- Accommodation Disturbance
- Blurred Vision
- Burning Sensation Of Eyes
Respiratory:
- Apnea
- Dyspnea

Contraindication to Flurazepam Include:

Intolerance to flurazepam, other benzodiazepines, or any other ingredient in this combination
Patients who have previously experienced allergic cross-reactivity to one or more benzodiazepines may be at risk.
Pregnancy

Warnings and precautions

Anterograde amnesia
- Memory loss (anterograde amnesia) has been linked to benzodiazepines.
Depression in the CNS:
- It can lead to CNS depression that may result in mental or physical impairments.
- Patients who are unable to perform tasks that require mental alertness should be warned about the dangers of using the drug.
Hypersensitivity reactions
- Flurazepam has been linked to hypersensitivity reactions including anaphylaxis, angioedema and anaphylaxis. Flurazepam should not be used on patients who have angioedema.
Paradoxical reactions
- Paradoxical reactions can occur, which may include aggressive or hyperactive behavior.
- Children and adolescents, patients who are older, patients with personality disorders or psychiatric disorders, and patients who have a history of such disorders, are at greater risk.
Activities that are sleep-related:
- The use of benzodiazepines has been linked to sleep-related dangerous activities like sleep-driving, cooking, eating, and making calls while asleep.
Depression
- Patients who have had a history of depression could be at greater risk for suicidal tendencies. This should be taken with caution.
- To avoid overdosing, patients with depression should only be given the lowest effective dose and for as short a time as possible.
- Some patients may experience a worsening in their depression when they are on benzodiazepine therapy.
Use of drugs:
- Patients who are addicted to drugs or alcoholics should be warned about the dangers of using benzodiazepines.
- Patients who abuse drugs and alcoholics are more likely to become dependent on drugs.
- Patients may develop tolerance to the drug or psychological dependence over time.
Hepatic impairment
- Patients with hepatic impairment should be cautious.
Renal impairment
- Patients with impaired renal function should be cautious.
Respiratory disease
- Patients with respiratory diseases should be cautious.

Flurazepam: Drug Interaction

Risk Factor C (Monitor therapy)
Alcohol (Ethyl)	Alcohol's CNS depressing effect may be amplified by CNS depressants (Ethyl).
Alizapride	CNS depressants may have an enhanced CNS depressant impact.
Aprepitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Bosentan	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Brexanolone	CNS Depressants may enhance the CNS depressant effect of Brexanolone.
Brimonidine (Topical)	May enhance the CNS depressant effect of CNS Depressants.
Bromopride	May enhance the CNS depressant effect of CNS Depressants.
Cannabidiol	May enhance the CNS depressant effect of CNS Depressants.
Cannabis	May enhance the CNS depressant effect of CNS Depressants.
Chlorphenesin Carbamate	May enhance the adverse/toxic effect of CNS Depressants.
Clofazimine	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
CNS Depressants	May enhance the adverse/toxic effect of other CNS Depressants.
CYP3A4 Inducers (Moderate)	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
CYP3A4 Inhibitors (Moderate)	May decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors).
Deferasirox	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Dimethindene (Topical)	May enhance the CNS depressant effect of CNS Depressants.
Doxylamine	May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended.
Dronabinol	May enhance the CNS depressant effect of CNS Depressants.
Duvelisib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Erdafitinib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Erdafitinib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Esketamine	May enhance the CNS depressant effect of CNS Depressants.
Fosamprenavir	May increase the serum concentration of Flurazepam.
Fosaprepitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Fosnetupitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
HydrOXYzine	May enhance the CNS depressant effect of CNS Depressants.
Ivosidenib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Kava Kava	May enhance the adverse/toxic effect of CNS Depressants.
Larotrectinib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Lofexidine	May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Magnesium Sulfate	May enhance the CNS depressant effect of CNS Depressants.
Melatonin	May enhance the sedative effect of Benzodiazepines.
MetyroSINE	CNS Depressants may enhance the sedative effect of MetyroSINE.
Minocycline	May enhance the CNS depressant effect of CNS Depressants.
Mirtazapine	CNS Depressants may enhance the CNS depressant effect of Mirtazapine.
Nabilone	May enhance the CNS depressant effect of CNS Depressants.
Netupitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Palbociclib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Piribedil	CNS Depressants may enhance the CNS depressant effect of Piribedil.
Pramipexole	The sedative effects of pramipexole might be enhanced by CNS depressants.
Ritonavir	Flurazepam serum levels can rise.
ROPINIRole	The sedative effects of CNS depressants may increase those of ROPINIRole.
Rotigotine	Rotigotine's sedative effects may be boosted by CNS depressants.
Rufinamide	CNS depressants' harmful or toxic effects could be increased. Particularly, drowsiness and lightheadedness could be worsened.
Saquinavir	Flurazepam serum levels can rise.
Sarilumab	May lower the serum level of CYP3A4 substrates (High risk with Inducers).
Selective Serotonin Reuptake Inhibitors	Selective serotonin reuptake inhibitors may have a worsened or more hazardous effect when taken with CNS depressants. Particularly, there may be an increased risk of psychomotor impairment.
Siltuximab	May lower the serum level of CYP3A4 substrates (High risk with Inducers).
Simeprevir	May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).
Teduglutide	May increase the serum concentration of Benzodiazepines.
Tetrahydrocannabinol	May enhance the CNS depressant effect of CNS Depressants.
Tetrahydrocannabinol and Cannabidiol	May enhance the CNS depressant effect of CNS Depressants.
Tocilizumab	May lower the serum level of CYP3A4 substrates (High risk with Inducers).
Trimeprazine	CNS depressants may have an enhanced CNS depressant impact.
Yohimbine	May lessen the therapeutic impact of anxiety medications.
Risk Factor D (Consider therapy modification)
Blonanserin	CNS Depressants may enhance the CNS depressant effect of Blonanserin.
Buprenorphine	CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine patches (Butrans brand) at 5 mcg/hr in adults when used with other CNS depressants.
Chlormethiazole	May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used.
CloZAPine	Benzodiazepines may intensify CloZAPine's harmful or hazardous effects. Prior to starting clozapine, consider lowering the dose of benzodiazepines or even stopping them altogether.
CYP3A4 Inducers (Strong)	May increase the metabolism of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling.
CYP3A4 Inhibitors (Strong)	May decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors).
Dabrafenib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects).
Droperidol	May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Enzalutamide	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP3A4 substrate should be performed with caution and close monitoring.
Flunitrazepam	CNS Depressants may enhance the CNS depressant effect of Flunitrazepam.
HYDROcodone	CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Lorlatinib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Avoid concurrent use of lorlatinib with any CYP3A4 substrates for which a minimal decrease in serum concentrations of the CYP3A4 substrate could lead to therapeutic failure and serious clinical consequences.
Methadone	The CNS depressive effect of methadone may be strengthened by benzodiazepines. Management: When at all possible, clinicians should refrain from combining the use of benzodiazepines with methadone; nonetheless, any combination should be used with extreme caution.
Methotrimeprazine	CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established.
MiFEPRIStone	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Minimize doses of CYP3A4 substrates, and monitor for increased concentrations/toxicity, during and 2 weeks following treatment with mifepristone. Avoid cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, and tacrolimus.
Mitotane	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane.
Opioid Agonists	CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
OxyCODONE	CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Perampanel	May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination.
Pitolisant	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Combined use of pitolisant with a CYP3A4 substrate that has a narrow therapeutic index should be avoided. Other CYP3A4 substrates should be monitored more closely when used with pitolisant.
St John's Wort	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling.
Stiripentol	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Use of stiripentol with CYP3A4 substrates that are considered to have a narrow therapeutic index should be avoided due to the increased risk for adverse effects and toxicity. Any CYP3A4 substrate used with stiripentol requires closer monitoring.
Suvorexant	CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended.
Tapentadol	May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Theophylline Derivatives	May diminish the therapeutic effect of Benzodiazepines.
Zolpidem	CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol.
Risk Factor X (Avoid combination)
Azelastine (Nasal)	CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal).
Bromperidol	May enhance the CNS depressant effect of CNS Depressants.
Conivaptan	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Fusidic Acid (Systemic)	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Idelalisib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
OLANZapine	May intensify the harmful or negative effects of benzodiazepines. Due to the possibility of cumulative negative side effects, avoid using parenteral benzodiazepines and intramuscular olanzapine concurrently (e.g., cardiorespiratory depression). There are no particular instructions for oral administration in the prescribing information for olanzapine.
Orphenadrine	The CNS depressing action of orphenadrine may be enhanced by CNS depressants.
Oxomemazine	CNS depressants may have an enhanced CNS depressant impact.
Paraldehyde	The CNS depressing effects of paraldehyde may be enhanced by CNS depressants.
Sodium Oxybate	The CNS depressive effects of Benzodiazepines and Sodium Oxybate may be enhanced.
Thalidomide	The CNS depressing effect of thalidomide may be enhanced by CNS depressants.

Monitoring parameters:

Daytime alertness;
respiratory rate;
behavior profile

How to administer Flurazepam?

It should be taken at bedtime without regard to meals.

Mechanism of action of Flurazepam:

At several locations across the central nervous system, including the limbic and reticular systems, it binds to stereospecific GABA neuron postsynaptic GABA receptors.
By boosting the inhibitory effect GABA exerts on neuronal excitability, it is feasible to increase the permeability of neuronal membranes for chloride ions.
This change in the chloride ions causes stability and hyperpolarization (a less excitable state).
The GABA-A receptors appear to be related to the actions and receptors of benzodiazepines.
GABAB receptors are not occupied by benzodiazepines.

Absorption:

Rapid

Protein binding:

Flurazepam: ~97 percent; N-desalkylflurazepam: ~98 percent.

Metabolism:

Hepatic to N-desalkylflurazepam (active) and N-hydroxyethylflurazepam

Half-life elimination:

Flurazepam: 2.3 hours
N-desalkylflurazepam:
- Adults:
  - Single dose: 74 to 90 hours;
  - Multiple doses: 111 to 113 hours
- Elderly (61 to 85 years):
  - Single dose: 120 to 160 hours;
  - Multiple doses: 126 to 158 hours

Time to peak, serum:

Flurazepam: 30 to 60 minutes
N-desalkylflurazepam: 10.6 hours (range: 7.6 to 13.6 hours)
N-hydroxyethylflurazepam: ~1 hour

Excretion:

Urine: N-hydroxyethylflurazepam (22 percent to 55 percent );
N-desalkylflurazepam (<1%)

International Brand Names of Flurazepam:

BIO-Flurazepam
Dalmane 15
Fordrim
Insumin
Manlsum
Nergart
Noctosom
Slipam
Somlan
Dalmane 30
PMS-Flurazepam
Som-Pam
Aluctin
Dalmadorm
Dalmane
Dalmapam
Dalpam
Dormodor
Felison
Florapam
Flunox
Fluralema
Fluraz
Fluzepam
Staurodorm
Valdorm

Flurazepam Brand Names in Pakistan:

Flurazepam (HCl) Tablets 15 mg in Pakistan
Zemon	Evron (Pvt) Ltd.

Disclaimer Notice:

Emedz.net is not an online pharmacy:

We are not affiliated with any pharmaceutical companies:

Flurazepam (Dalmane) - Uses, Dose, Side effects, MOA, Brands

Flurazepam Uses:

Insomnia:

Flurazepam dose in Adults

Flurazepam dose in the treatment of Insomnia in Adults:

Flurazepam dose in Children

Flurazepam dose in the treatment of Insomnia in adolescents aged 15 years or more: Limited data available:

Pregnancy Risk Factor C

Use flurazepam while breastfeeding

Dose in Kidney Disease:

Dose in Liver disease:

Side effects of Flurazepam:

Cardiovascular:

Central Nervous System:

Dermatologic:

Endocrine & Metabolic:

Gastrointestinal:

Hematologic & Oncologic:

Hepatic:

Neuromuscular & Skeletal:

Ophthalmic:

Respiratory:

Contraindication to Flurazepam Include:

Warnings and precautions

Anterograde amnesia

Depression in the CNS:

Hypersensitivity reactions

Paradoxical reactions

Activities that are sleep-related:

Depression

Use of drugs:

Hepatic impairment

Renal impairment

Respiratory disease

Monitoring parameters:

How to administer Flurazepam?

Mechanism of action of Flurazepam:

International Brand Names of Flurazepam:

Flurazepam Brand Names in Pakistan:

Flurazepam (HCl) Tablets 15 mg in Pakistan

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