<unk>  has fewer side effects than other benzodiazepines and less potential to induce tolerance and rebound effects. There is significantly less potential for<unk>  to induce respiratory depression or to adversely affect motor coordination than other benzodiazepines. The different side effect profile of<unk>  may be due to its more selective binding profile to type 1 benzodiazepine receptors. *Ataxia *Daytime somnolence *Hypokinesia *Cognitive and performance impairments In September 2020, the U.S. Food and Drug Administration (FDA) required the boxed warning be updated for all benzodiazepine medicines to describe the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions consistently across all the medicines in the class. Tolerance and dependence Tolerance may occur to<unk>  but more slowly than seen with other benzodiazepines such as triazolam.<unk>  causes significantly less drug tolerance and less withdrawal symptoms including less rebound insomnia upon discontinuation compared to other benzodiazepines.<unk>  may cause less rebound effects than other type1 benzodiazepine receptor selective nonbenzodiazepine drugs due to its longer half-life. Short-acting hypnotics often cause next day rebound anxiety.<unk>  due to its pharmacological profile does not cause next day rebound withdrawal effects during treatment. No firm conclusions can be drawn, however, whether long-term use of<unk>  does not produce tolerance as few, if any, long-term clinical trials extending beyond 4 weeks of chronic use have been conducted.<unk>  should be withdrawn gradually if used beyond 4 weeks of use to avoid the risk of a severe benzodiazepine withdrawal syndrome developing. Very high dosage administration over prolonged periods of time, up to 52 weeks, of<unk>  in animal studies provoked severe withdrawal symptoms upon abrupt discontinuation, including excitability, hyperactivity, convulsions and the death of two of the monkeys due to withdrawal-related convulsions. More monkeys died however, in the diazepam-treated monkeys. In addition it has now been documented in the medical literature that one of the major metabolites of<unk> , N-desalkyl-2-oxoquazepam (N-desalkylflurazepam), which is long-acting and prone to accumulation, binds unselectively to benzodiazepine receptors, thus<unk>  may not differ all that much pharmacologically from other benzodiazepines. Special precautions Benzodiazepines require special precaution if used in the during pregnancy, in children, alcohol or drug-dependent individuals and individuals with comorbid psychiatric disorders.<unk>  and its active metabolites are excreted into breast milk. Accumulation of one of the active metabolites of<unk> , N-desalkylflurazepam, may occur in the elderly. A lower dose may be required in the elderly. Elderly<unk>  is more tolerable for elderly patients compared to flurazepam due to its reduced next day impairments. However, another study showed marked next day impairments after repeated administration due to accumulation of<unk>  and its long-acting metabolites. Thus the medical literature shows conflicts on<unk> 's side effect profile. A further study showed significant balance impairments combined with an unstable posture after administration of<unk>  in test subjects. An extensive review of the medical literature regarding the management of insomnia and the elderly found that there is considerable evidence of the effectiveness and durability of non-drug treatments for insomnia in adults of all ages and that these interventions are underutilized. Compared with the benzodiazepines including<unk> , the nonbenzodiazepine sedative/hypnotics appeared to offer few, if any, significant clinical advantages in efficacy or tolerability in elderly persons. It was found that newer agents with novel mechanisms of action and improved safety profiles, such as the melatonin agonists, hold promise for the management of chronic insomnia in elderly people. Long-term use of sedative/hypnotics for insomnia lacks an evidence base and has traditionally been discouraged for reasons that include concerns about such potential adverse drug effects as cognitive impairment (anterograde amnesia), daytime sedation, motor incoordination, and increased risk of motor vehicle accidents and falls. In addition, the effectiveness and safety of long-term use of these agents remain to be determined. It was concluded that more research is needed to evaluate the long-term effects of treatment and the most appropriate management strategy for elderly persons with chronic insomnia.
Quazepam
Halazepam
Oxazepam
Triazolam
Gidazepam
Nordazepam
Bromazepam
Cinolazepam