Side effects of<unk>  are similar to those of other hypnotic benzodiazepines and can for the most part be regarded as a class effect. In a sleep study, 1 mg<unk>  increased total sleep time, reduced wakefulness, but did not alter REM sleep. However, at 2 mg doses, there were significant increases in stage 3 sleep and reductions in REM sleep. Rebound effects have been reported after chronic use including rebound REM. In one clinical trial with patients who had prior experience with older hypnotics temazepam and nitrazepam, most preferred<unk>  due to less heavy sedation, amnesia, and residual effects. Some side effects, including drowsiness, amnesia, and respiratory depression, are increased when<unk>  is combined with other drugs with similar effects, e.g. alcohol and nonbenzodiazepine drugs. Although<unk>  has been associated with adversely affecting immediate and delayed recall memory functions, studies have shown that<unk> 's amnesic properties may be lesser compared to other hypnotic benzodiazepines. For example, in a 1984 study comparing the amnesic effects of<unk>  to temazepam and flurazepam showed that amnesia was smallest after<unk>  and greatest after temazepam, which had produced greater amnesia than both<unk>  and flurazepam by a significant margin. Side effects of<unk>  include: *somnolence *paradoxical increase in aggression *lightheadedness *confusion *muscle weakness *ataxia (particularly in the elderly) *anterograde amnesia *headache *vertigo *hypotension *salivation changes *gastro-intestinal disturbances *visual disturbances *dysarthria *tremor *changes in libido *incontinence *urinary retention *blood disorders and jaundice *skin reactions *dependence and withdrawal reactions Residual "hangover" effects after nighttime administration of<unk>  such as sleepiness, impaired psychomotor and cognitive functions may persist into the next day which may impair the ability of users to drive safely and increase risks of falls and hip fractures. Benzodiazepines require special precaution if used during pregnancy, in children, in alcohol- or drug-dependent individuals and individuals with comorbid psychiatric disorders.<unk>  may be unsuitable for the elderly due to residual effects on memory and body sway which may result in falls.<unk>  causes impaired driving skills, thus caution is required in individuals who drive or operate machinery. Tolerance, dependence, and withdrawal The risks of tolerance, dependence, and withdrawal are very low when the drug is used for 2–4 weeks only, and<unk>  is generally a safe and effective drug when used for no longer than 2–4 weeks. Some sleep disturbance in the form of rebound insomnia can, however, occur even after short-term usage of 7 days. Those with a history of addiction may be at increased risk of problems of tolerance and dependence especially those with a past history of dependency on sedative hypnotic drugs.<unk>  as with other benzodiazepines is generally only recommended for short-term use (2–4 weeks) due to tolerance and loss of efficacy. Tolerance to and loss of the sedative effects of benzodiazepine hypnotics can occur within 14 days of regular use. Some studies however suggest such treatments retain their effectiveness in the long term - such a lack of consistency in the findings of many studies could be due to the variation of responses to benzodiazepine treatment. Dependence is the medical term for addiction. Dependence can either be psychological and/or physical. Psychological dependence can manifest itself as a reliance on a drug to cope with everyday life or in the form of craving. Physical dependence occurs due to physiological adaptations occurring as the body attempts to overcome the drugs effects which is known as tolerance and the continuing need to take the drug to avoid or suppress withdrawal symptoms which can sometimes resemble the original condition being treated. When the dose or the drug is discontinued withdrawal symptoms typically occur.<unk>  as with all other benzodiazepines produces both physical and psychological dependence but the main problem of concern is physical dependence which appears in the form of the benzodiazepine withdrawal syndrome after the dosage is reduced or the drug is stopped completely. The dependence induced by<unk>  is related to changes in the sensitivity of the GABA-BZD receptor complex. Withdrawal symptoms which can occur from stopping benzodiazepines such as<unk>  can include: *rebound insomnia and nightmares *anxiety, panic attacks, and agoraphobia *clinical depression *malaise *lack of concentration *abdominal discomfort *depersonalisation and feelings of unreality *emotional lability *cognitive impairment *tinnitus *paraesthesiae, tingling, numbness, and pain *muscle pain, weakness, tension, painful tremor, shaking attacks, jerks, blepharospasm *excitability, jumpiness, and restlessness *stiffness *sweats Abrupt or over rapid withdrawal from high doses can provoke: *epileptic seizures *hallucinations (visual, auditory) *misperceptions Withdrawal symptoms typically subside after 4–8 weeks but in approximately 10-15% of individuals symptoms can persist for many months and in rare cases years. Some "Withdrawal Symptoms" can emerge despite a constant dosage with the body needing extra dosage in order to feel normal. This is sometimes associated with dosage escalation.<unk>  has a short to intermediate half-life of approximately 10–12 hours. Shorter acting benzodiazepine compounds are generally associated with a more intense and immediate withdrawal reaction compared to longer acting benzodiazepines. For this reason it is generally recommended to cross from<unk>  to an equivalent dose of diazepam to gradually taper the dosage.
Lormetazepam
Cinolazepam
Halazepam
Triazolam
Medazepam
Diclazepam
Phenazepam
Oxazepam