PharmaceuticalBenzodiazepineSchedule IVLong-acting hypnotic

Flurazepam

Also known as Dalmane · Dalmadorm

Written by enwyReviewed 5 Aug 20262 sources0 comments

Long-acting benzodiazepine hypnotic approved for insomnia. Effective for sleep onset and maintenance but its very long-lived active metabolite causes pronounced day-after sedation and drug accumulation, and it carries the full benzodiazepine dependence and withdrawal profile.

01 Overview

Flurazepam (brand Dalmane) is one of the original benzodiazepine hypnotics, FDA-approved in 1970 for short-term treatment of insomnia. It is reliably effective at reducing sleep onset latency and nocturnal awakenings.

Its defining liability is pharmacokinetic: flurazepam is metabolised to N-desalkylflurazepam, an active metabolite with a half-life of 40-250 hours that accumulates with nightly use, producing marked next-day sedation, cognitive impairment, and fall risk, particularly in the elderly. As a benzodiazepine it produces tolerance, physical dependence, and a withdrawal syndrome, and it is a Schedule IV controlled substance. It has largely been superseded by shorter-acting agents.

02 Mechanism

Positive allosteric modulator at the benzodiazepine site of GABA-A receptors, enhancing GABA-mediated chloride influx and CNS depression; the long-lived active metabolite N-desalkylflurazepam prolongs the effect.

03 Dosing

Tier	Dose	Route	Notes
Adult	15–30 mg/day	Oral	15-30 mg at bedtime; use 15 mg in the elderly and for the shortest duration possible.

04 Effects

Effect	Magnitude	Evidence
Reduced sleep onset latencyReliably shortens time to fall asleep.		Clinical
Improved sleep maintenanceReduces nocturnal awakenings; the long half-life sustains effect through the night.		Clinical

05 Side effects

Effect	Severity	Frequency	Evidence
Drug accumulation / next-day sedationThe long-lived active metabolite accumulates over consecutive nights, causing daytime drowsiness, cognitive impairment, and falls.	Moderate	Very common with continued use	Clinical
Dependence and withdrawalTolerance, physical dependence, and a withdrawal syndrome (rebound insomnia, anxiety, seizures on abrupt cessation).	Severe	Common with prolonged use	Clinical
Respiratory depression with CNS depressantsDangerous, potentially fatal respiratory depression when combined with opioids or alcohol.	Life-threatening	Uncommon but potentially fatal	Clinical

06 Legal status

United Kingdom

Class C / Schedule 4 (CD)

Prescription-only controlled drug. · as of Jan 2026

United States

Schedule IV

FDA-approved 1970; DEA Schedule IV benzodiazepine. · as of Jan 2026

07 References

Flurazepam: pharmacokinetics of the active metabolite and clinical hangoverClin Pharmacol Ther / review

Dalmane (flurazepam) prescribing informationUS FDA

08 Discussion0 comments

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This page is reference information, not medical advice. Doses and protocols are documented as they appear in the clinical literature and in practice — describing them is not a recommendation to use them. Countermeasures listed here are not a substitute for a physician. Legal status varies by jurisdiction and changes.