Lorazepam/temazepam
1
Reactions 1264 - 8 Aug 2009 Lorazepam/temazepam Sleep apnoea syndrome and respiratory insufficiency: case report A 63-year-old woman, who had obstructive sleep apnoea/hypopnoea syndrome experienced exacerbation of her symptoms during treatment with lorazepam and temazepam for insomnia. The woman, a lifetime smoker with squamous cell cancer of the tonsil who had opted for palliative care, was admitted to a hospice in January 2008 for symptom control of insomnia. She had a 36-year history of poor sleep, that had been successfully managed with temazepam 10mg nocte [duration of therapy not stated], but her sleep had deteriorated over the previous 3 weeks with overnight wakefulness and subsequent daytime somnolence. A trial of lorazepam 0.5mg nocte [duration of treatment not stated] had not improved sleep but had exacerbated her daytime drowsiness. Other medications included morphine [Oramorph] and amitriptyline. Her temazepam dosage was increased to 20mg nocte to improve her sleep pattern. The following day, her somnolence was such that the patient fell asleep in the consultation and was noted to have periods of apnoea followed by abrupt waking. Physical examination revealed the oropharynx was obscured by tumour bulk. Overnight pulse oximetry confirmed numerous episodes of desaturation (minimum saturation 77%) with corresponding periods of tachycardia (maximum pulse 127 beats/min), consistent with obstructive sleep apnoea. A trial of nasal CPAP support was started, however the woman could not tolerate the mask. To minimise contributory sedative effects from medication, her temazepam was reduced to 10mg nocte, morphine was stopped and amitriptyline was reduced to a twice daily regimen. She was advised to sleep on her front or side to maintain airway patency. Author comment: "The symptoms of daytime sleepiness in this case appear to have been exacerbated by both lorazepam and temazepam. This may be due to a hangover effect, or it is possible that the introduction of a benzodiazepine worsened the patient’s nocturnal apnoeic symptoms with a consequent increase in daytime sleepiness." Dando N, et al. An unusual cause of insomnia. Palliative Medicine 23: 471-472, No. 5, 2009 - England 801146833 1 Reactions 8 Aug 2009 No. 1264 0114-9954/10/1264-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Lorazepam/temazepam
Reactions 1264 - 8 Aug 2009
Lorazepam/temazepam
Sleep apnoea syndrome and respiratoryinsufficiency: case report
A 63-year-old woman, who had obstructive sleepapnoea/hypopnoea syndrome experienced exacerbation ofher symptoms during treatment with lorazepam andtemazepam for insomnia.
The woman, a lifetime smoker with squamous cellcancer of the tonsil who had opted for palliative care, wasadmitted to a hospice in January 2008 for symptom controlof insomnia. She had a 36-year history of poor sleep, thathad been successfully managed with temazepam 10mgnocte [duration of therapy not stated], but her sleep haddeteriorated over the previous 3 weeks with overnightwakefulness and subsequent daytime somnolence. A trialof lorazepam 0.5mg nocte [duration of treatment notstated] had not improved sleep but had exacerbated herdaytime drowsiness. Other medications includedmorphine [Oramorph] and amitriptyline. Her temazepamdosage was increased to 20mg nocte to improve her sleeppattern. The following day, her somnolence was such thatthe patient fell asleep in the consultation and was noted tohave periods of apnoea followed by abrupt waking.Physical examination revealed the oropharynx wasobscured by tumour bulk. Overnight pulse oximetryconfirmed numerous episodes of desaturation (minimumsaturation 77%) with corresponding periods of tachycardia(maximum pulse 127 beats/min), consistent withobstructive sleep apnoea.
A trial of nasal CPAP support was started, however thewoman could not tolerate the mask. To minimisecontributory sedative effects from medication, hertemazepam was reduced to 10mg nocte, morphine wasstopped and amitriptyline was reduced to a twice dailyregimen. She was advised to sleep on her front or side tomaintain airway patency.
Author comment: "The symptoms of daytime sleepinessin this case appear to have been exacerbated by bothlorazepam and temazepam. This may be due to a hangovereffect, or it is possible that the introduction of abenzodiazepine worsened the patient’s nocturnal apnoeicsymptoms with a consequent increase in daytime sleepiness."Dando N, et al. An unusual cause of insomnia. Palliative Medicine 23: 471-472,No. 5, 2009 - England 801146833
1
Reactions 8 Aug 2009 No. 12640114-9954/10/1264-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
