Temazepam

Temazepam's muscle relaxant properties reduce upper airway tone, potentially worsening obstruction in patients with obstructive sleep apnea. Standard clinical guidance contraindicates benzodiazepines in this population.

Temazepam's muscle relaxant effect may worsen muscle weakness in myasthenia gravis, potentially compromising respiratory function. StatPearls lists myasthenia gravis as a contraindication.

In patients with severe depression and active suicidal ideation, temazepam's CNS depressant and disinhibitory effects may increase suicide risk. Benzodiazepines may facilitate impulsive behavior while impairing judgment.

Patients with a history of substance use disorder face elevated risk of temazepam misuse and dependence. The historical gel capsule injection crisis in the UK and Australia concretely demonstrates this risk. Mesolimbic dopamine disinhibition mediates reinforcement.

Severe hepatic impairment may reduce glucuronide conjugation capacity, prolonging temazepam's elimination half-life and increasing exposure. While temazepam is less affected by liver disease than CYP-metabolized benzodiazepines, severe impairment warrants caution.

Patients with known hypersensitivity to temazepam or other benzodiazepines must not receive this substance due to risk of allergic or anaphylactic reactions.

Temazepam carries FDA Pregnancy Category X designation. Animal studies documented fetal harm including exencephaly and rib abnormalities. In utero benzodiazepine exposure in humans is associated with neonatal withdrawal syndrome characterized by hypotonia, respiratory depression, and hypothermia.

Elderly patients demonstrate increased pharmacodynamic sensitivity to temazepam, producing enhanced sedation, psychomotor impairment, and fall risk at standard doses. Meta-analysis found adverse cognitive events 4.78× more common with sedative-hypnotics vs placebo in older adults. Hip fracture risk is elevated. Not an absolute contraindication but warrants particular caution and lowest effective dosing.

Benzodiazepines may cause mydriasis, increasing intraocular pressure in patients with narrow-angle glaucoma. This is a class-level contraindication applied to temazepam by structural analogy with other benzodiazepines.

Co-administration with alcohol produces synergistic CNS depression with potentially fatal respiratory compromise. Acute alcohol intoxication amplifies all temazepam effects including respiratory depression, sedation, and cognitive impairment.

Injection of temazepam by any route causes severe, often irreversible vascular injury. Histological examination demonstrated limb ischaemia in all cases studied. Intra-arterial injection invariably leads to tissue loss and amputation. Documented complications include gangrene, compartment syndrome, rhabdomyolysis, and death. This is an absolute contraindication specific to temazepam, not a general benzodiazepine class effect.