CLINICAL USE

Hypnotic

DOSE IN NORMAL RENAL FUNCTION

3.75–7.5 mg at night

PHARMACOKINETICS

  • Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp : 388.8
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp : 45–80
  • %Excreted unchanged in urine &nbsp &nbsp : <5

  • Volume of distribution (L/kg) &nbsp &nbsp &nbsp : 91.8–104.6 litres

  • half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp : 3.5–6.5/Unchanged

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50 &nbsp &nbsp : Dose as in normal renal function
  • 10 to 20 &nbsp &nbsp : Dose as in normal renal function
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : Start with lower dose

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp: Dialysed. Dose as in GFR <10 mL/min

  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp : Dialysed. Dose as in GFR <10 mL/min
  • HDF/high flux &nbsp : Dialysed. Dose as in GFR <10 mL/min
  • CAV/VVHD &nbsp &nbsp &nbsp: Dialysed. Dose as in normal renal function

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs
  • Antibacterials: metabolism inhibited by erythromycin and quinupristin/ dalfopristin; concentration significantly reduced by rifampicin
  • Antipsychotics: enhanced sedative effects
  • Antivirals: concentration possibly increased by ritonavir

    ADMINISTRATION

    Reconstition

    –

    Route

    Oral

    Rate of Administration

    –

    Comments

    –

    OTHER INFORMATION

    It is recommended that elderly patients and those with severe renal disease should start treatment with 3.75 mg; however, accumulation has not been observed .
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