Estazolam

INTRODUCTION

Indications

Short-term management of insomnia.

Action

Depresses the CNS, probably by potentiating gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter. Therapeutic Effects: Relief of insomnia.

Adverse Reactions/Side Effects

CNS: abnormal thinking, behavior changes, drowsiness, hallucinations, headache, weakness, abnormal dreams, sleep-driving, confusion, depression, dizziness, hangover, malaise, nervousness. Resp: cold symptoms, pharyngitis. CV: chest pain. GI: abdominal pain, dyspepsia, nausea. MS: back pain, lower extremity pain, stiffness. Neuro: abnormal coordination, hypokinesia. Misc: body pain, physical dependence, psychologic dependence.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor daytime drowsiness, short-term memory deficits, and, “hangover” symptoms (headache, nausea, malaise, irritability, dysphoria). Repeated or excessive symptoms may require change in dose or medication.

• Be alert for confusion, depression, nervousness, abnormal thoughts, hallucinations, or other alterations in cognitive function (See Appendix D). Notify physician promptly if these symptoms develop.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Report any coordination problems or decreased bodily movements (hypokinesia) that are consistent with onset of drug therapy or changes in drug dose.

• Assess any back pain, lower extremity pain, weakness, or stiffness to rule out musculoskeletal pathology; that is, try to determine if symptoms are drug induced rather than caused by anatomic or biomechanical problems.

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth). Implement fall-prevention strategies, especially in older adults or if drowsiness and dizziness carry over into the daytime (see Appendix E).

• Help patient explore nonpharmacologic methods to improve sleep, such as relaxation techniques, regular exercise, avoidance of caffeine, and so forth.

Patient/Client-Related Instruction

• Instruct patients on prolonged treatment not to discontinue medication without consulting their physician. Long-term use can cause tolerance and physical/psychologic dependence, and increased sleep problems (rebound insomnia) can occur when the drug is suddenly discontinued.

• Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

• Caution patient and family/caregivers to guard against complex motor behaviors that can occur while asleep, including driving a car.

• Instruct patient to report other bothersome side effects, including severe or prolonged headache, cold symptoms, irritation of the throat and pharynx, chest pain, or GI problems (nausea, abdominal pain, indigestion).

Pharmacokinetics

Absorption: Well absorbed following oral administration.

Distribution: Highly lipid soluble. Crosses the blood-brain barrier and placenta; enters breast milk.

Protein Binding: 93%.

Metabolism ...