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Flurazepam (Dalmane)

A long-acting benzodiazepine sleep medication with a long history, largely displaced by shorter-acting options and generally avoided in older adults.

Medically reviewed by Shariq Refai, MD, MBA Last reviewed: June 8, 2026

What it treats

Flurazepam is approved by the U.S. Food and Drug Administration for short-term treatment of insomnia, particularly when trouble falling asleep and trouble staying asleep are both problems.

In practice, current clinical guidelines and Beers Criteria steer away from long-acting benzodiazepines like flurazepam for insomnia, in favor of shorter-acting options or, increasingly, non-benzodiazepine choices such as ramelteon, low-dose doxepin, and the orexin antagonists (suvorexant, lemborexant, daridorexant).

How it works

Flurazepam is a benzodiazepine. It strengthens the effect of GABA, the brain's main calming chemical messenger. That reduces nerve activity broadly and produces sedation, hypnosis, and reduced anxiety.

Its practical distinction is duration. Flurazepam itself has a short half-life, but it's metabolized to N-desalkylflurazepam, which has a half-life of 40 to 250 hours. That long-lived metabolite is what continues acting after the initial dose has worn off. Over several nights, it accumulates.

Receptor mechanism (detail)

Flurazepam is a positive allosteric modulator at the GABA-A receptor. It makes GABA's own effect stronger. Its clinical duration is set by its long-acting metabolite N-desalkylflurazepam, which builds up over several nights of dosing and gives flurazepam a total effective duration far longer than the drug you take.

Potency and typical dosing pattern

Ranges are typical framework only, not a prescription for any individual.

Adults: 15 to 30 mg at bedtime. Older adults: 15 mg at bedtime, with careful review of whether flurazepam is the right choice at all (see Beers Criteria).

Safety monitoring

  • Next-day sedation and impaired driving. More pronounced than with short-acting sleep medications because of metabolite accumulation.
  • Fall risk in older adults. Beers Criteria specifically flags long-acting benzodiazepines like flurazepam as potentially inappropriate in older adults.
  • Dependence and tolerance. Not intended for long-term use.
  • Respiratory depression with opioids or alcohol (FDA boxed warning).
  • Cognitive impairment. Memory and reaction time can be affected the next day.
  • Withdrawal seizures with abrupt discontinuation of long-term use.
  • Paradoxical disinhibition, occasional.

What to expect

The first few nights

Falling asleep and staying asleep both usually improve quickly. What's less obvious is that the sedating effect is not confined to bedtime. Metabolites accumulate, so nights 3, 4, and 5 may feel more sedating (and next-day grogginess more noticeable) than night 1.

Common side effects

  • Next-day drowsiness, sometimes lasting into the afternoon.
  • Dizziness and unsteadiness.
  • Coordination and balance problems (particularly a concern with nighttime bathroom trips in older adults).
  • Headache.
  • Dry mouth.
  • Confusion in older adults.

If a side effect is bothersome or persistent, that's a conversation for the prescriber. Don't just stop after regular use.

Serious side effects and warnings

Boxed warning: dependence and withdrawal. Benzodiazepines carry an FDA boxed warning about abuse, misuse, addiction, physical dependence, and withdrawal.

Boxed warning: combining with opioids. Benzodiazepines and opioids together can cause profound sedation, slowed breathing, coma, and death.

  • Falls and fractures in older adults. Long-acting benzodiazepines are a well-documented driver of hip fractures in this group.
  • Impaired driving. Studies show measurably worse driving performance the day after flurazepam.
  • Complex sleep behaviors. Sleepwalking, sleep-eating, and sleep-driving have been reported with benzodiazepines and z-drugs.
  • Respiratory depression in patients with sleep apnea or COPD.
  • Dependence can develop, and abrupt stopping after long-term use can trigger withdrawal, including seizures.

Sexual side effects

Flurazepam isn't particularly associated with sexual side effects. Reduced libido is occasionally reported.

Weight, appetite, and sleep

Flurazepam is a sleep medication. Weight and appetite aren't typical concerns. The relevant sleep concern is that heavy sedation isn't the same as good sleep, and long-acting sedation bleeds into daytime alertness.

Starting and dosing basics

This section is general background, not a dosing instruction for any individual. The right dose is a decision for a prescriber.

Flurazepam comes as capsules. It's meant for short courses, not open-ended use. In older adults, a lower dose (or a different medication) is generally the safer choice.

Missed doses and interactions

If a night is missed, don't double up the next night. Alcohol and other sedatives (including opioids, sedating antihistamines, and other benzodiazepines) add to drowsiness and respiratory suppression and should be approached with care. Give every prescriber and pharmacist the full medication list.

Stopping and tapering

Flurazepam should not be stopped abruptly after regular use. The taper is a prescriber's decision and usually steps the dose down over 1 to 4 weeks depending on how long it's been taken. Because metabolites are so long-lived, some of the taper is "built in", but that isn't a reason to stop cold.

Pregnancy and breastfeeding

Benzodiazepines are generally avoided in pregnancy and breastfeeding unless a clinician judges they are needed. Anyone pregnant, planning a pregnancy, or breastfeeding should discuss flurazepam with their prescriber.

Cost and generic availability

Flurazepam is generic and inexpensive. Cost is rarely the reason it isn't chosen. The reason is that shorter-acting options usually make more clinical sense.

Common questions

Why is flurazepam considered outdated for sleep? Because its long-acting metabolite sticks around for days. That produces next-day drowsiness, worse balance, and, in older adults, a documented rise in falls and fractures. Shorter-acting options (or non-benzodiazepine options) usually give a better safety profile.

Should I take it if I'm over 65? Usually not. The American Geriatrics Society Beers Criteria specifically lists long-acting benzodiazepines as potentially inappropriate in older adults. If a prescriber does choose flurazepam, they've weighed the trade-offs carefully.

Is it addictive? It carries the same class-level risk of dependence as other benzodiazepines. Regular use over weeks can lead to tolerance and withdrawal on stopping.

Can I drink while taking it? No. Alcohol and flurazepam together deepen sedation and slow breathing.

Questions to ask your prescriber

  • Why is flurazepam the right sleep medication for me over shorter-acting options?
  • How long do you expect me to take it?
  • What next-day effects should I watch for, especially with driving?
  • If I'm over 65, is there a safer alternative?
  • How would we stop it when the time comes?

Sources

This guide draws on current prescribing information and public health references. It is reviewed for clinical accuracy and updated as guidance changes and current as of June 8, 2026.

Define this drug class in the network glossary Benzodiazepine on Shrinktionary

THE KNOWLEDGE PATH

Walk this topic outward.

  1. MEDICATION Flurazepam (Dalmane) (current)
  2. CLASS Benzodiazepines
  3. CONDITION Generalized Anxiety Disorder (on Shrinkopedia)
  4. MAP The Generalized Anxiety Map (on AR)
  5. CARE Anxiety care at shrinkMD

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When to seek urgent help

Benzodiazepines can be especially dangerous when combined with opioids, alcohol, or other sedating medications, and when stopped suddenly after regular use. Don't stop or change the dose on your own.

  • Severe drowsiness, slowed or weak breathing, blue lips, or unresponsiveness, especially after combining with opioids, alcohol, or other sedatives.
  • A seizure, severe tremor, hallucinations, or extreme anxiety after missing doses or stopping.
  • A fall, especially with a head injury or possible fracture.

If you or someone else is in immediate danger, or thinking about suicide: in the U.S., call or text 988 for the Suicide and Crisis Lifeline, call 911, or go to the nearest emergency room. Outside the U.S., see findahelpline.com for a local crisis line.

Managing a medication needs a prescriber

Any psychiatric medication has to be started and adjusted by a clinician who can follow you over time. If you don't have a prescriber, our guides section explains the options, including in-person care and telepsychiatry, and how to choose between them.