Temazepam and diazepam belong to the same class of medicines called benzodiazepines. Despite the same classification both drugs are prescribed and used to treat different conditions and have a different effects on the body. Temazepam vs diazepam highlights similarities and differences between both drugs.
Temazepam vs Diazepam: legal classification
Temazepam and diazepam are both prescription-only medicines (POMs). Both drugs belong to a different categories of controlled drugs. In the UK, controlled drugs are classified as controlled drugs schedule 1, 2, 3, 4a, 4b and 5.
Temazepam is classified as a schedule 3 controlled drug, whereas diazepam is schedule 4. From a patient perspective, the difference in legal classification between temazepam and diazepam does not mean much. From the operational point of view, temazepam has additional storage requirements, which means it has to be stored in a safe (NICE BNF, 2022).
Prescriptions for temazepam and diazepam have additional legal requirements and restrictions, which are different from other prescription-only drugs.
Temazepam vs diazepam: licensed use
When compared to diazepam, temazepam has narrower licensed use. Temazepam is mainly prescribed to treat insomnia (short-term use) but also can be used as a conscious sedative for dental procedures and as premedication given before surgery.
Diazepam is licensed for:
- Muscle spasm
- Tetanus (muscle tension)
- Insomnia caused by anxiety
- Acute anxiety and agitation
- Control of panic attacks
- Acute alcohol withdrawal
- Dystonic reactions (involuntary contractions of muscles) caused by drugs
- Sedation in dental procedures
- Seizures (status epilepticus), convulsions (febrile convulsions and convulsions caused by poisoning)
- Pain due to muscle spasm in terminally ill patients
Generally, benzodiazepines are used short-term and only to treat severe anxiety. The use of benzodiazepines to treat insomnia is limited to severe and disabling cases of sleeping problems.
Both drugs have a similar mechanism of action, and both can cause sedation.
Why is diazepam licensed for the treatment of varied conditions and prescribed more commonly than temazepam?
One of the contributing factors which affect the popularity of diazepam over temazepam is the duration of action between drugs.
Diazepam has a much longer duration of action than temazepam. Drugs with a shorter mechanism of action (temazepam) are more likely to cause dependence (addiction). Diazepam stays in the body for much longer, hence it is less likely to cause dependence (physical and psychological).
Temazepam vs Diazepam: withdrawal symptoms
Additionally, the use of benzodiazepines is associated with withdrawal symptoms. For long-acting benzodiazepines, like temazepam, withdrawal symptoms may develop at any time up to three weeks after stopping the treatment (NICE BNF, 2022).
For short-acting benzodiazepines, such as diazepam, withdrawal symptoms may happen just after one day of stopping the treatment (ibid).
Dose reduction is recommended to avoid withdrawal symptoms. Patients who take benzodiazepines short-term (2-4 weeks) can stop benzodiazepines after a dose reduction within 2-4 weeks. Patients who use benzodiazepines long-term may need a long period of dose reduction over a few months or longer.
What withdrawal symptoms may be experienced with diazepam or temazepam?
Withdrawal symptoms after stopping benzodiazepines may include (NICE BNF, 2022):
- Loss of appetite
- Loss of body weight
- Perspiration (sweating)
- Tinnitus (ringing in the ears)
Temazepam vs diazepam: risk of side effects
Use of temazepam or diazepam is associated with the possibility of side effects, for example:
- Ataxia (involuntary movement)
- Impaired motor ability
What are temazepam s and diazepam’s alternatives?
Benzodiazepines are represented by a large class of drugs. Alternatives drugs to temazepam and diazepam will differ depending on the condition treated.
Recently (September and beyond) temazepam became out of stock in the UK. Read more about temazepam shortage. The price of temazepam 10mg and 20mg tablets skyrocketed, making the supply to patients more difficult. Temazepam alternative drugs are currently in demand. Since temazepam is mainly prescribed for short-term treatment of insomnia, I will list temazepam alternatives indicated for this condition.
- Nitrazepam is a benzodiazepine, licensed in the UK for short-term treatment of insomnia. Other benzodiazepines indicated for short-term treatment of insomnia include oxazepam, lorazepam.
- Z-drugs (benzodiazepines) are commonly prescribed for the short-term management of insomnia. Zopiclone and zolpidem are two widely prescribed drugs.
- Melatonin – not commonly prescribed for adults (but children), despite its licensed indication for short-term use in adults over 55 years of age (modified-release melatonin). For adults, it is recommended to use melatonin for three weeks and continue if there is a response to the treatment, for another 10 weeks only (NICE, 2022). A huge advantage of insomnia treatment with melatonin over benzodiazepine is non-dependence and lack of withdrawal symptoms.
- Promethazine – promethazine hydrochloride and promethazine teoclate are first-generation antihistamines that can be used for the treatment of a various conditions including insomnia due to their sedative properties. Read more about promethazine and its alternatives.
Benzodiazepines such as diazepam are often prescribed for short-term relief of severe anxiety. Panic and anxiety disorders can be managed with different drugs including antidepressants such as selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and tricyclic antidepressants (TCAs), all of which are preferred in the long-term management of panic disorders (NICE, 2011). Other benzodiazepines which can be used for anxiety and/or insomnia include:
Diazepam alternative muscle relaxants
Diazepam can be used to treat a muscle spasm. The most common alternative to diazepam prescribed as a muscle relaxant is baclofen. Methocarbamol can also be prescribed in the treatment of painful muscle tension.
Temazepam vs diazepam: conclusion
Diazepam and temazepam belong to the same drug class. Diazepam is prescribed to treat a wider range of conditions, with temazepam mainly used as a short-term treatment of insomnia. Over the last few years, the number of prescriptions issued for diazepam remained the same. For temazepam, the number of prescriptions issued decreased significantly. Temazepam’s shorter mechanism of action and possibly more dependent properties contribute to decreasing prescribing of this drug.
Which is better diazepam or temazepam?
Both drugs belong to the same class of drugs called benzodiazepines. Temazapam is mainly used to treat insomnia since it has shorter duration of action. Temazepam may be better option for symptoms of insomia. Diazepam on the other hand has a long duration of action with range of doses which can be prescribed making it more suitable for conditions like anxiety and muscle spasm.
Can you take diazepam with temazepam?
Use of drugs from the same class is not common. In practice minority of patients may take diazepam during the day and temazepam at night. This practice is however not common.
How Long Does temazepam make you sleep?
Since temazepam has a short duration of action (between 5 and 11 hours) patients should expect sedative effect to last around that time. Actual sleep time will depend on dose taken and other circumstances like age of person taking temazepam (Heel et al., 1981).
What is the highest mg of temazepam?
In the UK the usual dose for temazepam is 10-20mg. Higher dose is only taken in exceptional circumstances, for example a range from 15mg to 30mg can be used when temazepam is taken before surgery or dental procedures.
Heel RC, Brogden RN, Speight TM, Avery GS. Temazepam: a review of its pharmacological properties and therapeutic efficacy as an hypnotic. Drugs. 1981 May;21(5):321-40. doi: 10.2165/00003495-198121050-00001. PMID: 6112127. Available at: https://doi.org/10.2165/00003495-198121050-00001 Accessed on 06/10/2022
NICE BNF (2022). Controlled drugs and drug dependence. Available at: https://bnf.nice.org.uk/medicines-guidance/controlled-drugs-and-drug-dependence/ accessed on 02/10/2022
NICE BNF (2022). Hypnotics and anxiolytics. Available at: https://bnf.nice.org.uk/treatment-summaries/hypnotics-and-anxiolytics/ Accessed on 03/10/2022
NICE (2022). What issues should I be aware of when prescribing modified released melatonin? Available at: https://cks.nice.org.uk/topics/insomnia/prescribing-information/melatonin/ Accessed on 06/10/2022
NICE (2011). Generalised anxiety disorder and panic disorder in adults: management. Available at: https://www.nice.org.uk/guidance/cg113 Accessed on 06/10/2022
Open Prescribing. Analysis of drugs. Available at: https://openprescribing.net/analyse/ Accessed on 05/10/2022