Side effects of loprazolam are generally the same as for other benzodiazepines such as
diazepam. The most significant difference in side effects of loprazolam and diazepam is it is less prone to day time sedation as the half-life of loprazolam is considered to be intermediate whereas diazepam has a very long half-life. The side effects of loprazolam are the following: •
drowsiness • paradoxical increase in aggression •
lightheadedness •
confusion • muscle weakness •
ataxia (particularly in the elderly) •
amnesia •
headache •
vertigo •
hypotension • salivation changes • gastro-intestinal disturbances • visual disturbances •
dysarthria •
tremor • changes in
libido •
incontinence •
urinary retention •
blood disorders and
jaundice •
skin reactions • dependence and withdrawal reactions Residual 'hangover' effects after nighttime administration of loprazolam such as sleepiness, impaired psychomotor and
cognitive functions may persist into the next day which may increase risks of falls and
hip fractures.
Tolerance, dependence and withdrawal Loprazolam, like all other benzodiazepines, is recommended only for the short-term management of insomnia in the UK, owing to the risk of serious adverse effects such as tolerance, dependence and withdrawal, as well as adverse effects on mood and cognition. Benzodiazepines can become less effective over time, and patients can develop increasing physical and psychological adverse effects, e.g., agoraphobia, gastrointestinal complaints, and peripheral nerve abnormalities such as burning and tingling sensations. Loprazolam has a low risk of
physical dependence and withdrawal if it is used for less than 4 weeks or very occasionally. However, one placebo-controlled study comparing 3 weeks of treatment for
insomnia with either loprazolam or
triazolam showed rebound
anxiety and insomnia occurring 3 days after discontinuing loprazolam therapy, whereas with triazolam the rebound anxiety and insomnia was seen the next day. The differences between the two are likely due to the differing elimination half-lives of the two drugs. These results would suggest that loprazolam and possibly other benzodiazepines should be prescribed for 1–2 weeks rather than 2–4 weeks to reduce the risk of physical dependence, withdrawal, and rebound phenomenon. ;Withdrawal symptoms Slow reduction of the dosage over a period of months at a rate that the individual can tolerate greatly minimizes the severity of the withdrawal symptoms. Individuals who are
benzodiazepine dependent often cross to an equivalent dose of
diazepam to taper gradually, as diazepam has a longer half-life and small dose reductions can be achieved more easily. •
anxiety and
panic attacks •
sweating •
nightmares •
insomnia •
headache •
tremor •
nausea and
vomiting • feelings of
unreality • abnormal sensation of movement • hypersensitivity to
stimuli •
hyperventilation • flushing •
sweating •
palpitations • dimensional distortions of rooms and television pictures •
paranoid thoughts and feelings of persecution •
depersonalization • fears of going mad • heightened perception of taste, smell, sound, and light;
photophobia •
agoraphobia •
clinical depression • poor
memory and
concentration •
aggression • excitability •
Somatic Symptoms •
numbness • altered sensations of the skin •
pain •
stiffness • weakness in the neck, head, jaw, and limbs • muscle
fasciculation, ranging from twitches to jerks, affecting the legs or shoulders •
ataxia •
paraesthesia • influenza-like symptoms • blurred double vision •
menorrhagia • loss of or dramatic gain in
appetite • thirst with
polyuria •
urinary incontinence •
dysphagia •
abdominal pain •
diarrhoea •
constipation Major complications can occur after abrupt or rapid withdrawal, especially from high doses, producing symptoms such as: •
psychosis •
confusion •
visual and
auditory hallucinations •
delusions •
epileptic seizures (which may be fatal) • suicidal thoughts or actions • abnormal, often severe, drug seeking behavior It has been estimated that between 30% and 50% of long-term users of benzodiazepines will experience
withdrawal symptoms. However, up to 90% of patients withdrawing from benzodiazepines experienced withdrawal symptoms in one study, but the rate of taper was very fast at 25% of dose per week. Withdrawal symptoms tend to last between 3 weeks to 3 months, although 10–15% of people may experience a protracted
benzodiazepine withdrawal syndrome with symptoms persisting and gradually declining over a period of many months and occasionally several years. ==Contraindications and special caution==