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Short-acting benzodiazepine hypnotic Pregnancy: Use is not recommended during pregnancy - data are limited, benzodiazepines cross the placenta, and case-control studies have reported cleft lip and palate. Reduced fetal movement and fetal heart rate variability have been described after second and/or third trimester administration. High doses in late pregnancy or during childbirth may cause neonatal respiratory distress, hypothermia, hypotonia and feeding difficulties, and prolonged later-pregnancy use may cause physical dependence with a neonatal withdrawal syndrome - monitor the newborn appropriately. Benzodiazepines are found in breast milk and should not be given to breast-feeding mothers. (SPC 4.6)

Loprazolam

Loprazolam is a benzodiazepine hypnotic used for the short-term treatment of insomnia that is severe, disabling or causing marked distress.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 1 mg at bedtime; this may be increased to 1.5 mg or 2 mg if necessary
Route: Oral
Frequency: Once at bedtime
Max: Elderly: dosage should be limited to 1 mg at bedtime. Frail, debilitated or aged patients: a starting dose of a half tablet may be appropriate and dosage should not exceed 1 mg
Prior to starting treatment, a discussion should be held with the patient to put in place a strategy for ending treatment, in order to minimise the risk of dependence, addiction and drug withdrawal syndrome. Treatment should be given for the shortest possible duration and, if possible, intermittently, using the lowest dose that controls symptoms; long-term use is not recommended. Duration generally varies from a few days to two weeks, with a maximum of four weeks including the tapering-off process, and treatment should always be tapered off gradually - patients who have taken benzodiazepines for a long time may require a longer reduction period. Children: there is insufficient evidence to recommend the use of loprazolam in children. eMC SPC section 4.2.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Sensitivity to benzodiazepines
  • Acute pulmonary insufficiency; severe respiratory insufficiency
  • Myasthenia gravis
  • Phobic or obsessional states
  • Sleep apnoea syndrome
  • Monotherapy in depression or in anxiety associated with depression
  • Chronic psychosis
  • Alcohol intake

Side effects

  • Next-day drowsiness, headache, nausea, hypotonia, blurring of vision, dizziness and ataxia, particularly in sensitive patients or when dosage has been excessive
  • Anterograde amnesia and other cognitive disorders
  • Rare paradoxical behavioural effects - aggressive outbursts, excitement, confusion, and the uncovering of depression with suicidal tendencies (discontinue if these occur)
  • Drug dependence and drug withdrawal syndrome - rebound insomnia, anxiety, tension, depression, restlessness, tremor, sweating; in severe cases derealisation, hallucinations, hyperthermia and convulsions
  • Falls
  • More rarely hypotension, gastrointestinal and visual disturbances, skin rashes, urinary retention, changes in libido, blood dyscrasias and jaundice; speech disorders (frequency not known)

Interactions

  • Alcohol - listed as a contraindication in SPC 4.3
  • Other drugs that lower the convulsive threshold, such as antidepressants - convulsions on benzodiazepine withdrawal may be more common (SPC 4.8)

Clinical monograph

How it works

It enhances the inhibitory action of GABA at the GABA-A receptor, increasing chloride conductance to produce sedative and hypnotic effects.

Prescribing in practice

  • Tolerance and dependence can develop, so it should be prescribed at the lowest effective dose for the shortest possible time, generally no more than a short course.
  • It can cause next-day sedation and impair psychomotor performance, with additive effects when combined with alcohol or other CNS depressants.
  • Use with caution in the elderly and avoid abrupt withdrawal after regular use.

Monitoring

Review the ongoing need for treatment regularly and monitor for tolerance, dependence and excessive daytime sedation.

Counselling the patient

  • Explain that the medicine is intended only for short-term use.
  • Avoid alcohol and be cautious about driving, particularly the morning after a dose.
  • Do not stop suddenly after regular use; seek advice on reducing the dose.

Evidence & guidelines

Guidance from NICE and current prescribing references supports using benzodiazepine hypnotics such as loprazolam only short term owing to the risk of dependence.

Reference: NICE TA77; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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