estazolam
Estazolam (Prosom) is a sleeping pill that can help adults with insomnia fall asleep and stay asleep. It's a benzodiazepine medication that's not a first-choice treatment option for trouble sleeping, and it's only meant for short-term use since it can be habit-forming. It comes as a tablet that you take by mouth right before you get into bed. It's only available as a generic since the brand-name medication, Prosom, is no longer on the market. In addition to causing sleepiness, other common side effects can include headache, weakness, and nervousness.
What is Estazolam (Prosom)?
What is Estazolam (Prosom) used for?
Short-term treatment of insomnia
How Estazolam (Prosom) works
Estazolam (Prosom) is a benzodiazepine. It slows down brain activity to help you relax, making it easier to fall asleep and stay asleep.
Drug Facts
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What are the risks and warnings for Estazolam (Prosom)?
Estazolam (Prosom) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Sedation and difficulty breathing
Risk factors: Taking with opioid pain medications or alcohol | Taking for a longer time and at higher doses than prescribed
Combining estazolam (Prosom) with certain pain medications called opioids or alcohol can cause severe drowsiness, difficulty breathing, and can even result in death. If it's absolutely necessary for you to take an opioid medication, discuss with your prescriber to make sure the combination is as safe as possible or if other medication options are available. Get medical help right away if you have trouble breathing or have trouble waking up easily after taking estazolam (Prosom). Educate those around you to keep an eye out for these side effects as well.
Misuse, dependence, and withdrawal
Risk factors: Taking higher doses of estazolam (Prosom) over a longer period of time | Alcohol use | Stopping estazolam (Prosom) suddenly
Additionally, taking estazolam (Prosom) over longer periods of time can raise the risk for physical dependence. If so, suddenly stopping estazolam (Prosom) can lead to withdrawal symptoms, including hallucinations, a change in behavior, and trouble sleeping. Sometimes, withdrawal symptoms can last weeks to years. Don't stop taking estazolam (Prosom) without first talking to your prescriber. Take the medication only as instructed to lower the risk of dependence and overdose.
Effect on driving and concentration
Risk factors: Drinking alcohol | Also taking other medications that cause drowsiness | Older adults
Estazolam (Prosom) can make you feel sleepy and affect your concentration and focus. Drinking alcohol while taking estazolam (Prosom) and taking additional medications that make you feel drowsy can make this effect worse. Avoid activities that require you to be alert, like driving or operating machinery, until you know how the medication affects you.
Severe allergic reaction
Some people have experienced allergic reactions to estazolam (Prosom). Let your prescriber know right away if you have any symptoms of a reaction such as itching, fever, nausea, trouble breathing, or a fast heartbeat. Get medical help as soon as possible if you have an anaphylactic reaction, such as hives, swelling in the face or lips, or throat tightness.
Abnormal behaviors during sleep
Risk factors: Drinking alcohol | Taking other sedative medications | Taking doses of estazolam (Prosom) higher than prescribed
Some people who take sleeping medications will perform unusual or complex behaviors in their sleep. These activities include sleep walking, sleep eating, and sleep driving, with no memory of the activities in the morning. It's more likely to happen if you drink alcohol, take other medications that make you sleepy, or take estazolam (Prosom) at doses that are higher than prescribed. But it can still happen if you take estazolam (Prosom) by itself as directed. If this happens, contact your prescriber. There might be a sleep medication better suited for you.
Suicidal thoughts and behaviors
Risk factors: History of depression
Estazolam (Prosom) can cause people to develop suicidal thoughts or behaviors. Your risk is higher if you have a history of depression. If you or anyone around you notice any unusual changes in your behavior or thoughts, get medical help right away.
More on Estazolam (Prosom) warnings
What are the side effects of Estazolam (Prosom)?
Common Side Effects
- Sleepiness (42%)
- Headache (16%)
- Weakness (11%)
- Slow muscle movement (8%)
- Nervousness (8%)
- Dizziness (7%)
- General discomfort (5%)
Other Side Effects
- Pain
- Poor coordination
- Muscle stiffness
- Confusion
- Depression
- Abnormal thoughts
- Abnormal dreams
- Nausea
- Indigestion
- Itchiness
- Cold symptoms
Serious Side Effects
- Slowed brain activity: excessive sleepiness, confusion, coma
- Trouble breathing: shallow breaths, tiredness, slow breaths
- Dangerous sleep behaviors: sleepwalking, sleep driving, or doing any activity while not being fully alert
- Serious allergic reaction: itchy, red rash (hives), shortness of breath, chest tightness, throat closing, nausea, vomiting, swelling of lips, tongue, face, or eyes
- Suicidal thoughts and behavior
Source: DailyMed
More on Estazolam (Prosom) side effects
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Absence of or decrease in body movement
clumsiness or unsteadiness
dizziness
sleepiness or unusual drowsiness
Less common
false beliefs that cannot be changed by facts
headache
mood or mental changes
poor insight and judgment
problems with memory or speech
tiredness
trouble thinking and planning
trouble walking
Rare
Aggressive or angry
blood in the urine
bloody nose
bloody, black, or tarry stools
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
chest pain or tightness
chills
crying
decrease in the amount of urine
decreased awareness or responsiveness
decreased reflexes
deep or fast breathing with dizziness
difficult urination
dryness or soreness of throat
dysphoria
fainting
false or unusual sense of well-being
fast, irregular, pounding, or racing heartbeat or pulse
fear or nervousness
feeling of unreality
feeling of warmth
frequent strong or increased urge to urinate
hoarseness
increased urge to urinate during the night
irritability
lack of feeling or emotion
loss of bladder control
loss of memory
mouth sores or ulcers
muscle spasm or jerking of all extremities
noisy breathing
numbness of the feet, hands, and around mouth
paranoia
problems with memory
quick to react or overreact emotionally
rapidly changing moods
redness of the face, neck, arms, and occasionally, upper chest
restlessness
seeing, hearing, or feeling things that are not there
seizures
sense of detachment from self or body
severe sleepiness
severe stomach pain
shakiness and unsteady walk
shakiness in the legs, arms, hands, or feet
skin rash
sores, ulcers, or white spots on the lips or in the mouth
sudden loss of consciousness
swelling
swollen glands
swollen lymph nodes
trouble breathing
trouble in swallowing
trouble sleeping
uncaring
uncontrolled eye movements
unsteadiness, trembling, or other problems with muscle control or coordination
unusual bleeding or bruising
unusual tiredness or weakness
voice changes
waking to urinate at night
Incidence not known
Blistering, peeling, or loosening of the skin
fever with or without chills
general feeling of tiredness or weakness
joint or muscle pain
lower back or side pain
muscle cramps
red, irritated eyes
red skin lesions, often with a purple center
sweating
unable to sleep
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Change in consciousness
irregular, fast or slow, or shallow breathing
pale or blue lips, fingernails, or skin
slurred speech
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Lack or loss of strength
Less common
Pain in the legs or feet
Rare
Blemishes on the skin
bloated
blurred vision
burning feeling in the chest or stomach
change in color vision
change in taste bad unusual or unpleasant (after) taste
changes in vision, especially night blindness
continuing ringing or buzzing or other unexplained noise in the ears
cramping in the lower stomach, back, or legs
decreased interest in sexual intercourse
difficulty having a bowel movement (stool)
difficulty in moving
difficulty seeing at night
double vision
ear or eye pain
excess air or gas in stomach or intestines
full feeling
glare or snowy image caused by bright light
hearing loss
hives or welts
inability to have or keep an erection
increased or decreased appetite
increased sensitivity of eyes to sunlight
indigestion
loss in sexual ability, desire, drive, or performance
muscle pains or stiffness
pain in the arms, jaw, or neck
pain or tenderness around the eyes and cheekbones
pain, swelling, or redness in joints
passing gas
red, sore eyes
redness of the skin
seeing double
stomach upset or tenderness
stuffy or runny nose
swelling of the breasts
weight gain or loss
white or brownish vaginal discharge
Incidence not known
Increased sensitivity of skin to sunlight
redness or other discoloration of skin
severe sunburn
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Estazolam (Prosom)
Pros
Helps you fall asleep and stay asleep throughout the night
Available as a lower-cost generic medication
Don't need to take every day for it to work well
Cons
Is a controlled substance, so there is a risk for misuse and dependency
Can cause sleep-driving or unusual behaviors during sleep
Might not be safe in older adults since it raises the risk of falls
Pharmacist tips for Estazolam (Prosom)
Take estazolam (Prosom) on an empty stomach either right before you go to bed or if you're still awake after trying to sleep.
Estazolam (Prosom) can cause drowsiness and dizziness. Avoid activities that require you to be alert (like driving) until you know how it affects you.
Don't take estazolam (Prosom) unless you're able to get 7 or 8 hours of sleep time before you need to be up. This will help prevent any daytime sleepiness you might feel from the medication the next day.
Estazolam (Prosom) is meant for short-term treatment of insomnia. It's not clear if it's safe or still works if you take it for more than 4 months.
If you've been taking estazolam (Prosom) every night for some time, talk to your prescriber before suddenly stopping the medication. They will want to lower your dose slowly over time to prevent bothersome side effects, like anxiety, irritability, a racing heart, dizziness, and headache
Avoid alcohol and other medications that cause sleepiness like opioids when taking estazolam (Prosom). Taking them together can be dangerous because it can lead to severe drowsiness and breathing problems.
Continue to practice good sleep hygiene while taking estazolam (Prosom). This is meant to be used in addition to these best practices, not replace them.
Frequently asked questions about Estazolam (Prosom)
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Estazolam (Prosom) dosage forms
Typical dosing for Estazolam (Prosom)
The typical starting dose is 1 mg by mouth at bedtime.
Interactions between Estazolam (Prosom) and other drugs
More on Estazolam (Prosom) interactions
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Flumazenil
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Alfentanil
- Alprazolam
- Amobarbital
- Benzhydrocodone
- Bromazepam
- Bromopride
- Buprenorphine
- Butabarbital
- Butalbital
- Butorphanol
- Calcium Oxybate
- Cannabidiol
- Carbinoxamine
- Carisoprodol
- Cetirizine
- Chloral Hydrate
- Chlorzoxazone
- Clarithromycin
- Clobazam
- Cobicistat
- Codeine
- Dantrolene
- Dihydrocodeine
- Doxylamine
- Esketamine
- Ethchlorvynol
- Fentanyl
- Flibanserin
- Fospropofol
- Gabapentin
- Gabapentin Enacarbil
- Hydrocodone
- Hydromorphone
- Ketamine
- Lemborexant
- Levocetirizine
- Levorphanol
- Lofexidine
- Loxapine
- Magnesium Oxybate
- Meclizine
- Meperidine
- Mephenesin
- Mephobarbital
- Meprobamate
- Metaxalone
- Methadone
- Methocarbamol
- Methohexital
- Metoclopramide
- Midazolam
- Mirtazapine
- Morphine
- Morphine Sulfate Liposome
- Nalbuphine
- Oxycodone
- Oxymorphone
- Pentazocine
- Pentobarbital
- Periciazine
- Phenobarbital
- Potassium Oxybate
- Pregabalin
- Primidone
- Propofol
- Remimazolam
- Scopolamine
- Secobarbital
- Sodium Oxybate
- Sufentanil
- Tapentadol
- Thiopental
- Tramadol
- Trazodone
- Zolpidem
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Rifapentine
- St John's Wort
- Theophylline
How much does Estazolam (Prosom) cost?
Estazolam (Prosom) contraindications
Use with ketoconazole or itraconazole
What are alternatives to Estazolam (Prosom)?
Short-term treatment of insomnia (trouble sleeping)
Insomnia (trouble sleeping)
Waking up in the middle of the night - certain sublingual tablets only
Estazolam (Prosom) images
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References
Best studies we foundAnbalagan, S., et al. (2024). Neonatal abstinence syndrome. StatPearls.
Dr. Reddy’s Laboratories Inc. (2024). Estazolam tablet [package insert]. DailyMed.
Fitzgerald, T., et al. (2015). Residual effects of sleep medications are commonly reported and associated with impaired patient-reported outcomes among insomnia patients in the United States. Sleep Disorders.
Griffin, C. E., 3rd, et al. (2013). Benzodiazepine pharmacology and central nervous system-mediated effects. Ochsner Journal.
Sateia, M. J., et al. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine.
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