nitrazepam nitrazepam nitrazepam, sold under the brand name mogadon among others, is a hypnotic drug of the benzodiazepine class used for short-term relief from severe, disabling anxiety and insomnia. it also has sedative (calming) properties, as well as amnestic (inducing forgetfulness), anticonvulsant, and skeletal muscle relaxant effects. nitrazepamclinical datatrade namesalodorm, apodorm, arem, cerson, insoma, insomin, mogadon, nitrados, nitrazadon, nitrosun, nitravet, ormodon, paxadorm, remnos, epam and somniteahfs/drugs.cominternational drug namesdependenceliabilitypsychological: moderateaddictionliabilitymoderateroutes ofadministrationoralatc coden05cd02 (who) legal statuslegal status au: s4 (prescription only) ca: schedule iv de: prescription only (anlage iii for higher doses) un: psychotropic schedule iv pharmacokinetic databioavailability53–94%metabolismhepaticelimination half-life16–38 hoursexcretionrenalidentifiers iupac name 7-nitro-5-phenyl-1h-benzodiazepin-2(3h)-one cas number146-22-5 ypubchem cid4506drugbankdb01595 ychemspider4350 yunii9clv70w7hskeggd00531 ychebichebi:7581 nchemblchembl13209 ycomptox dashboard (epa)dtxsid5023372 echa infocard100.005.151 chemical and physical dataformulac15h11n3o3molar mass281.271 g·mol−13d model (jsmol)interactive image smiles (c1=cc2=c(c=c1)nc(cn=c2c3=cc=cc=c3)=o)=o inchi inchi=1s/c15h11n3o3/c19-14-9-16-15(10-4-2-1-3-5-10)12-8-11(18(20)21)6-7-13(12)17-14/h1-8h,9h2,(h,17,19) ykey:kjonhkayojnzec-uhfffaoysa-n y ny (what is this?) (verify) it was first synthesized in the late 1950s by a team of researchers at hoffmann-la roche in switzerland. it was patented in 1961 and came into medical use in 1965. medical use a box of mogadon pills containing 5mg of nitrazepam. nitrazepam is used to treat short-term sleeping problems (insomnia), namely difficulty falling asleep, frequent awakening, early awakening, or a combination of each. nitrazepam is sometimes tried to treat epilepsy when other medications fail. it has been found to be more effective than clonazepam in the treatment of west syndrome, which is an age-dependent epilepsy, affecting the very young. in uncontrolled studies, nitrazepam has shown effectiveness in infantile spasms and is sometimes considered when other anti-seizure drugs have failed. however, drowsiness, hypotonia, and most significantly tolerance to anti-seizure effects typically develop with long-term treatment, generally limiting nitrazepam to acute seizure management. a light-activated derivative of nitrazepam (fulgazepam) has been developed for research purposes. side effects more common more common side effects may include: central nervous system depression, including somnolence, dizziness, depressed mood, fatigue, ataxia, headache, vertigo, impairment of memory, impairment of motor functions, hangover feeling in the morning, slurred speech, decreased physical performance, numbed emotions, reduced alertness, muscle weakness, double vision, and inattention have been reported. unpleasant dreams and rebound insomnia have also been reported. nitrazepam is a long-acting benzodiazepine with an elimination half-life of 15–38 hours (mean elimination half-life 26 hours). residual "hangover" effects after nighttime administration of nitrazepam such as sleepiness, impaired psychomotor and cognitive functions may persist into the next day, which may impair the ability of users to drive safely and increases the risk of falls and hip fractures. less common less common side effects may include: hypotension, faintness, palpitation, rash or pruritus, gastrointestinal disturbances, and changes in libido are less common. very infrequently, paradoxical reactions may occur, for example, excitement, stimulation, hallucinations, hyperactivity, and insomnia. also, depressed or increased dreaming, disorientation, severe sedation, retrograde amnesia, headache, hypothermia, and delirium tremens are reported. severe liver toxicity has also been reported. cancer benzodiazepine use is associated with an increased risk of developing cancer. however, conflicting evidence implies that further research is needed in order to conclude that products of this class really do induce cancer. mortality nitrazepam therapy, compared with other drug therapies, increases risk of death when used for intractable epilepsy in an analysis of 302 patients. the risk of death from nitrazepam therapy may be greater in younger patients (children below 3.4 years in the study) with intractable epilepsy. in older children (above 3.4 years), the tendency appears to be reversed in this study. nitrazepam may cause sudden death in children. it can cause swallowing incoordination, high-peaked esophageal peristalsis, bronchospasm, delayed cricopharyngeal relaxation, and severe respiratory distress necessitating ventilatory support in children. nitrazepam may promote the development of parasympathetic overactivity or vagotonia, leading to potentially fatal respiratory distress in children. liver nitrazepam has been associated with severe hepatic disorders, similar to other nitrobenzodiazepines. nitrobenzodiazepines such as nitrazepam, nimetazepam, flunitrazepam, and clonazepam are more toxic to the liver than other benzodiazepines as they are metabolically activated by cyp3a4 which can result in cytotoxicity. this activation can lead to the generation of free radicals and oxidation of thiol, as well as covalent binding with endogenous macromolecules; this results, then, in oxidation of cellular components or inhibition of normal cellular function. metabolism of a nontoxic drug to reactive metabolites has been causally connected with a variety of adverse reactions. other long-term effects main article: long-term effects of benzodiazepines long-term use of nitrazepam may carry mental and physical health risks, such as the development of cognitive deficits. these adverse effects show improvement after a period of abstinence. some other sources however seem to indicate that there is no relation between the use of benzodiazepine medication and dementia. further research is needed in order to assert that this class of medication does really induce cognitive decline. abuse potential