Estazolam (Prosom): Uses, Side Effects, Dosage, & More

What Is Estazolam (Prosom)?

Estazolam is considered an oral hypnotic medication. It is part of the benzodiazepine family that includes medications like Xanax, Ativan, and Valium. Estazolam carries a significant risk of serious side effects that can lead to death. It should only be used under the direct supervision of a licensed provider. Estazolam’s branded version of the drug, Prosom, has been discontinued in the US.^1,2

Estazolam is a controlled substance in the US that is subject to more strict prescription regulations. Because laws vary by state, verify prescription requirements with your local pharmacy. In addition, certain providers may not be allowed to prescribe controlled substances in every state, so check with your therapist.¹

How Does Estazolam Work?

Estazolam, like other benzodiazepines, acts on receptors in the central nervous system (CNS) to cause CNS depression.² This CNS depression, or calming of the nerves, helps to reduce symptoms of insomnia allowing for better sleep. Taking Estazolam has been shown to help make it easier to fall asleep, prevent waking up at night, and lengthening the overall amount of sleep.¹

What Is Estazolam Used to Treat?

Estazolam is FDA approved to treat insomnia. FDA approval means studies have shown estazolam to be safe and effective in treating insomnia when used as prescribed.¹ There are many available prescription benzodiazepines that treat other conditions like seizures, anxiety, and panic attacks. However, estazolam should not be used for any of these conditions. Estazolam is only recommended for short term, infrequent use and should not be used regularly or for more than 12 weeks at a time.¹

If your prescriber would like to have you take estazolam off-label for other conditions besides insomnia, they should provide robust reasoning for doing so. Off label uses of medications have not been approved by the FDA and should only be used at the discretion of your prescriber.

Common Side Effects of Estazolam

Taking estazolam puts you at risk of experiencing many different side effects which can range from inconvenient to dangerous. Since the medication works to promote sleeping, many side effects are related to CNS depression.

It is important to take estazolam only before bedtime and avoid any driving or activities where you need to be alert. If any side effect worsens or does not go away on its own, contact your prescriber right away.

Common side effects of estazolam include:*¹

• Drowsiness
• Dizziness
• Abnormal coordination
• Loss of muscle movement
• Constipation

*All medications, including estazolam, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Serious Side Effects of Estazolam

Taking estazolam can cause serious side effects that may be life threatening. If you experience any of the following side effects, you must seek medical help right away. Many of these side effects are related to extreme CNS depression that can lead to difficulty breathing and/or a coma. Taking your estazolam exactly as prescribed, and not more, is one way to help avoid these severe side effects.

Serious side effects of estazolam include: *¹

• Extreme sedation leading to respiratory depression and death
• Misuse and addiction
• Physical dependence
• Severe anaphylactic reaction
• Neonatal sedation and withdrawal (if used during pregnancy)
• Sleep driving or sleep walking
• Abnormal vision

*All medications, including estazolam, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Estazolam Warnings & Precautions

Anyone taking estazolam should understand the many warnings and precautions before starting treatment. Certain conditions may put a person at a higher risk of experiencing serious side effects.

If any of the following warnings or precautions apply to you, a discussion with your doctor is necessary to determine if estazolam is a good treatment option. Your dosage may need to be adjusted, or your prescriber may consider changing medications all together. Be aware of the following warnings and precautions for however long you may use estazolam.

Warnings and precautions for estazolam include:¹

• Avoid using estazolam with opioids: Both medications can cause extreme sedation leading to death. Combining the two can increase that risk and cause injury or death.
• Risk of addiction or misuse: Using any benzodiazepines, estazolam included, exposes a patient to the risk of abuse and addiction which can lead to overdose and death. You should not use estazolam if you have a history of substance abuse, and estazolam should only be taken exactly as prescribed.
• Risk of dependence and withdrawal: Using estazolam for an extended length of time can cause physical dependence and may lead to benzodiazepine withdrawal symptoms when stopped. Consult your prescriber if you wish to stop taking estazolam, and they can provide directions for stopping estazolam safely.
• Risk of severe anaphylactic reactions: There have been reports of severe swelling of the mouth and throat leading to deadly airway obstruction from taking estazolam. If you suspect a severe reaction call 911 and seek medical help right away.
• Avoid taking estazolam with antifungal agents: Ketoconazole and itraconazole should never be taken with estazolam due to the significant interaction. The two antifungal drugs will cause more severe sedation than normal from a typical dose of estazolam.
• Risk of neonatal sedation and withdrawal: A pregnant woman taking estazolam late in pregnancy can lead to sedation or withdrawal symptoms in the baby at birth. Taking any drug during pregnancy should be a decision between the patient and the prescriber.

What to Avoid When Taking Estazolam

There are certain medications and supplements to avoid when taking estazolam. The combinations below can cause increased risk of experiencing side effects. In addition, certain combinations can cause one or both medications to not work as well as intended. Be sure to discuss all medications you take with your prescriber including over the counter medications and supplements.

Substances you should avoid while taking estazolam include:¹

• Opioids: Opioids increase the risk of severe respiratory depression leading to death. The two should not be combined if possible.
• Other benzodiazepines: Taking other benzodiazepine medications increases the risk of severe respiratory depression leading to death. The two should not be combined if possible.
• Drugs that work in the CNS: There are many drugs that work in the CNS and can cause estazolam to be more sedating than intended. Be sure to alert all of your prescribers that you will be taking estazolam to prevent any dangerous interactions.
• Drugs that inhibit estazolam metabolism: Some medications cause estazolam to be more potent than intended when taken together. A short list of some examples of these medications to be avoided with estazolam include ketoconazole, itraconazole, diltiazem, and fluvoxamine.

Estazolam Dosages for FDA-Approved Treatment

Estazolam is only FDA approved in the US to treat short term insomnia. With only one approved use, there are relatively few doses currently available. If you and your prescriber identify a dose that is unavailable, work together to find a combination of available doses, or utilize a compounding pharmacy in your area.¹

Estazolam Forms & Strengths

Estazolam is available as an oral tablet in multiple doses. Most patients will be prescribed a 1 mg tablet to be taken once nightly as needed for insomnia. Based on each patient’s specific health and treatment plan, the dose may start lower or increase after some time. Any dose changes should only be done at the direction of your prescriber and be unique to each patient.¹

Estazolam is available in the following forms and strengths:¹

• 1 milligram (mg) oral tablet
• 2 milligrams (mg) oral tablet

How Long Does it Take for Estazolam to Start Working?

Estazolam works relatively quickly after taking, similarly to other benzodiazepines. Based on studies the medication starts to cause sedation within a half hour and can last about 8 hours before it starts to wear off. This is important to plan out when you will be taking estazolam. Once taken, do not plan to do anything else except sleep for the next 8 to 9 hours to avoid waking up drowsy.¹

How Should I Take Estazolam?

Estazolam should be taken by mouth just prior to sleep as needed for insomnia. It can be taken with or without food. Estazolam causes sedation for up to 8 hours, and patients should not plan to do anything besides sleep for the duration of that time. Estazolam is not intended to be used every night but instead only when needed. Estazolam should not be taken longer than 12 weeks to reduce the risk of physical dependence.¹

What Happens If I Miss a Dose of Estazolam?

If you miss a dose of estazolam and remember at least 8 hours before you need to be awake you can take the missed dose. Otherwise, it is safest to skip the missed dose and take your regular dose the next evening if needed. Do not double up on the next dose. Doubling up on any dose is never recommended as this can increase your risk of experiencing dangerous side effects.¹

Can You Overdose on Estazolam?

Yes it is possible to overdose from taking too much estazolam at one time. Additionally, when higher than normal doses of estazolam are combined with other CNS depressing substances like opioids, alcohol, or other benzodiazepines, the risk of overdose increases even more. Symptoms of an overdose include trouble staying alert, confusion, slowed breathing, dizziness, and loss of coordination. If an overdose is suspected, call 911 right away and get professional medical help.¹

What Should You Do If You Take Too Much Estazolam?

If you or someone you know takes too much estazolam, contact 911 immediately. Getting help right away is key to reducing injury and preventing death. Even if there are no symptoms of overdose at the moment, you should still seek help. Overdose symptoms can be delayed and continue to worsen if not treated. If possible, try to make note of how much estazolam was taken and anything else ingested within the last 24 hours by the patient.¹

How to Get a Prescription for Estazolam

Estazolam is a controlled substance, specifically a schedule IV (four) drug. There are specific regulations that are different from regular prescription medications. Laws vary by state, but in general the prescription requirements are more strict than usual and require more frequent follow ups with your prescriber.

If you have a provider and are interested in taking estazolam, start by asking them. If you need to find a psychiatrist, you can search within your insurance covered providers, or look for a telehealth provider as well. Be sure to ask your provider if they can prescribe controlled substances in your state.

Questions to Ask Your Healthcare Provider About Estazolam

Spending time with your doctor, psychiatrist, or therapist to discuss the risks of estazolam is an important part of safe treatment. It is the time to discuss your health history, risks of experiencing side effects, and identify any potential drug interactions. You should feel confident about how to use estazolam and what to expect from treatment after this discussion. Remember that online psychiatry services may be a good option if you need access to a prescriber.

Questions to ask your care team about estazolam include:

• How safe is estazolam?
• How is this drug different from other benzos?
• How long will it take for me to adjust to taking estazolam?
• When can I expect it to start working?
• Should I use the medication every night?
• Should I still take my dose if I need to be up early?
• Can I drink alcohol and take estazolam?
• Will my dose change?
• Am I at risk for more serious symptoms if I am already taking other medications?
• What is the best dosage to ensure fewer side effects?
• Are there other medications I shouldn’t take with estazolam?
• What should I do if I want to stop taking estazolam?