তেমাজিপাম

তেমাজিপাম (ব্র্যান্ড নাম রেস্টোরিল ও নরমিসন) -কার্যকরী মানসিক ওষুধ-গুলোর মধ্যে বেনজোডায়াজেপিন শ্রেণিভুক্ত অন্তর্বর্তী ক্রিয়াশীল ৩-হাইড্রক্সি  হিপনোটিক। এটি ডায়াজিপাম এর ৩-হাইড্রক্সিএনালগ আর ডায়াজিপামের অন্যতম প্রাথমিক সক্রিয় বিপাকীয় উপাদান। তেমাজিপাম ইনসমনিয়ার স্বল্পমেয়াদী চিকিৎসার জন্য অনুমোদিত। তাছাড়া,তেমাজিপামের বিষণ্ণতারোধী,খিঁচুনি-প্রতিরোধী এবং কঙ্কাল পেশী শিথিলকারক বৈশিষ্ট্য রয়েছে।

তেমাজিপাম ১৯৬৫ সালে প্যাটেন্ট করা হয় এবং ১৯৮১ সালে মার্কিন যুক্তরাষ্ট্রে বিক্রির জন্য বাজারে ছাড়া হয়।

চিকিৎসাশাস্ত্রে ব্যবহার     
ঘুম গবেষণাগারে সমীক্ষা চালিয়ে দেখা গেছে,তেমাজিপাম রাত্রে জাগরণের পরিমাণ উল্লেখযোগ্যহারে হ্রাস করে, কিন্তু স্বাভাবিক ঘুমের প্যাটার্ন বিকৃত করে দেয় বলে অসুবিধাও আছে। এটি গুরুতর ইনসমনিয়া ও অন্যান্য গুরুতর বা অকেজো করে দেয়া ঘুমের সমস্যার জন্য আনুষ্ঠানিকভাবে নির্দেশিত। যুক্তরাজ্যে ওষুধ সহিষ্ণুতা ও শারীরিক অবস্থার ওপর ভিত্তি করে এই হিপনোটিক ওষুধ প্রেসক্রাইব এর নির্দেশিকা দুই থেকে চার সপ্তাহ বেঁধে দেয়া হয়েছে।  .

 মার্কিন যুক্তরাষ্ট্র বিমান বাহিনী "নো-গো-পিল" হিসেবে অনুমোদিত অন্যতম হিপনোটিক হিসেবে এ ওষুধ ব্যবহার করে যাতে করে বিমানচালক ও বিশেষ দায়িত্বপালনরত কর্মীরা মিশনের প্রস্তুতি গ্রহণের সময় উপকৃত হন। অস্ত্রোপচারের সময় এই ওষুধ ব্যবহারের অনুমোদন নেয়ার ক্ষেত্রে আগে "গ্রাউন্ড টেস্ট" করা প্রয়োজনীয়,আর ফ্লাইট অভিযানের ক্ষেত্রে ১২ ঘণ্টা-র বিধিনিষেধ আরোপ করা হয়েছে। "নো-গো-পিল"হিসেবে ব্যবহৃত অন্যান্য হিপনোটিকগুলো হল জালিপ্লম ও জোলপিডেম,যাদের সেরে ওঠার আবশ্যিক সময়সীমা অপেক্ষাকৃত সংক্ষিপ্ত।

বিরূপ পার্শ্ব-প্রতিক্রিয়া 
নিম্নোক্ত প্রতিটি পরিস্থিতিতে সম্ভব হলে তেমাজিপামের ব্যবহার বর্জনীয়: 
 এটাক্সিয়া (পেশী নড়াচড়ার সমন্বয় সাধনের স্থূল অভাব) 
 তীব্র হাইপোভেন্টিলেসন 
 তীব্র সংকীর্ণ কৌণিক গ্লুকোমা  
 তীব্র হেপাটিক ত্রুটি (হেপাটাইসিস ও লিভার সিরোসিস  
 তীব্র রেনাল ত্রুটি (যেমন- ডায়ালাইসিস এর রোগী)      
 স্লিপ অ্যাপনিয়া
 তীব্র বিষণ্ণতা,বিশেষ করে এর সাথে আত্মহত্যার প্রবণতাও যখন জড়িত থাকে 
 এলকোহল, মাদক, বা অন্যান্য সাইকো-একটিভ উপাদানের প্রতি তীব্র নেশাগ্রস্ততা  
 মাইঅ্যাসথেনিয়া গ্রাভিস (স্বয়ং-অনাক্রম্য ব্যাধি যা পেশীকে দুর্বল করে)   
 হাইপারসেনসিটিভি বা বেনজোডায়াজেপিনশ্রেণীর কোন ওষুধের প্রতি অ্যালার্জি

বিশেষ সতর্কতা প্রয়োজন 
গর্ভাবস্থায় তেমাজিপাম ব্যবহার করা উচিত নয়,কারণ এটা ভ্রূণ-এর ক্ষতি করতে পারে।শিশুদের বেলায় তেমাজিপাম কতটা নিরাপদ ও কার্যকরী তা নিশ্চিত নয়,তাই সাধারণভাবে ১৮ বছরের নিচের কাউকে এ ওষুধ দেয়া উচিত নয়, আর ছয়মাসের কম বয়সী কোন বাচ্চাকে দেয়া অবশ্যই অনুচিত।]</ref>  North America has never had a serious problem with temazepam misuse, but is becoming increasingly vulnerable to the illicit trade of temazepam.

Australia
Temazepam accounts for most benzodiazepine sought by forgery of prescriptions and through pharmacy burglary in Victoria. Due to rife intravenous abuse, the Australian government decided to put it under a more restrictive schedule than it had been, and since March 2004 temazepam capsules have been withdrawn from the Australian market, leaving only 10 mg tablets available.
Benzodiazepines are commonly detected by Customs at different ports and airports, arriving by mail, also found occasionally in the baggage of air passengers, mostly small or medium quantities (up to 200–300 tablets) for personal use. From 2003 to 2006, customs detected about 500 illegal importations of benzodiazepines per year, most frequently diazepam. Quantities varied from single tablets to 2,000 tablets.

United Kingdom
In 1987, temazepam was the most widely abused legal prescription drug in the United Kingdom. The use of benzodiazepines by street-drug abusers was part of a polydrug abuse pattern, but many of those entering treatment facilities were declaring temazepam as their main drug of abuse. Temazepam was the most commonly used benzodiazepine in a study, published 1994, of injecting drug users in seven cities, and had been injected from preparations of capsules, tablets, and syrup. The increase in use of heroin, often mixed with other drugs, which most often included temazepam, diazepam, and alcohol, was a major factor in the increase in drug-related deaths in Glasgow and Edinburgh in 1990-1992. Temazepam use was particularly associated with violent or disorderly behaviours and contact with the police in a 1997 study of young single homeless people in Scotland. The BBC series Panorama featured an episode titled "Temazepam Wars", dealing with the epidemic of temazepam abuse and directly related crime in Paisley, Scotland.

Medical research issues
The Journal of Clinical Sleep Medicine published a paper expressing concerns about benzodiazepine receptor agonist drugs, the benzodiazepines and the Z-drugs used as hypnotics in humans. The paper cites a systematic review of the medical literature concerning insomnia medications and states  almost all trials of sleep disorders and drugs are sponsored by the pharmaceutical industry, while this is not the case in general medicine or psychiatry. It cites another study that "found that the odds ratio for finding results favorable to industry in industry-sponsored trials was 3.6 times as high as in non–industry-sponsored studies". Issues discussed regarding industry-sponsored studies include: comparison of a drug to a placebo, but not to an alternative treatment; unpublished studies with unfavorable outcomes; and trials organized around a placebo baseline followed by drug treatment, but not counterbalanced with parallel-placebo-controlled studies. Quoting a 1979 report that too little research into hypnotics was independent of the drug manufacturers, the authors conclude, "the public desperately needs an equipoised assessment of hypnotic benefits and risks" and  the NIH and VA should provide leadership to that end.

Street terms
Street terms for temazepam include king kong pills (formerly referred to barbiturates, now more commonly refers to temazepam), jellies, jelly, Edinburgh eccies, tams, terms, mazzies, temazies, tammies, temmies, beans, eggs, green eggs, wobbly eggs, knockouts, hardball, norries, oranges (common term in Australia and New Zealand), rugby balls, ruggers, terminators, red and blue, no-gos, num nums, blackout, green devils, drunk pills, brainwash, mind erasers, neurotrashers, tem-tem's (combined with buprenorphine), mommy's big helper, vitamin T, big T, TZ, Resties (North America) and others. In the Northeast of England "The Mazepam" has become a popular by word for temazepam in recent months.

Availability

Temazepam is available in English-speaking countries under the following brand names:

Euhypnos
Normison
Norkotral
Nortem
Remestan
Restoril
Temaze
Temtabs
Tenox

In Spain, the drug is sold as 'temzpem'. In Hungary the drug is sold as Signopam.

Legal status
In the United States, Temazepam is currently a Schedule IV drug under the international Convention on Psychotropic Substances of 1971.

In Austria, temazepam is listed in UN71 Schedule III under the Psychotropic Substances Decree of 1997. The drug is considered to have a high potential for abuse and addiction, but has accepted medical use for the treatment of severe insomnia.

In Australia, temazepam is a Schedule 4 - Prescription Only medicine. It is primarily used for the treatment of insomnia, and is also seen as pre-anaesthetic medication.

In Canada, temazepam is a Schedule IV controlled substance requiring a registered doctor's prescription.

In Denmark, temazepam is listed as a Class D substance under the Executive Order 698 of 1993 on Euphoric Substances which means it has a high potential for abuse, but is used for medical and scientific purposes.

In Finland, temazepam is more tightly controlled than other benzodiazepines. The temazepam product Normison was pulled out of shelves and banned because the liquid inside gelatin capsules had caused a large increase in intravenous temazepam use. The other temazepam product, Tenox, was not affected and remains as prescription medicine. Temazepam intravenous use has not decreased to the level before Normison came to the market.

In France, temazepam is prescribed by physicians, it is listed under Medical Psychotropics UN71 Schedule III, being prescribed only when other drugs will not do, prescription nonrenewable (a new doctor visit every time), and being available only in seven-pill, in theory one-week, packaging.

In Hong Kong, temazepam is regulated under Schedule 1 of Hong Kong's Chapter 134 Dangerous Drugs Ordinance. Temazepam can only be used legally by health professionals and for university research purposes. The substance can be given by pharmacists under a prescription. Anyone who supplies the substance without prescription can be fined HKD$10,000. The penalty for trafficking or manufacturing the substance is a $5,000,000-fine and life imprisonment. Possession of the substance for consumption without license from the Department of Health is illegal with a $1,000,000-fine and/or seven years of jail time.

In Ireland, temazepam is a Schedule 3 controlled substance with strict restrictions.

In the Netherlands, temazepam is available for prescription as 10- or 20-mg tablets and capsules. Formulations of temazepam containing less than 20 mg are included in List 2 of the Opium Law, while formulations containing 20 mg or more of the drug (along with the gel-capsules) are a List 1 substance of the Opium Law, thus subject to more stringent regulation. Besides being used for insomnia, it is also occasionally used as a preanesthetic medication.

In Norway, temazepam is not available as a prescription drug. It is regulated as a Class A substance under Norway's Narcotics Act.

In Portugal, temazepam is a Schedule IV controlled drug under Decree-Law 15/93.

In Singapore, temazepam is a Class A controlled drug (Schedule I), making it illegal to possess and requiring a private prescription from a licensed physician to be dispensed.

In Slovenia, it is regulated as a Group II (Schedule 2) controlled substance under the Production and Trade in Illicit Drugs Act.

In South Africa, temazepam is a Schedule 5 drug, requiring a special prescription, and is restricted to 10– to 30-mg doses.

In Sweden, temazepam is classed as a "narcotic" drug listed as both a List II (Schedule II) which denotes it is a drug with limited medicinal use and a high risk of addiction, and is also listed as a List V (Schedule V) substance which denotes the drug is prohibited in Sweden under the Narcotics Drugs Act (1968). Temazepam is banned in Sweden and possession and distribution of even small amounts is punishable by a prison sentence and a fine.

In Switzerland, temazepam is a Class B controlled substance, like all other benzodiazepines. This means it is a prescription-only drug.

In Thailand, temazepam is a Schedule II controlled drug under the Psychotropic Substances Act. Possession and distribution of the drug is illegal.

In the United Kingdom, temazepam is a Class C controlled drug under the Misuse of Drugs Act 1971 (Schedule 3 under the Misuse of Drugs Regulations 2001). If prescribed privately (not on the NHS), temazepam is available only by a special controlled drug prescription form (FP10PCD) and pharmacies are obligated to follow special procedures for storage and dispensing. Additionally, all manufacturers in the UK have replaced the gel-capsules with solid tablets. Temazepam requires safe custody and up until June 2015 was exempt from CD prescription requirements.

In the United States, temazepam is a Schedule IV drug and is only available by prescription. Specially coded prescriptions may be required in certain states.

Synthesis
Pharmacologically active metabolite of diazepam, q.v.

N-oxides are prone to undergo the Polonovski rearrangement when treated with acetic anhydride, and this was illustrated by the synthesis of oxazepam. It is not surprising that the N-methyl analogue (1) also undergoes this process, and hydrolysis of the resulting acetate gives temazepam (2). Care must be exacted with the conditions, or the inactive rearrangement product (3) results.
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তথ্যসূত্র

বহিঃসংযোগ
 Temazepam | Rx-List
 Temazepam | Inchem
 Temazepam | Medline Plus
 Active Ingredients information | DrugLib 
 Benzodiazepine Addiction, Withdrawal & Recovery | benzo.org.uk

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GABAA receptor positive allosteric modulators