Editing Flunitrazepam (section)

==Adverse effects==
Adverse effects of flunitrazepam include dependency, both physical and psychological; reduced sleep quality resulting in [[somnolence]]; and [[overdose]], resulting in excessive sedation, impairment of balance and speech, respiratory depression or coma, and possibly death. Because of the latter, flunitrazepam is commonly used in suicide among the elderly.<ref name="Carlsten_2003">{{cite journal | vauthors = Carlsten A, Waern M, Holmgren P, Allebeck P | title = The role of benzodiazepines in elderly suicides | journal = Scandinavian Journal of Public Health | volume = 31 | issue = 3 | pages = 224–228 | year = 2003 | pmid = 12850977 | doi = 10.1080/14034940210167966 | publisher = SAGE Publications | s2cid = 24102880 }}</ref> When used in late pregnancy, it might cause [[hypotonia]] of the fetus.

===Dependence===
Flunitrazepam, as with other [[benzodiazepine]]s, can lead to [[drug dependence]].<ref name=CESAR/> Discontinuation may result in [[benzodiazepine withdrawal syndrome]], characterised by [[seizures]], [[psychosis]], insomnia, and [[anxiety (mood)|anxiety]]. [[Rebound insomnia]], worse than baseline insomnia, typically occurs after discontinuation of flunitrazepam even from short-term single nightly dose therapy.<ref>{{cite journal | vauthors = Kales A, Scharf MB, Kales JD, Soldatos CR | title = Rebound insomnia. A potential hazard following withdrawal of certain benzodiazepines | journal = JAMA | volume = 241 | issue = 16 | pages = 1692–1695 | date = April 1979 | pmid = 430730 | doi = 10.1001/jama.241.16.1692 }}</ref>

===Paradoxical effects===
Flunitrazepam may cause a [[paradoxical reaction]] in some individuals, including anxiety, [[aggressiveness]], [[Psychomotor agitation|agitation]], [[confusion]], [[disinhibition]], loss of [[impulse control]], talkativeness, [[violent]] behavior, and even [[convulsions]]. [[Paradoxical adverse effects]] may even lead to [[criminal behaviour]].<ref>{{cite journal | vauthors = Bramness JG, Skurtveit S, Mørland J | title = Flunitrazepam: psychomotor impairment, agitation and paradoxical reactions | journal = Forensic Science International | volume = 159 | issue = 2–3 | pages = 83–91 | date = June 2006 | pmid = 16087304 | doi = 10.1016/j.forsciint.2005.06.009 }}</ref>

===Hypotonia===
{{See also|Hypotonia}}
Benzodiazepines such as flunitrazepam are [[Lipophilicity|lipophilic]] and rapidly penetrate membranes and, therefore, rapidly cross over into the [[placenta]] with significant uptake of the drug. Use of benzodiazepines including flunitrazepam in late pregnancy, especially high doses, may result in [[hypotonia]], also known as floppy baby syndrome.<ref>{{cite journal | vauthors = Kanto JH | title = Use of benzodiazepines during pregnancy, labour and lactation, with particular reference to pharmacokinetic considerations | journal = Drugs | volume = 23 | issue = 5 | pages = 354–380 | date = May 1982 | pmid = 6124415 | doi = 10.2165/00003495-198223050-00002 | s2cid = 27014006 }}</ref>

===Other===
Flunitrazepam impairs cognitive functions. This may appear as lack of concentration, [[confusion]] and [[anterograde amnesia]]—the inability to create memories while under the influence. It can be described as a [[hangover]]-like effect which can persist to the next day.<ref name=Residual2004>{{cite journal | vauthors = Vermeeren A | title = Residual effects of hypnotics: epidemiology and clinical implications | journal = CNS Drugs | volume = 18 | issue = 5 | pages = 297–328 | year = 2004 | pmid = 15089115 | doi = 10.2165/00023210-200418050-00003 | s2cid = 25592318 }}</ref> It also impairs [[Psychomotor learning|psychomotor]] functions similar to other benzodiazepines and [[nonbenzodiazepine]] [[hypnotic]] drugs; falls and hip fractures were frequently reported. The combination with [[alcohol (drug)|alcohol]] increases these impairments. Partial, but incomplete tolerance develops to these impairments.<ref name="Mets-2010">{{cite journal | vauthors = Mets MA, Volkerts ER, Olivier B, Verster JC | title = Effect of hypnotic drugs on body balance and standing steadiness | journal = Sleep Medicine Reviews | volume = 14 | issue = 4 | pages = 259–267 | date = August 2010 | pmid = 20171127 | doi = 10.1016/j.smrv.2009.10.008 }}</ref>

Other adverse effects include:
* Slurred speech
* [[Gastrointestinal disturbance]]s, lasting 12 or more hours
* Vomiting
* [[Respiratory depression]] in higher doses

===Special precautions===
Benzodiazepines require special precaution if used in the elderly, during pregnancy, in children, in alcohol- or drug-dependent individuals, and in individuals with [[comorbid]] [[psychiatric disorders]].<ref>{{cite journal | vauthors = Authier N, Balayssac D, Sautereau M, Zangarelli A, Courty P, Somogyi AA, Vennat B, Llorca PM, Eschalier A | display-authors = 6 | title = Benzodiazepine dependence: focus on withdrawal syndrome | journal = Annales Pharmaceutiques Françaises | volume = 67 | issue = 6 | pages = 408–413 | date = November 2009 | pmid = 19900604 | doi = 10.1016/j.pharma.2009.07.001 }}</ref>

Impairment of driving skills with a resultant increased risk of [[road traffic accidents]] is probably the most important adverse effect. This side-effect is not unique to flunitrazepam but also occurs with other hypnotic drugs. Flunitrazepam seems to have a particularly high risk of road traffic accidents compared to other hypnotic drugs. Extreme caution should be exercised by drivers after taking flunitrazepam.<ref>{{cite journal | vauthors = Gustavsen I, Bramness JG, Skurtveit S, Engeland A, Neutel I, Mørland J | title = Road traffic accident risk related to prescriptions of the hypnotics zopiclone, zolpidem, flunitrazepam and nitrazepam | journal = Sleep Medicine | volume = 9 | issue = 8 | pages = 818–822 | date = December 2008 | pmid = 18226959 | doi = 10.1016/j.sleep.2007.11.011 | hdl-access = free | hdl = 10852/34650 }}</ref><ref name=UKdrivingregs2014>UK Dept. of Transport. July 2014. {{cite web | url = https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/325275/healthcare-profs-drug-driving.pdf | title = Guidance for healthcare professionals on drug driving | work = The Department for Transport | date = 2014 | location = London }}</ref>