Nimetazepam is an intermediate-acting hypnotic drug which is a benzodiazepine derivative. It was first synthesized by a team at Hoffmann-La Roche in 1962. It possesses hypnotic, anxiolytic, sedative, and skeletal muscle relaxant properties. Nimetazepam is also an anticonvulsant. It is sold in 5 mg tablets known as Erimin and Lavol. It is generally prescribed for the short-term treatment of severe insomnia in patients who have difficulty falling asleep or maintaining sleep. The sole global manufacturer of Nimetazepam has ceased manufacturing Erimin since early November 2015. Patients being prescribed Erimin are being switched to Lavol and other hypnotics, e.g. estazolam, nitrazepam, flunitrazepam, etc.
Pharmacokinetics
Taken orally, Nimetazepam has very good bioavailability with nearly 100% being absorbed from the gut. It is among the most rapidly absorbed and quickest acting oral benzodiazepines, and hypnotic effects are typically felt within 15–30 minutes after oral ingestion. The blood level decline of the parent drug was biphasic with the short half-life ranging from 0.5–0.7 hours and the terminal half-life from 8 to 26.5 hours. It is the N-methylated analogue of nitrazepam, to which it is partially metabolized. nitrazepam has a long elimination half-life, so effects of repeated dosage tend to be cumulative.
Recreational use
There is a risk of misuse and dependence in both patients and non-medical users of Nimetazepam. The pharmacological properties of Nimetazepam such as high affinity binding, high potency, being short to intermediate – acting and having a rapid onset of action increase the abuse potential of Nimetazepam. The physical dependence and withdrawal syndrome of Nimetazepam also adds to the addictive nature of Nimetazepam. Nimetazepam has a particular reputation in South East Asia for recreational use, at around USD 7 per tab, and is particularly popular among persons addicted to amphetamines or opioids. Stimulant addicts do not have healthy coping mechanisms due to the nature of addiction, causing insomnia, depression and exhaustion. In addition, Nimetazepam has an anti-depressant and muscle relaxant effect. Nimetazepam also has withdrawal suppression effect and lower drug seeking versus nitrazepam in rhesus monkey. which might help stimulant addicts to overcome withdrawal symptoms.
Drug misuse
Nimetazepam has a reputation for being particularly subject to abuse. Although is still a significant drug of abuse in some Asian countries such as Japan and Malaysia, Nimetazepam is subject to legal restrictions in Malaysia, and due to its scarcity, many tablets sold on the black market are in fact counterfeits containing other benzodiazepines such as diazepam or nitrazepam instead.
Legal status
In the United States, Nimetazepam is categorized Schedule IVFDA and DEA. Nimetazepam is currently a Schedule IV drug under the internationalConvention on Psychotropic Substances of 1971. In Singapore, Nimetazepam is a physician prescribed drug, and is regulated under the Misuse of Drugs Act. The illegal possession or consumption of Nimetazepam is punishable by up to 10 years of imprisonment, a fine of 20,000 Singapore dollars, or both illegally. Importing or exporting nimetazepam is punishable by up to 20 years of imprisonment and/or caning. In Hong Kong, Nimetazepam is regulated under Schedule 1 of Hong Kong's Chapter 134 Dangerous Drugs Ordinance. Nimetazepam 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 $10000. 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 7 years of jail time. Similarly in Taiwan and Indonesia Nimetazepam is also regulated as a controlled prescribed substance. In Victoria Australia, nimetazepam is regulated under Schedule 11 of "Drugs, Poisons and Controlled substances act 1981". It is deemed to fall under the category of "7-NITRO-1,4-BENZODIAZEPINES not included elsewhere in this Part"..
Toxicity
In a rat study Nimetazepam showed greater damage to the fetus, as did nitrazepam when compared against other benzodiazepines, all at a dosage of 100 mg/kg. Diazepam however showed relatively weak fetal toxicities. The same fetotoxicity of nitrazepam could not be observed in mice and is likely due to the particular metabolism of the drug in the rat. In a rat study nimetazepam showed slight enlargement of the liver and adrenals and atrophy of the testes and ovaries were found in high dose groups of both drugs at the 4th and 12th week, however, in histopathological examination, there were no change in the liver, adrenals and ovaries. Degenerative changes of seminiferous epithelium in the testes were observed, but these atrophic change returned to normal by withdrawal of the drugs for 12 weeks.
