Triazolam

Class
Anticonvulsants and anxiolytics
Subclass
Benzodiazepines
Substance name
Triazolam
Brand names
Halcion®
Common formulations
Tablet
Dosage and administration
Adults patients
Treatment of insomnia
•
Maintenance: 0.25 mg PO qHS for 7-10 days
•
Maximum: 0.5 mg per day
Consider titrating to 0.5 mg in patients not responding to 0.25 mg. Consider starting at 0.125 mg daily in patients with low body weight. Administer 0.125-0.25 mg daily in elderly patients. Taper dose gradually when discontinuing.
Indications for use
Labeled indications
Adults
•
Treatment of insomnia
Safety risks
Boxed warnings
Benzodiazepine withdrawal syndrome
•
Use extreme caution when discontinuing treatment in patients who have received prolonged treatment with benzodiazepines.
Drug abuse, drug misuse, benzodiazepine use disorder
•
Use extreme caution in patients taking the drug for a prolonged period.
Respiratory depression, coma, death
•
Use extreme caution in patients receiving concomitant opioids.
Contraindications
Hypersensitivity to triazolam or its components
Concomitant use of potent CYP3A inhibitors
•
Do not use tirazolam with potent CYP3A inhibitors, such as ketoconazole, itraconazole, nefazodone, lopinavir, or ritonavir.
Warnings and precautions
Anterograde amnesia
•
Maintain a high level of suspicion in all patients.
Behavioral or personality changes, aggressive behavior, agitation, hallucinations, sleepdriving
•
Use caution in all patients, especially with the use of alcohol and other CNS depressants. Initiate treatment at the lowest effective dose. Consider discontinuing triazolam if sleepdriving or increased daytime anxiety is reported.
Benzodiazepine withdrawal syndrome
•
Do not discontinue abruptly in patients taking the drug for a prolonged period.
Exacerbation of depression
•
Use caution in patients with severe or latent depression. Monitor for suicidal thoughts.
Exacerbation of insomnia
•
Use caution in patients with unrecognized psychiatric or physical disorder.
Falls in the elderly
•
Use caution in elderly patients.
Respiratory distress
•
Use caution in patients with compromised respiratory function. Consider discontinuing triazolam if respiratory depression or apnea occurs.
Somnolence
•
Use extreme caution in patients performing activities requiring mental alertness, such as driving or operating machinery.
Specific populations
Renal impairment
CrCl 0-90 mL/min
•
No guidance available.
Renal replacement therapy
Any modality
•
No guidance available.
Hepatic impairment
Any severity
•
No guidance available.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: C
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals. Enroll patients in a dedicated pregnancy outcome monitoring registry. Monitor neonates for sedation, respiratory depression and withdrawal symptoms.
Breastfeeding
Consider alternative agents that may be safer.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
No overt adverse effects reported in breastfed infants.
Adverse reactions
Very common > 10%
•
Somnolence
Common 1-10%
•
Dizziness, headache, incoordination, ataxia, nausea, vomiting, lightheadedness, nervousness
Uncommon < 1%
•
Chronic constipation, change in taste, diarrhea, dry mouth, nightmares, insomnia, paresthesia, tinnitus, weakness, euphoria, tachycardia, fatigue, confusion, memory impairment, depression, visual disturbances
Unknown frequency
•
Benzodiazepine use disorder, benzodiazepine withdrawal syndrome, acute liver failure, chest pain, jaundice, falls, anterograde amnesia, loss of appetite, muscle spasms, syncope, pruritus, urinary incontinence, urinary retention, dystonia, cognitive impairment, behavioral or personality changes, aggressive behavior, suicidal ideation, anxiety, respiratory depression
Interactions
Drug(s)
Check Interactions
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