• Short-term management of insomnia.

Contraindicated in:

• Hypersensitivity
• Cross-sensitivity with other benzodiazepines may occur
• Pre-existing CNS depression
• Uncontrolled severe pain
• Concomitant use of potent CYP3A4 inhibitors
• OB: May cause fetal harm
• Lactation: Use not recommended while breast feeding.

Use Cautiously in:

• Pre-existing hepatic dysfunction (dose ↓ recommended)
• History of suicide attempt or drug addiction
• Geri: Appears on Beers list and is associated with ↑ risk of falls (↓ dose required); ↑sensitivity to benzodiazepines
• Pedi: Safety and effectiveness not established.

CNS: abnormal thinking, behavior changes, dizziness, excessive sedation, hangover, headache, anterograde amnesia, confusion, hallucinations, sleep-driving, lethargy, mental depression, paradoxical excitation.

EENT: blurred vision.

GI: constipation, diarrhea, nausea, vomiting.

Derm: rashes.
Misc: physical dependence, psychological dependence, tolerance.

Drug-Drug:

• Concomitant use of potent CYP3A4 inhibitors, including, itraconazole, ketoconazole, nefazodone, indinavir, nelfinavir, ritonavir, saquinavir, and lopinavir may ↓ metabolism and ↑ levels; concurrent use contraindicated.
• Erythromycin, clarithromycin, and cimetidine may ↑ levels; consider ↓ triazolam dose
• Use with opioids or other CNS depressants, including other benzodiazepines, non-benzodiazepine sedative/hypnotics, anxiolytics, general anesthetics, muscle relaxants, antipsychotics, and alcohol may cause profound sedation, respiratory depression, coma, and death; reserve concurrent use for when alternative treatment options are inadequate.
• May ↓ effectiveness of levodopa.
• May ↑ toxicity of zidovudine.
• Isoniazid may ↓ excretion and ↑ effects of triazolam.
• Sedative effects may be ↓ by theophylline.

Drug-Natural Products:

• Concomitant use of kava-kava, valerian, chamomile, or hops can ↑ CNS depression.

Drug-Food:

• Grapefruit juice significantly ↑ blood levels and effects.

(Generic available)

• Tablets: 0.125 mg; 0.25 mg;

• PO (Adults): 0.125–0.25 mg (up to 0.5 mg) at bedtime.
• PO (Geriatric Patients or Debilitated Patients): 0.125 mg at bedtime initially; may be ↑ as needed.

Halcion

• Acts at many levels in the CNS, producing generalized depression.
• Effects may be mediated by GABA, an inhibitory neurotransmitter.

• Relief of insomnia.

Therapeutic Classification: sedative/hypnotics

Pharmacologic Classification: benzodiazepines

Absorption: Well absorbed following oral administration.

Distribution: Widely distributed, crosses blood-brain barrier. Probably crosses the placenta and enters breast milk.

Protein Binding: 89%.

Metabolism/Excretion: Metabolized by the liver.

Half-life: 1.6–5.4 hr.

Schedule IV (C-IV)

(sedation)

• Instruct patient to take triazolam as directed. Discuss the importance of preparing environment for sleep (dark room, quiet, avoidance of nicotine and caffeine). If less effective after a few weeks, consult health care professional; do not increase dose.
• Advise patient to avoid grapefruit and grapefruit juice during therapy.
• May cause daytime drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known. Instruct patient and family how to reduce falls risk at home.
• Inform patient that after taking triazolam patient may get out of bed and perform activities (driving a car ("sleep-driving"), making and eating food, talking on the phone, having sex, sleep-walking) while unaware. You may not remember anything done during the night; increased risk with alcohol or other CNS depressants.
• Advise patient to avoid the use of alcohol and other CNS depressants and to consult health care professional prior to using OTC preparations that contain antihistamines or alcohol.
• Instruct patient to notify health care professional if an increase in daytime anxiety occurs. May occur after as few as 10 days of therapy. May require discontinuation of triazolam.
• Advise patient to inform health care professional if confusion, depression, or persistent headaches occur. Instruct family or caregiver to notify health care professional if personality changes occur.
• Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.
• Emphasize the importance of follow-up appointments to monitor progress.

trye-AZ-oh-lam