Triazolam

Triazolam is a prescription medicine used to treat the symptoms of insomnia.

• Triazolam is available under the following different brand names: Halcion

Adult dosage

Tablet: Schedule IV

• 0.125mg
• 0.25mg

Geriatric dosage

• Initiate a lower dose of 0.125 mg at bedtime; not to exceed 0.25 mg/day

Insomnia

Adult dosage

• 0.125-0.25 mg orally every night at bedtime
• Maximum dose: 0.5 mg orally every night at bedtime

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

Common side effects of Triazolam include:

• dizziness,
• daytime drowsiness,
• loss of coordination,
• headache, and
• tingly or prickly feeling on the skin

Serious side effects of Triazolam include:

• unusual changes in mood or behavior,
• confusion,
• memory loss (amnesia),
• hallucinations,
• depression, and
• suicidal thoughts

Rare side effects of Triazolam include:

• none 

This is not a complete list of side effects and other serious side effects or health problems that may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Triazolam has severe interactions with the following drugs:
  • chloramphenicol
  • cobicistat
  • darunavir
  • itraconazole
  • ketoconazole
  • levoketoconazole
  • lopinavir
  • mifepristone
  • nelfinavir
  • nirmatrelvir
  • nirmatrelvir/ritonavir
  • ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)
  • saquinavir
  • tipranavir
• Triazolam has serious interactions with at least 47 other drugs.
• Triazolam has moderate interactions with at least 262 other drugs.
• Triazolam has minor interactions with the following drugs:
  • brimonidine
  • cilostazol
  • ciprofloxacin
  • esomeprazole
  • eucalyptus
  • fleroxacin
  • gemifloxacin
  • levofloxacin
  • moxifloxacin
  • ofloxacin
  • omeprazole
  • rifabutin
  • sage
  • vinpocetine
  • zolpidem

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns.

Contraindications

• Documented hypersensitivity
• Acute alcohol intoxication
• Myasthenia gravis (allowable in limited circumstances)
• Narrow-angle glaucoma (questionable)
• Severe respiratory depression
• Depressed neuroses, psychotic reactions
• IV use in shock, coma, depressed respiration, patients who recently received other respiratory depressants
• Medications that significantly impair the oxidative metabolism mediated by cytochrome P450 3A (CYP 3A) including ketoconazole, itraconazole, nefazodone, and several HIV protease inhibitors

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Triazolam?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Triazolam?”

Cautions

• Use caution in COPD, sleep apnea, renal/hepatic disease, open-angle glaucoma (questionable), impaired gag reflex, depression, suicide ideation
• Benzodiazepines may worsen depression; take appropriate precautions (e.g., limiting the total prescription size and increased monitoring for suicidal ideation) in patients with depression
• Anterograde amnesia may occur
• Hypersensitivity reactions reported
• Sleep-related activities (sleep-driving, sleep-cooking, sleep-eating, etc) may occur
• Hyperactive aggressive behavior may occur
• May impair ability to perform hazardous tasks
• Failure of insomnia to remit after 7 - 10 days of treatment may indicate the presence of primary psychiatric and/or medical illness that should be evaluated
• An increase in daytime anxiety may occur; consider therapy discontinuation if this occurs
• Use caution and consider appropriate dose reduction when used concomitantly with weak or moderate CYP450 3A inhibitors
• Therapy can cause drowsiness and a decreased level of consciousness; patients, particularly the elderly, are at higher risk of falls
• Use of Halcion during later stages of pregnancy can result in sedation (respiratory depression, lethargy, hypotonia) and withdrawal symptoms (hyperreflexia, irritability, restlessness, tremors, inconsolable crying, and feeding difficulties) in neonates; observe newborns for signs of sedation and neonatal withdrawal syndrome and manage accordingly
• Benzodiazepines expose users to risks of abuse, misuse, and addiction, which can lead to overdose or death; abuse and misuse of benzodiazepines often (but not always) involve the use of doses greater than the maximum recommended dosage and commonly involve concomitant use of other medications, alcohol, and/or illicit substances, which is associated with an increased frequency of serious adverse outcomes, including respiratory depression, overdose, or death
• Use of the drug, particularly in patients at elevated risk of abuse, necessitates counseling about risks and proper use of the drug along with monitoring for signs and symptoms of abuse, misuse, and addiction; do not exceed recommended dosing frequency
• Avoid or minimize concomitant use of CNS depressants and other substances associated with abuse, misuse, and addiction (eg, opioid analgesics, stimulants); advise patients on proper disposal of the unused drug; if a substance use disorder is suspected, evaluate patient and institute (or refer them for) early treatment, as appropriate
• For patients treated more frequently than recommended, use a gradual taper to discontinue therapy (a patient-specific plan should be used to taper the dose), to reduce the risk of withdrawal reactions
• Patients at an increased risk of withdrawal adverse reactions after benzodiazepine discontinuation or rapid dosage reduction include those who take higher dosages and those who have had longer durations of use
• In some cases, benzodiazepine users have developed a protracted withdrawal syndrome with withdrawal symptoms lasting weeks to more than 12 months
• Withdrawal effects
  • Withdrawal phenomena results in increased wakefulness during the last third of the night, and the appearance of increased signs of daytime anxiety or nervousness
  • Withdrawal effects can occur after discontinuing these drugs following use for only a week or two but may be more common and more severe after longer periods of continuous use
  • A phenomenon known as ‘rebound insomnia may occur after stopping therapy, on the first few nights after the drug is stopped, insomnia is worse than before the sleeping pill was given
  • Other withdrawal phenomena following abrupt stopping of benzodiazepine sleeping pills range from mild unpleasant feelings to a major withdrawal syndrome which may include abdominal and muscle cramps, vomiting, sweating, tremor, and convulsions

Pregnancy and Lactation

• There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to drugs during pregnancy; healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Other Psychiatric Medications at 1-866-961-2388 or visiting online at https://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/othermedications/
• Infants born to mothers using benzodiazepines during later stages of pregnancy reported experiencing symptoms of sedation and neonatal withdrawal
• At this time, there is no clear evidence that triazolam exposure in early pregnancy can cause major birth defects
• Benzodiazepines cross the placenta and may produce respiratory depression and sedation in neonates; monitor neonates exposed to therapy during pregnancy and labor for signs of sedation, respiratory depression, withdrawal, and feeding problems and manage accordingly
• Lactation
  • There are no data on the presence of drugs in human milk or effects on milk production; there are reports of central nervous system depression (sedation, respiratory depression), withdrawal symptoms, and feeding problems in infants who are breastfed by mothers taking benzodiazepines
  • The drug and its metabolites are present in the milk of lactating rats; when a drug is present in animal milk, the drug will likely be present in human milk; the developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for therapy and any potential adverse effects on the breastfed infant from the drug or underlying maternal condition
  • Infants exposed to the drug through breast milk should be monitored for sedation, respiratory depression, withdrawal symptoms, and feeding problems; a lactating woman may consider interrupting breastfeeding and pumping and discarding breast milk during treatment and for 28 hours (approximately 5 elimination half-lives) after therapy administration to minimize drug exposure to a breastfed infant