triazolam (Rx)

Brand and Other Names:Halcion
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet: Schedule IV

  • 0.125mg
  • 0.25mg

Insomnia

0.125-0.25 mg PO qHS

Maximum dose: 0.5 mg PO qHS

Dosage Modifications

Hepatic impairment: Administer a lower dose; avoid use in cirrhosis

Safety and efficacy not established

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

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Interactions

Interaction Checker

and triazolam

No Results

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Drowsiness (14%)

            1-10%

            Headache (5-10%)

            Dizziness (5-10%)

            Nervousness (5-10%)

            Ataxia (4-5%)

            Lightheadedness (4-5%)

            N/V (4-5%)

            <1%

            Anterogade amnesia

            Paradoxical reactions

            Travelers amnesia-especially if combined with EtOH

            Confusion

            Cramps

            Fatigue

            Memory impairment

            Depression

            Visual disturbance

            Xerostomia

            Anterograde amnesia

            Dreaming/nightmares

            Confusion

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            Warnings

            Black Box Warnings

            Concomitant use of benzodiazepines and opioids may result in profound respiratory depression, coma, and death; administer concomitantly when there are no alternative options; limit dosages and durations to minimum required; monitor for signs and symptoms of respiratory depression and sedation

            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 oxidative metabolism mediated by cytochrome P450 3A (CYP 3A) including ketoconazole, itraconazole, nefazodone, and several HIV protease inhibitors

            Caution

            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 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 presence of primary psychiatric and/or medical illness that should be evaluated

            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

            Use caution in patients with history of drug abuse or acute alcoholism; tolerance, psychological and physical dependence may occur with prolonged use

            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

            Withdrawal effects

            • Withdrawal phenomena results in increased wakefulness during last third of the night, and 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 phenomena known as ‘rebound insomnia’ may occur after stopping therapy, on the first few nights after drug is stopped, insomnia is actually 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
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            Pregnancy & Lactation

            Pregnancy

            There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to drug 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 to experience 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

            Animal data

            • Oral administration to male and female rats before mating, and continuing during gestation and lactation did not result in embryotoxicity at doses up to approximately 100 times the MRHD based on mg/m2 body surface area, but did cause an increase in number of stillbirths and postnatal pup mortalities at doses greater than or equal to approximately 40 times the MRHD based mg/m2 body surface area

            Lactation

            There are no data on presence of drug 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, it is likely that the drug will 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 drug or from underlying maternal condition

            Infants exposed to 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 in order to minimize drug exposure to a breast fed infant

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing membrane permeability to chloride ions, which in turn increases the inhibitory activity of GABA on neuronal excitability.

            Pharmacokinetics

            Half-Life: 1.5-5.5 hr

            Peak plasma time: 0.5-2 hr

            Onset of action: 15-30 min

            Vd: 0.8-1.8 L/kg

            Protein binding: 89%

            Duration: 6-7 hr

            Peak plasma concentration: 1-6 ng/mL

            Metabolism: CYP3A4, glucuronic acid conjugation

            Metabolites: Inactive metabolites

            Excretion: Urine

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.