Generic Name

Triazolam

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Classification

FDA Approved Indications

• Short-term treatment of insomnia, particularly sleep onset difficulties

Mechanism of Action

Enhances the effect of gamma-aminobutyric acid (GABA) at the GABA-A receptor, resulting in sedative, hypnotic, anxiolytic, anticonvulsant, and muscle-relaxant properties.

Dosage and Administration

Adult: 0.125 mg to 0.25 mg at bedtime; may be increased to 0.25 mg or decreased based on response and tolerability

Pediatric: Not approved for pediatric use

Geriatric: Lower starting doses are recommended, typically 0.125 mg due to increased sensitivity and risk of adverse effects

Renal Impairment: Use cautiously; no specific dose adjustment, but monitor for increased sedation

Hepatic Impairment: Use cautiously; start at lower doses, monitor for adverse effects.

Pharmacokinetics

Absorption: Rapidly absorbed after oral administration

Distribution: Widely distributed, crosses the blood-brain barrier

Metabolism: Primarily hepatic via CYP3A4 enzymes

Excretion: Renal and fecal routes

Half Life: 2 to 6 hours, longer in the elderly or hepatic impairment.

Contraindications

• Hypersensitivity to triazolam or other benzodiazepines
• Narrow-angle glaucoma

Precautions

• History of substance abuse, psychiatric disorders, respiratory impairment, hepatic impairment, pregnancy, and lactation. Use with caution in elderly due to increased sensitivity to sedative effects.

Adverse Reactions - Common

• Drowsiness (Very common)
• Dizziness (Common)
• Amnesia, especially anterograde (Common)
• Gait disturbances (Less common)

Adverse Reactions - Serious

• Complex sleep-related behaviors (e.g., sleepwalking, sleep driving, hallucinations) (Rare but serious)
• Respiratory depression (Rare)
• Allergic reactions (rash, angioedema) (Rare)

Drug-Drug Interactions

• CNS depressants, including alcohol, opioid analgesics, and other sedatives/hypnotics; CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin)

Drug-Food Interactions

N/A

Drug-Herb Interactions

• Kava, valerian, and other herbs with sedative properties

Nursing Implications

Patient/Family Teaching

• Take medication exactly as prescribed, usually immediately before bed.
• Do not consume alcohol or other CNS depressants.
• Avoid driving or operating heavy machinery until alertness is confirmed.
• Inform about potential for amnesia and unusual behaviors.

Special Considerations

Black Box Warnings:

• Potential for sleep-driving, sleep-related behaviors, and amnesia.
• Risk of dependence, abuse, and withdrawal symptoms.

Genetic Factors: Genetic variations in CYP3A4 may affect metabolism and response.

Lab Test Interference: None typical.

Overdose Management

Signs/Symptoms: Extreme sedation, confusion, ataxia, respiratory depression, coma.

Treatment: Supportive care, airway management, monitoring vital signs, and administration of flumazenil (a benzodiazepine antagonist) in serious cases, with caution.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable under recommended conditions for the shelf life indicated by manufacturer.