Short-term (generally 7–10 days) management of insomnia.
Decreases sleep latency, increases the duration of sleep, and decreases the number of nocturnal awakenings.
Has been used for the prevention or short-term treatment of transient insomnia associated with sleep-wake schedule changes† (e.g., rapid travel across time zones [“jet lag”], rotating shift work). May be useful for this purpose in some patients; however, consider the possibility of transient impairment of cognitive function (e.g., anterograde amnesia [“traveler’s amnesia”]). (See Amnesia under Cautions.)
Dosage and Administration
General
Use only when able to get 7–8 hours of sleep before being active again.
Avoid prolonged administration. Generally limit hypnotic therapy to 7–10 days.
Write prescriptions for short-term (7–10 days) use only; the quantity dispensed to the patient should not exceed a 1-month supply.
Reevaluate patient if triazolam is to be used for more than 2–3 weeks.
Avoid abrupt discontinuance in patients who have received prolonged therapy (because of potential for precipitating withdrawal manifestations); after therapy with more than the lowest dose for longer than a few weeks, taper dosage gradually, particularly in patients with a seizure history.
Consider gradual dosage reduction (e.g., over several nights) when discontinuing short-term triazolam therapy (because of potential for rebound insomnia).
Administration
Oral Administration
Administer at bedtime.
Avoid concomitant oral administration with grapefruit juice.
Dosage
Individualize dosage; use the smallest effective dose.
Some adverse effects (e.g., amnesia, dizziness, drowsiness, lightheadedness) appear to be dose related. Inconclusive whether other effects (e.g., confusion, bizarre or abnormal behavior, agitation, hallucinations) are dose related.
Adults
Insomnia
Oral
Usual dose is 0.25 mg.
In some patients (e.g., those with low body weight), 0.125 mg may be adequate.
Reserve 0.5-mg dose for exceptional cases in which the patient does not respond adequately to a lower dose.
Prescribing Limits
Adults
Insomnia
Oral
Maximum 0.5 mg daily.
Special Populations
Hepatic Impairment
No specific dosage recommendations.
Renal Impairment
No specific dosage recommendations.
Geriatric or Debilitated Patients
Usual dosages in healthy geriatric patients should be approximately half those in younger adults.
Initially, 0.125 mg daily. Increased risk of adverse (e.g., behavioral) effects if therapy is initiated at doses >0.125 mg.
Reserve 0.25-mg dose for exceptional cases in which the patient does not respond adequately to a lower dose.
May cause fetal harm; avoid use of benzodiazepines as hypnotics during pregnancy. If used during pregnancy or if patient becomes pregnant, apprise of potential fetal hazard.
Adequate Patient Evaluation
Insomnia may be a manifestation of an underlying physical and/or psychiatric disorder; carefully evaluate patient before providing symptomatic treatment.
Failure of insomnia to remit after 7–10 days of treatment, worsening of insomnia, or emergence of new abnormal thinking or behavior may indicate the presence of an underlying psychiatric and/or medical condition.
Complex Sleep-related Behaviors
Potential risk of complex sleep-related behaviors such as sleep-driving (i.e., driving while not fully awake after ingesting a sedative-hypnotic drug, with no memory of the event), making phone calls, or preparing and eating food, while asleep.
Adverse Psychiatric Events
Abnormal thinking and behavioral changes (e.g., aggressiveness, uncharacteristic extroversion, bizarre behavior, agitation, hallucinations, depersonalization, amnesia) may occur unpredictably in patients receiving benzodiazepines.
Some evidence suggests that some such behavioral effects may occur more frequently with triazolam than with other hypnotic benzodiazepines.
Immediately evaluate any new behavioral sign or symptom.
Amnesia
Anterograde amnesia of varying degrees of severity reported following therapeutic doses. Frequency may be greater with triazolam than with other benzodiazepines. May be particularly disturbing with triazolam, especially when high doses (e.g., 0.5 mg) are used.
Anterograde amnesia (“traveler’s amnesia”) that occurred upon awakening and persisted for several hours has been reported by individuals who took triazolam to induce sleep while traveling (e.g., during airplane flights). Concomitant use of alcohol may have been a contributory factor in some cases.
Bizarre behavior has been associated with the period of amnesia in some patients.
Consider the risk of anterograde amnesia in patients receiving triazolam, particularly when relatively high doses are considered (e.g., for transient insomnia associated with sleep-wake schedule changes) or when the duration of drug effect is likely to exceed the intended period of sleep (e.g., when taken to induce sleep while traveling).
CNS Depression
Performance of activities requiring mental alertness and physical coordination may be impaired.
Concurrent use of other CNS depressants may potentiate CNS depression. (See Specific Drugs and Foods under Interactions.)
Dependence and Abuse Potential
Psychologic and physical dependence may occur following prolonged use.
Patients with a history of drug or alcohol dependence or abuse are at risk of habituation or dependence; use only with careful surveillance in such patients.
Tolerance and Withdrawal Effects
Tolerance and adaptation to the hypnotic effect may occur after several weeks of therapy, resulting in diminished effectiveness during the end of each night’s use (early morning insomnia) and, possibly, increased daytime anxiety.
Increase in daytime anxiety reported after as few as 10 days of continuous use; daytime anxiety also may occur between nightly doses as a manifestation of interdose withdrawal. If increased daytime anxiety occurs, discontinuance may be advisable.
Potential for rebound insomnia for 1 or 2 nights after drug discontinuance.
Rapid dosage reduction or abrupt discontinuance may result in signs and symptoms of withdrawal (similar to barbiturates or alcohol).
Interactions
Concomitant use with drugs that are potent inhibitors of CYP3A (e.g., itraconazole, ketoconazole, nefazodone, delavirdine, efavirenz, HIV protease inhibitors) is contraindicated. Less potent inhibitors of CYP3A should be used concomitantly with caution; consider possible need for reduction of triazolam dosage. (See Interactions.)
Sensitivity Reactions
Potential risk of anaphylaxis and angioedema; may occur even with the first dose of drug.
General Precautions
Suicide
Use with caution in depressed patients; potential for suicidal tendencies. Prescribe and dispense drug in the smallest feasible quantity.
Respiratory Effects
Use with caution in patients with compromised respiratory function (e.g., chronic pulmonary insufficiency, sleep apnea). Respiratory depression and apnea reported infrequently in these patients.
Specific Populations
Pregnancy
Category X. (See Fetal/Neonatal Morbidity and Mortality under Cautions.)
If used during the last weeks of pregnancy, potential for neonatal CNS depression.
Lactation
Distributed into milk in rats; not known whether distributed into human milk. Use not recommended.
Pediatric Use
Safety and efficacy not established in children <18 years of age.
Geriatric Use
Increased sensitivity to dose-related adverse effects. Clearance is reduced and plasma concentrations are increased by about 50%. Use reduced dosages (see Geriatric or Debilitated Patients under Dosage and Administration); use the smallest effective dose.
Hepatic Impairment
Use with caution.
Renal Impairment
Use with caution.
Common Adverse Effects
Drowsiness, headache, dizziness, nervousness, lightheadedness, coordination disorders or ataxia, nausea or vomiting.
Media Gallery
Drug Info Tools
