Triazolam

Benzodiazepines produce an additive CNS depressant effect, including respiratory depression, when co-administered with opioids or other CNS depressants. Triazolam should be used with caution when combined with CNS depressants. Enhancement of the central depressive effect may occur in cases of concomitant use with antipsychotics (neuroleptics), hypnotics, anxiolytics/sedatives, antidepressant agents, narcotic analgesics, anti-epileptic products, anaesthetics and sedative antihistamines. In the case of narcotic analgesics enhancement of the euphoria may also occur leading to an increase in psychic dependence.

Benzodiazepines produce an additive CNS depressant effect, including respiratory depression, when co-administered with alcohol. Concomitant intake with alcohol is not recommended.

Increased bioavailability of triazolam has been shown when taken concomitantly with grapefruit juice.

Caution must be used in treating patients with mild to moderate hepatic insufficiency.

Oral contraceptives and imatinib may lead to enhanced clinical effects of triazolam due to the inhibition of the CYP3A4 isoenzyme. Caution is therefore recommended in case of concomitant use with triazolam.

Caution and consideration of dose reduction is recommended when triazolam is coadministered with cimetidine or macrolide antibiotics such as erythromycin, clarithromycin, and troleandomycin.

The co-administration of triazolam with other azole-type antifungals is not recommended.

Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death. Limit dosages and durations to the minimum required.

Enhancement of the clinical effects may occur in cases of concomitant use of aprepitant with triazolam due to the inhibition of the enzyme CYP3A4. This interaction may require a dose-reduction of triazolam.

Caution is recommended when triazolam is co-administered with isoniazid, fluvoxamine, sertraline, paroxetine, diltiazem, and verapamil.

Rifampicin and carbamazepine cause CYP3A4 induction. Therefore, the effect of triazolam may be diminished significantly during therapy with rifampicin or carbamazepine.

Benzodiazepines should be used with extreme caution in patients with a history of alcohol or drug abuse.

The data concerning teratogenicity and effects on postnatal development and behavior following benzodiazepine treatment are inconsistent. There is evidence from some early studies with other members of the benzodiazepine class that in utero exposure may be associated with malformations. Later studies with the benzodiazepine class of drugs have provided no clear evidence of any type of defect.

Infants exposed to benzodiazepines during late third trimester of pregnancy or during labor have been reported to exhibit either the floppy infant syndrome or neonatal withdrawal symptoms. If triazolam is used during pregnancy, or if the patient becomes pregnant while taking triazolam, the patient should be apprised of the potential hazard to the foetus

Triazolam should not be used by nursing mothers.

Triazolam can have a major influence on the ability to drive and operate machines. Patients should be advised not to drive or operate machinery during treatment until it has been established that they are not affected by daytime drowsiness or dizziness. If insufficient sleep duration occurs, the likelihood of impaired alertness may be increased.