Triazolam

INTRODUCTION

Indications

Short-term management of insomnia.

Action

Acts at many levels in the CNS, producing generalized depression. Effects may be mediated by gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter. Therapeutic Effects: Relief of insomnia.

Adverse Reactions/Side Effects

CNS: abnormal thinking, behavior changes, dizziness, excessive sedation, hangover, headache, anterograde amnesia, confusion, hallucinations, sleep driving, lethargy, mental depression, paradoxical excitation. EENT: blurred vision. GI: constipation, diarrhea, nausea, vomiting. Derm: rashes. Misc: physical dependence, psychologic dependence, tolerance.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor daytime drowsiness, anxiety, short-term memory deficits, and “hangover” symptoms (headache, blurred vision, nausea, irritability, lethargy, dysphoria). Repeated or excessive symptoms may require change in dose or medication.

• Watch for other behavioral or personality changes such as confusion, nervousness, excitation, decreased concentration, hallucinations, or expression of abnormal thoughts. Notify physician if these changes become problematic.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth). Implement fall-prevention strategies, especially in older adults or if drowsiness and dizziness carry over into the daytime (See Appendix E).

• Help patient explore nonpharmacologic methods to improve sleep, such as relaxation techniques, regular exercise, avoid caffeine, and so forth.

Patient/Client-Related Instruction

• Instruct patients on prolonged treatment not to discontinue medication without consulting their physician. Long-term use can cause tolerance and physical/psychologic dependence, and increased sleep problems (rebound insomnia) can occur when the drug is suddenly discontinued.

• Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

• Caution patient and family/caregivers to guard against complex motor behaviors that can occur while asleep, including driving a car.

• Instruct patient to report severe or prolonged skin rash or GI problems (nausea, vomiting, diarrhea, constipation).

Pharmacokinetics

Absorption: Well absorbed following oral administration.

Distribution: Widely distributed, crosses blood-brain barrier. Probably crosses the placenta and enters breast milk.

Protein Binding: 89%.

Metabolism and Excretion: Metabolized by the liver.

Half-life: 1.6–5.4 hr.

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Cross-sensitivity with other benzodiazepines may occur; Preexisting CNS depression; Uncontrolled severe pain; OB/Pedi: ...