Contraindications to Triazolam
Before a practitioner uses any medication, they should be knowledgeable of its pharmacology. Likewise every practitioner, but particularly those using sedatives, should be able to initiate resuscitation, including cardiopulmonary resuscitation and artificial ventilation as well as assisting ventilation. The equipment necessary to provide these emergency treatments must, of course, be available.
There are a few absolute contraindications to the use of triazolam. Patients who are known to be hypersensitive to triazolam or other benzodiazepine drugs should avoid its use. Myasthenia gravis patients should be avoided as triazolam has a muscle relaxation effect. Glaucoma patients should avoid all benzodiazepines as these drugs raise intraocular pressure by increasing the outflow resistance to aqueous humor. (However, this can often be reversed by pilocarpine.) All the benzodiazepine drugs are tiatrogenic and should not be given to pregnant women. As triazolam has been shown to pass through the lacrimal glands of mice into the milk, it should not be given to lactating mothers. As it is a CNS depressant, it should be given cautiously to anyone on other CNS depressants. Because of their depressant effect on the liver mechanisms that metabolize triazolam, it should be given cautiously in patients receiving cimetadine (Tagamet), erythromycin, izonizid and some oral contraceptives.
Relative contraindications
There are detailed studies of triazolam's use as a sedative with pediatric and geriatric populations and practitioners should be cautious when giving triazolam to these groups.
There have been reports of suicide attempts by psychiatric patients. Suicidal tendencies were unmasked, creating this paradoxical behavior Concurrent drug administration should be avoided as the possibility exists of displacement of other drugs from albumin binding cites.
The final relative contraindication is the fact that triazolam has not been approved by the FDA for dental sedation or the sedation of children.
Adverse effects
Adverse effects have been reported in less than 4 percent of patients. Most adverse effects have been reported with doses greater than .5 mg. or when combined with other CNS depressants.
The office should have an effective, efficient emergency protocol. This should include a person to be continuously in the room with the patient from the time of administration of the drug until they are judged able to leave the office. The patient should not be allowed to sleep at any time while in the office. Vital signs should be taken at regular intervals, every 15 minutes or more often if there is any indication of over-sedation, i.e. tendency to sleep, etc.
Management of adverse reactions should be planned before the drug is used and reviewed on a periodic basis. It should be noted that most adverse effects will be prevented by complete history-taking, physical examination and appropriate adjustment of drug dosage. Recognition of an emergency situation must be followed by initiation of a stabilization routine. This essentially entails the A-airway, B-breathing, and C-circulation of basic cardiac life support. Opening and maintaining a patient's airway is of paramount importance as is monitoring vital signs. Calling Emergency Medical Service by dialing 911 should follow if any doubt exists as to how to proceed.