TRIAZOLAM

Drugs in Pregnancy and Lactation.

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Name: TRIAZOLAM
Class: Hypnotic
Risk Factor:    XM

Fetal Risk Summary

Triazolam, a short-acting benzodiazepine, is used as a hypnotic for the treatment of insomnia. Although no congenital anomalies have been attributed to the use of triazolam during human pregnancies, other benzodiazepines (e.g., see Diazepam) have been suspected of producing fetal malformations after 1st-trimester exposure. In one report, the drug was not teratogenic in pregnant animals when administered in large oral doses (1).

No data have been located on the placental passage of triazolam. However, other benzodiazepines, such as diazepam, freely cross the placenta and accumulate in the fetus (see Diazepam). A similar distribution pattern should be expected for triazolam.

By the middle of 1988, the manufacturer had received more than 100 reports of in utero exposure to triazolam (J.H. Markillie, personal communication, Upjohn, 1989). Approximately one-seventh of these women were either lost to follow-up or further information was not available. Of the cases in which the outcome was known, more than one-half of the completed pregnancies ended with the delivery of a normal infant. Some of these exposures were reported in a 1987 correspondence that also included experience with alprazolam, another short-acting benzodiazepine (2). From these two sources, a total of five infants with congenital malformations have been described after in utero exposure to triazolam: extra digit on left foot and cleft uvula; incomplete closure of the foramen ovale (resolved spontaneously); small-for- gestational-age infant with left pelvic ectopic kidney; ventricular septal defect and possible coarctation of aorta (exposed to multiple drugs including triazolam); and premature, low-birth-weight infant with ventricular septal defect, pulmonary stenosis, intraventricular hemorrhage, hydrocephalus, apnea, bradycardia, anemia, jaundice, and seizure disorder (exposed to single 0.125-mg tablet at 1–2 weeks' gestation).

Single reports received by the manufacturer of defects in infants exposed in utero to either triazolam or alprazolam include pyloric stenosis, moderate tongue-tie, umbilical hernia and ankle inversion, and club foot (2).

Three cases of nonmalformation toxicities have been observed in infants exposed during gestation to triazolam: tachycardia, bradycardia, respiratory pauses, hypotonia and axial hypotony, impaired arachnoid reflexes, hypothermia, sleepy, and lifeless (symptoms resolved after infant received supportive care for several days; mother took multiple medications during pregnancy); fetal distress requiring emergency cesarean section and infant resuscitation, umbilical cord wrapped around neck, seizure activity, and generalized cortical atrophy (exposed to triazolam and a second [not identified] benzodiazepine early in pregnancy and during the last week of gestation; apparent recovery with no permanent disability by 6 months of age); and bradycardia, malaise, cyanosis, leukopenia, and chewing movements at 4 days of age (exposed during 3rd trimester; symptoms resolved by 1 week of age) (2).

Based on the available information, a cause-and-effect relationship between triazolam and the various infant outcomes does not appear to exist. Moreover, these cases cannot be used to derive rate or incidence data, because of the probable bias involved in the reporting of pregnancy exposures to the manufacturer (2).

In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, 138 newborns were exposed to triazolam during the 1st trimester (F. Rosa, personal communication, FDA, 1993). A total of seven (5.1%) major birth defects were observed (six expected). One cardiovascular defect (one expected) and one case of polydactyly (0.5 expected) were observed, but specific information on the other defects was not available. No anomalies were observed in four other categories of defects (oral clefts, spina bifida, limb-reduction defects, and hypospadias) for which specific data were available. These data do not support an association between the drug and congenital defects.

A 1990 report evaluated the available published data to determine the fetal risk that occurs from exposure to various drugs (3). The risk for triazolam, based on poor data, was determined to be “none-minimal.” This risk assignment was defined as “...a magnitude that patients and physicians would generally consider to be too small to influence the management of an exposed pregnancy” (3).

Breast Feeding Summary

Triazolam and its metabolites are excreted in milk of rats (4). No reports describing the use of triazolam during human lactation or measuring the amount, if any, excreted into milk have been located. The molecular weight (about 343), however, is low enough that passage into human milk should be anticipated. The effects of this exposure on a nursing infant are unknown, but closely related drugs (e.g., see Diazepam) are classified by the American Academy of Pediatrics as agents that may be of concern during breast-feeding (5).

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References

  1. Matsuo A, Kast A, Tsunenari Y. Reproduction studies of triazolam in rats and rabbits. Iyakuhin Kenkyu 1979;10:52–67. As cited in Shepard TH. Catalog of Teratogenic Agents. 6th ed. Baltimore, MD: Johns Hopkins University Press, 1989:630.
  2. Barry WS, St Clair SM. Exposure to benzodiazepines in utero. Lancet 1987;1:1436–7.
  3. Friedman JM, Little BB, Brent RL, Cordero JF, Hanson JW, Shepard TH. Potential human teratogenicity of frequently prescribed drugs. Obstet Gynecol 1990;75:594–9.
  4. Product information. Halcion. Pharmacia & Upjohn, 1998.
  5. Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 1994;93:13750.

Index

Q&A about Triazolam

gerdie65
What does the drug TRIAZOLAM do to you?
I am being sedated for dental work and want to know what this drug does for you,as far as feeling any pain.Will I feel the full impact of injections or pulling of teeth?Please help me understand,I am going to the dentist on Wednasday.Thank you.
SusiQ
Just last Thursday I had major dental work. I had to be put to sleep. One dentist I called said they would give me a pill, triazolam, and I would be in a so called twilight sleep. That wasn't good enough for me because I went on line and started reading things from people who had taken it and said they felt pain. I went to a dentist that gave me a 10 mg. valium to be taken an hour prior to surgery, they when I sat down in the chair they gave me laughing gas, then they gave me versed intravenously and another drug with it. When I was out they numbed my whole mouth. I don't remember a thing after sitting in the chair. I'm in terrible pain now but for the procedure I felt nothing. Good luck to you.
kathy429...
Triazolam. How early should I take it?
How early in advance should I take the .25mg of triazolam my dentist prescribed me for my dentist appointment tomorrow? He called it in to my pharmacy so I haven't talked to him. Also there are 2 in the bottle. I guess they are .25mg each. Should I take both at seperate times (like an hour or hour and a half apart) or just take one?
Mandy VZ
I've had this prescribed for dental work before. I was told to take both pills as a single dose 30 minutes to an hour before my procedure.
Megan Z
Triazolam for wisdom teeth extractions?
im getting my wisdom teeth out in a week, and the anxiety is sinking in. Im supposed to take this pill, Triazolam (blue) an hour before my appointment, and then when i get there, they're going to give me another one. I know its supposed to make me calm, but i dont know anything else. Since it's not going to put me to sleep, am i going to know everything that's going on, am i going to feel anything or any experiences with this?
nancy s
Triazolam may cause a severe allergic reaction. Stop taking triazolam and get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Take triazolam only when you are getting ready for several hours of sleep. You may fall asleep very quickly after taking the medicine.

Some people using this medicine have engaged in activity such as driving, eating, or making phone calls and later having no memory of the activity. If this happens to you, stop taking triazolam and talk with your doctor about another treatment for your sleep disorder.

I found that from a link and thought it would give you a better idea of what to expect. You will also be given anesthetic to numb your mouth. You will be aware, but maybe you will not care as much and then later forget what happened. I've never taken it, but if your dentist trusts it he's probably used it for some time with good success.
student programmer
What is the generic name of triazolam? Is it itself?
Marilyn B
Marketed under brand names Halcion®, Novodorm®, and Songar®

Generic name: Triazolam

Type of drug: Benzodiazepine sedative

Prescribed for: Insomnia and sleep disturbances
*Cate*
Triazolam safe during pregnancy?
I am having a dental procedure done on March 20th. Because I'm terrified of the dentist, they suggested using Triazolam to relax me. There is a good chance I may be pregnant. Is Triazolam safe to take until I find out?
Nebula D
I'm a dentist.

Absolutely not! Halcion (triazolam) is not safe to take during pregnancy. Do not take that medication until you are certain you are not pregnant.

All medications are given a pregnancy risk designation:

A-proven safe in human studies. No drugs have been "proven safe".

B-presumed to be safe based on animal studies.

C-no evidence either way to say safe or unsafe.

D-unsafe, but may still be used in certain circumstances

X-very unsafe, and use of drug is never justified during pregnancy.

Halcion (triazolam) is designated as "X".

A MESSAGE FOR ALL OF YOU READING THIS:

Always tell your dentist absolutely everything you know about your health history. Your mouth, being a part of your body, is like any other part of your body. Your health history is every bit as relevant to our work as it is to a physian's.
baby
what is the effective triazolam withdrawal strategy?
ilse72
I'm sorry but you really need to get the withdrawal strategy from your doctor. Withdrawing the medication will be based on how long you have been on it, dealing with issues that arise during the weaning process and implementing strategies to cope with the original problem (insomnia).

During this time period though, you will want to follow the routine strategies for coping with insomnia (in addition to anything your doctor recommends). The routine strategies include:

avoid or limit caffeine, nicotine, and alcohol, especially in the evening.

make sure none of your medications are affecting your sleep

go to bed and get up at the same time EVERY day

save the bed for sleeping and sex only...no tv

exercise daily at least 4 hours before bedtime

limit bedtime to 8 hours

do not nap

relax in the evenings...don't do anything stimulating

eat meals at regular times

try to avoid a bedtime snack

when in bed, concentrate on relaxing

get lots of sunshine

keep your bedroom quiet, dark, and cool

try a sleep mask

avoid beverages at night

try using white noise

It might help to try and keep a sleep diary so that you can document your sleep issues. Contact me for more info on this if you want to spend the time doing it.
Glitterg...
Has anyone taken triazolam (Dentists use it for oral sedation)?
I am going to the dentist this week and wanted to know how safe it is? Or the side effects of this drug? I am nervous and want to make sure it doesnt have any weird effect. I looked it up and Its typically used as a sleeping pill. and you are suppose to just sleep through the procedure and not remember anything. And if anyone knows how you feel afterward?? Thanks!
bizou_be...
I have used Triazolam for Dentist visits in the past. Don't be nervous, but be prepared to take the rest of the day off. Someone will have to pick you up from the dentist because you will be groggy for a few hours. It's like a sleeping pill, but it's also an amnesia causing substance, so you may wake up during the procedure, but you won't feel anything and you won't remember it much afterwards. Good luck and don't worry!
B&B
Triazolam while breastfeeding?
I know, I know, I know most meds are safe while breastfeeding. I am having oral surgery on March 31st, and have been prescribed a low-dose benzodiazepene (Triazolam) to take pre-surgery.

I seem to recall reading that benzos ARE one of the meds specifically contraindicated.

Can anyone elaborate on this? How long do you usually pump and dump? And, I plan to pump and bottle-feed breastmilk for a few days. My son is a lil' over two months. Are we past the nipple confusion stage? He has never had a bottle, and I think I'll be too whacked out to fiddle with spoon or syringe feeding.

Thanks.
mystic_e...
You should speak to motherisk:

http://www.motherisk.org/women/index.jsp

(416) 813-6780 - Motherisk's Home Line

But yes nipple confusion can still happen at 8 weeks. I would question the need for this medication at all.

http://www.kellymom.com/health/meds/seda...

Oral Agents

Triazolam and diazepam are used as oral pre-operative sedatives, often taken one hour prior to a procedure with a sip of water. If a patient is breastfeeding, the oral sedative of choice would be triazolam with a half life of 1.5-5.5 hours compared to diazepam's half life of 43 hours. Some pediatric concerns of poor suckling, lethargy and sedation have been reported with Valium. The milk to plasma ratio with Valium has been reported to be as high as 2.8.

Inhalation Agents

The inhalation agent of choice in dentistry is nitrous oxide blended with oxygen, also know as "laughing gas". A nitrous oxide/oxygen blend helps to reduce anxiety and works as a sedative. In the dental office, the patient breathes the gas through a nasal mask. Patients describe a sense of well being and relaxation. It works quickly and wears off quickly, making it a good choice for breastfeeding mothers and breastfed babies. Its half life is less than 3 minutes.



See also:

http://www.home.kellymom.net/health/meds...
Rhonda T
Dentist or Doctor Question 2Hydrocodone, plus 2 Triazolam 0.25?
I am getting ready to have 14 teeth pulled in about 3 hours, Iam suppose to take the Triazolam 1 hour before, Since i have a very low tolerance for pain and am very very aprehensive about the Dentist, can I take Hydrocodone before that, I don't want to over medicate myself but when I have my wisdom teeth out about 10 years ago, I felt alot of pain during the precedure. I just wanna make sure I am out of it.
Dr.kumar
Triazolam is an antianxiety drug. Your dentist will guide you what medicine you should take before the procedure. Please don't do self medication, as these drugs should not be taken without doctor's advice.Please tell your dentist about your previous experience , to take the necessary precautions. Something ,i would like to tell about your previous experience that, pain could be more when local anesthesia does not work,which is more common in case of lower wisdom tooth, your dentist should have given more local anesthesia ,10 years before. Failure in anesthesia can be caused by presence of infection, very much anxiety,etc. Can i ask why are you going to undergo serial extraction?
Mrs. Giggles
Question about Triazolam?
On Monday I am having 8 fillings done. I didn't have much dental work done as a child because my parents couldn't afford it. But now as a adult I can. Im going to a sedation dentistry to have this done because I faint at the glance of a needle. This way they are able to do all the things I need done in one day and I think the pill is so I dont freak out. Has anyone ever taking this pill before and if so how did it work for you. Thanks
spongebo...
Basically, the pill makes you sleep. It also erases all memory during the time you take it, so you won't remember any of the work, needle, etc. You also won't care. All you will do is sleep. You will be able to talk should you need to, but you won't remember it. Most people sleep, do little or no talking. You will be able to tell the dentist it hurts if it does, but you won't remember. You start taking a few pills and your dentist will give you some more when you arrive as needed to get you to proper sedation level. They usually also put you on nitrous oxide for added sleepiness and pain tolerance and to make you a little more out of it. It works like a charm, don't worry. However, make sure you have someone good taking care of you once you leave b/c you will be out of it for a while.