triazolam

General Information

Triazolam is a very short-acting benzodiazepine indicated for the short-term treatment of insomnia (generally 7 to 10 days) in adults.

It is primarily a sleep-onset agent; very short half-life can limit morning sedation but increases rebound insomnia and withdrawal risk when used beyond short courses.

Because triazolam is mainly a sleep-onset agent, it is a poor fit when the primary complaint is sleep maintenance or early-morning awakenings; avoid “dose chasing” and consider alternatives rather than escalating to chronic use.

Triazolam has clinically important CYP3A4 interaction risk; strong CYP3A4 inhibitors are contraindicated and moderate/weak inhibitors can still require dose reduction or an alternative hypnotic (label).

Behavioral adverse effects (confusion, disinhibition, anterograde amnesia) are a key safety limiter; discontinue if they emerge rather than escalating the dose.

The triazolam compare view, triazolam evidence feed, and triazolam print page can support safe-use counseling.

Triazolam is best reserved for time-limited, high-intensity insomnia when non-controlled options are inadequate and the team can reliably screen CYP3A4 interactions. Avoid chronic use; pivot to CBT-I and other strategies when insomnia persists.

Mechanism of Action

Refer to the Glossary entry on Neurotransmitters for background on receptor systems involved in serious mental illness.

Positive allosteric modulator of GABA-A receptors, producing rapid hypnotic effects via increased inhibitory neurotransmission.

Short duration does not eliminate risk: amnesia, disinhibition, and additive respiratory depression with sedatives remain key hazards.

Repeated nightly use can produce tolerance and dependence, with rebound insomnia when stopped abruptly.

• GABA-A receptor positive allosteric modulation.

Metabolism and Pharmacokinetics

• Mean plasma elimination half-life is reported in the range of 1.5–5.5 hours (label).
• Metabolized primarily via CYP3A4; metabolites (mostly conjugated glucuronides) are excreted primarily in urine (label).
• Strong CYP3A4 inhibitors can profoundly increase exposure and are contraindicated; grapefruit juice and moderate inhibitors can also increase levels (label).

Dosing and Administration

• Adult: 0.25 mg once daily before bedtime; 0.125 mg may be sufficient in sensitive patients (label).
• Maximum recommended dose: 0.5 mg once daily (label).
• Geriatric: start 0.125 mg and do not exceed 0.25 mg once daily (label).
• Take immediately before bedtime when a full sleep window is possible; avoid middle-of-the-night redosing.
• Avoid use beyond a short course; if extended, taper rather than abrupt discontinuation.

Monitoring & Labs

• Review medication list for CYP3A4 inhibitors/inducers and grapefruit intake before prescribing.
• Reassess within 1–2 weeks; stop if benefit is limited or adverse effects occur.
• Monitor for amnesia, confusion, disinhibition, and next-day impairment after initiation and dose changes.
• If use extends beyond a brief course, document a taper plan and monitor for rebound insomnia/withdrawal.

Sources: FDA/DailyMed label; AASM insomnia guideline; benzodiazepine safety guidance.

Adverse Effects

Interactions

• Strong CYP3A4 inhibitors are contraindicated; moderate inhibitors and grapefruit juice can raise exposure (label).
• Common strong/moderate CYP3A4 inhibitors include azole antifungals, macrolide antibiotics, HIV protease inhibitor/cobicistat regimens, and nefazodone; review the full medication list before prescribing.
• Additive CNS/respiratory depression with opioids, alcohol, antihistamines, and other sedatives.
• Avoid combining with other hypnotics (including Z-drugs) except in exceptional, closely monitored situations.

Other Useful Information

• Use only when the team can screen interactions and provide close follow-up; avoid “PRN forever” prescriptions.
• If insomnia persists, pivot to CBT-I and non-controlled options rather than escalating benzodiazepine doses.
• If confusion, disinhibition, or parasomnia-like events occur, discontinue and reassess for delirium risk, substance use, bipolar disorder, and sleep apnea.
• Limit quantities and avoid early refills; if insomnia persists beyond a short course, reassess diagnosis and next-step treatment rather than continuing nightly benzodiazepines.

References

1. Halcion (triazolam) prescribing information — DailyMed (2026)
2. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline — Journal of Clinical Sleep Medicine (2017)
3. ASAM guideline on benzodiazepines — Journal of Addiction Medicine (2020)
4. Residual effects of medications for sleep disorders on driving performance — European Neuropsychopharmacology (2024)