428 Triazolam
headache, dizziness, incoordination, and nervousness. Hangover from the
drug is common after awakening, although some studies show hangover to
be lighter with triazolam than with flurazepam or barbiturates. Triazolam can
produce double vision, and hours after taking a dose people can still have
difficulty controlling their movements—a particular problem for elderly per-
sons who already have trouble avoiding falls.
Alarmingly, people are not necessarily aware of how much they are affected
by a triazolam dose. While under the drug’s influence, users should avoid
operating dangerous machinery such as automobiles. A U.S. Army experiment
found that people could perform normally on computerized tests six hours
after taking a triazolam dose, but not everyone is as physically fit as combat-
ready soldiers (physical condition can make a difference on how fast a drug
is flushed from the body). For example, Swiss military and airline pilots
showed impaired performance when tested seven hours after taking the same
dose used in the U.S. Army study.
An unusual case report tells of vision damage in two persons who looked
at a television camera’s brilliant light while using triazolam. Another case
report notes the drug can interfere with male fertility. Triazolam is not rec-
ommended for use by children, although experiments have revealed no ill
effects in juveniles who receive the drug.
Abuse factors.Experimentation indicates that the greater a person’s history
of sedative abuse, the more appealing triazolam will be. Persons who did not
abuse drugs and who took triazolam in an experiment did not like it, and
compared to other benzodiazepines, the drug is considered to have average
or below-average potential for abuse. A published review of research on tria-
zolam concluded that its potential for abuse is less than pentobarbital’s. Re-
search finds little evidence of triazolam tolerance, but cases are reported of
the drug’s sleep-inducing and antianxiety properties declining in some per-
sons, who respond by taking more and more triazolam. Dependence can de-
velop, causing a withdrawal syndrome if the drug is cut off. Withdrawal
symptoms may be trivial but can include psychosis, delirium, and seizures.
Indeed, some psychological problems once attributed to the drug have later
been attributed partly to withdrawal. Typically someone experiencing depen-
dence on triazolam has already had trouble with drug abuse or is suffering
from anxiety or panic attacks.
Drug interactions.Normally people using triazolam should avoid the an-
tidepressant drug nefazodone due to its tendency to prolong effects of a tria-
zolam dose. The female hormone supplement progesterone makes the body
more sensitive to triazolam. The blood pressure medicine diltiazem, the hu-
man immunodeficiency virus AIDS (acquired immunodeficiency syndrome)
medicine ritonavir, and the antifungus drugs itraconazole and ketoconazole
not only extend the length of a triazolam dose but increase its effects. The
antacid cimetidine (Tagamet) is suspected of doing the same. Grapefruit juice
may increase the amount of triazolam accessible to the body after a dose, but
results have been inconsistent in experiments testing whether the combination
increases drug actions. Drugs that lessen effects of a triazolam dose include
caffeine, the tuberculosis medicine rifampin, and the anticonvulsant medi-
cines carbamazepine and phenytoin. The antibiotics roxithromycin and eryth-