Evaluation of long-term triazolam use in an ambulatory Veterans Administration Medical Center population

Triazolam is indicated for the short-term treatment of insomnia. To determine how it was being prescribed and used, we examined triazolam use in patients who had received the drug for greater than six weeks. We reviewed medical charts of 72 adult male patients from an ambulatory Veterans Administration population who had received a 30-day triazolam prescription with at least one refill. Results showed that although prescribed daily doses of triazolam were generally appropriate for the age of the patient being treated, the average length of therapy was 6.2 months. Seventy-five percent of the prescriptions had been written for a one-month supply with five refills. Neither prescriber specialty nor level of training was significantly related to length of therapy. Thirty-nine of the patients (54 percent) were available for a telephone interview to determine how the drug was actually being used and the adverse effects profile. Over 60 percent claimed to be taking the drug every night, 95 percent at the dose prescribed. Sixty-seven percent of the patients taking triazolam nightly reportedly did not sleep as well if they tried a night without the drug. Apart from effects on sleep, dizziness and confusion were the most commonly reported adverse effects. As a result of this study, automatic stop orders on discharge were implemented to limit triazolam therapy to inpatient stays. Physicians must evaluate the need for continued hypnotic therapy so that a longer-acting agent like flurazepam may be used if chronic medication is necessary.