Diagnosis and Management of Insomnia

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Abstract
Ten years ago there was controversy about the safety of triazolam. After Van der Kroef reported alarming side effects with triazolam,1 it was suspended from the market in the Netherlands. Subsequently, there were numerous case reports of cognitive impairment (amnesia, delirium, and psychotic symptoms), anxiety states, and withdrawal difficulties. As a result, the 0.5-mg tablet was removed from the market in several European countries and labeling for the 0.25-mg tablet was changed to reflect the side effects of amnesia, anxiety states, confusion, and depressed mood. More importantly, there are now data documenting the uniqueness of triazolam among benzodiazepine hypnotic drugs in producing a high rate of severe behavioral side effects. Thus, it is no longer accurate to state, as Gillin and Byerley did (Jan. 25 issue),2 that the frequency of triazolam's side effects is "controversial" as compared with other hypnotic drugs.