Can triazolam cause anxiety, hallucinations or any other psychiatric-side effect when given to chil

Fråga: Can triazolam cause anxiety, hallucinations or any other psychiatric-side effect when given to children as premedication before visits to the dentist?

The dentist is considering to change from flunitrazepam to triazolam as premedication to children 7-18 years old.

Sammanfattning: Triazolam seems to be an applicable sedative for use in pediatric dentistry; however, it is not registered in Sweden for this indication. However, clinicians should be aware of the possibility of appearance and longer than expected duration of side-effects, which could reduce the applicability of such therapy.

Svar: While benzodiazepines carry a lower risk of respiratory depression than some older sedative agents, a number of other side-effects have been reported. These side-effects include ataxia and anterograde amnesia, as well as daytime anxiety and rebound insomnia upon termination of drug use. Disinhibitory effects including extreme upset, anger and aggressive behaviour have also been reported, particularly in younger patients. In addiction, high doses of benzodiazepines are known to produce blurred vision and diplopia (1). We have found no studies comparing the efficacy and safety on triazolam versus flunitrazepam in children.

Triazolam is a potent, short-acting benzodiazepine sedative hypnotic, which has been used routinely by the medical community to treat insomnia and as a premedication for general anaesthesia (2). Beside its sedative properties, the drug shows also anticonvulsant, muscle relaxant and amnestic effects. It has been shown (3) that orally administered triazolam is a safe and more effective anxiolytic agent than diazepam for endodontic adult patients.

Since triazolam has shown promise as a sedative agent for use in pediatric dentistry, different studies have been carried out to elucidate its potential as premedication in children (1,4-7). Triazolam has a potential for use in pediatric dentistry because it is well-absorbed orally, does not have the bitter taste of other sedative agents (eg, midazolam), and has a relatively short half-life and a low level of toxicity. The safety of triazolam concerning the risk of respiratory depression has been established and some dosing guidelines have been suggested (4,5). However, triazolam has been shown to produce dose-dependent ataxia, amnesia and diplopia in children (1). Some children could find these side-effects upsetting, and it is therefore possible that their occurrence may compromise the efficacy of the drug as an anxiolytic agent. It has been suggested that clearance of triazolam may be smaller than what has been reported in adults and, accordingly visual disturbances can persist for 3.5-12h (1). It is also possible that such benzodiazepine side-effects could be the cause of some uncooperative behaviours, including extreme upset, anger and aggressive behaviour, which occur predominantly in younger patients.