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Hallucinations and Delirium in the Dental Office Following Triazolam Administration
Jason H. GoodchildDMD and
Mark DonaldsonPharmD
Article Category: Research Article
Volume/Issue: Volume 52: Issue 1
Online Publication Date: Mar 01, 2005
DOI: 10.2344/0003-3006(2005)52[17:HADITD]2.0.CO;2
Page Range: 17 – 20

INTRODUCTION Enteral (oral) conscious sedation has recently gained increased popularity as a treatment modality for adult dental patients. At the forefront of the technique is the drug triazolam which, despite a colorful history has emerged as a “near-ideal” agent for use as an in-office sedative. 1 As more dentists provide oral sedation, the number of adverse events will increase. Triazolam is a short-acting benzodiazepine with a pharmacokinetic profile favorable for oral sedation. The time to maximum concentration in plasma and

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Zaleplon (Sonata) Oral Sedation for Outpatient Third Molar Extraction Surgery
Steven I. GanzbergDMD, MS,
Thomas DietrichDDS,
Manuel ValerinDDS, and
F. Michael BeckDDS, MA
Article Category: Other
Volume/Issue: Volume 52: Issue 4
Online Publication Date: Jan 01, 2005
DOI: 10.2344/0003-3006(2005)52[128:ZOS]2.0.CO;2
Page Range: 128 – 131

Because of the large number of patients who are anxious regarding dental or oral surgical treatment, dentists have developed a range of techniques to provide anxiolysis and/or sedation for procedures that they perform. The most common forms of sedation in the dental office are nitrous oxide–oxygen inhalation sedation, or oral sedation with benzodiazepines. Triazolam (Halcion), a benzodiazepine derivative, is a sedative-hypnotic drug with a short half-life that causes little residual central nervous system depression (ie, drowsiness or ‘‘hangover

Figure 3.; Repeated sublingual doses. This graph illustrates time-concentration curves following 1 to 3 doses of triazolam, 0.25 mg administered sublingually. Notice that a single dose (1 Dose) results in a conventional peak time of 1 hour and then declines as drug is eliminated. However, a second dose results in a peak concentration 1.5 hours later (2 Doses). Finally, the peak following a third dose occurs 2.5 hours later (3 Doses). Although a single dose achieves peak serum concentration in 1 hour, the peak following additional increments becomes progressively longer. Precise serum concentrations are approximated and adapted from Pickrell et al.4
Daniel E. Becker
Figure 3.
Figure 3.

Repeated sublingual doses. This graph illustrates time-concentration curves following 1 to 3 doses of triazolam, 0.25 mg administered sublingually. Notice that a single dose (1 Dose) results in a conventional peak time of 1 hour and then declines as drug is eliminated. However, a second dose results in a peak concentration 1.5 hours later (2 Doses). Finally, the peak following a third dose occurs 2.5 hours later (3 Doses). Although a single dose achieves peak serum concentration in 1 hour, the peak following additional increments becomes progressively longer. Precise serum concentrations are approximated and adapted from Pickrell et al.4

When Can a Normal Dose Be an Overdose? Who Is at Risk?
Joel M. WeaverDDS, PhD, Editor-in-Chief
Article Category: Other
Volume/Issue: Volume 61: Issue 2
Online Publication Date: Jan 01, 2014
DOI: 10.2344/0003-3006-61.2.45
Page Range: 45 – 46

For most drugs, irrespective of their indications or mechanisms of actions, there is a recommended dose for adults and often multiple age- or weight-based recommended doses for children in the US Food and Drug Administration (FDA)–approved labeling, as seen in the package insert. For triazolam (Halcion) the usual recommended adult dose is 0.25 mg. Some drugs also have a recommended dose for elderly, medically compromised, or debilitated patients. For triazolam, this FDA-recommended dose is 0.125 mg. Many drugs also have an FDA maximum

The Fallacy of a Lifesaving Sublingual Injection of Flumazenil
Joel M WeaverDDS, PhD
Article Category: Editorial
Volume/Issue: Volume 58: Issue 1
Online Publication Date: Jan 01, 2011
DOI: 10.2344/0003-3006-58.1.1
Page Range: 1 – 2

individual patient variability but also required because the dose of the agonist to be reversed may range from a very small dose to a very large overdose. Therefore, a patient who is unconscious from 20 mg of midazolam or 2 mg of triazolam will likely need much more than 0.2 mg of flumazenil for reversal, whereas a patient given only 3 mg of midazolam or 0.5 mg triazolam may adequately respond to the initial 0.2 mg flumazenil dose. The mechanism of action of a competitive antagonist such as flumazenil dictates that the dose needed to reverse the agonist depends in large

Oral Sedation: A Primer on Anxiolysis for the Adult Patient
Mark DonaldsonBScPhm, RPh, PharmD,
Gino GizzarelliBScPhm, DDS, MSc, and
Brian ChanpongDDS, MSc
Article Category: Research Article
Volume/Issue: Volume 54: Issue 3
Online Publication Date: Jan 01, 2007
DOI: 10.2344/0003-3006(2007)54[118:OSAPOA]2.0.CO;2
Page Range: 118 – 129

–34 Triazolam (Halcion) Triazolam is widely used for the short-term treatment of insomnia. Its rapid onset, short duration of action, and lack of active metabolites makes it a near ideal antianxiety medication for dental patients. 35 It is short-acting with an onset of activity usually within 30 minutes, and with peak blood levels occurring after approximately 75 minutes. The oral bioavailability for triazolam is only 44% but can be increased to 53% with sublingual administration. 35–37 The usual adult dose for oral sedation can range from 0.125 mg to 0

Pharmacokinetic Considerations for Moderate and Deep Sedation
Daniel E. BeckerDDS
Article Category: Research Article
Volume/Issue: Volume 58: Issue 4
Online Publication Date: Jan 01, 2011
DOI: 10.2344/0003-3006-58.4.166
Page Range: 166 – 173

rate regardless of the route by which it was administered; elimination T1/2 is identical (adapted from Stambaugh et al2). Sublingual administration of a sedative such as triazolam introduces additional considerations. The drug is readily absorbed through nonkeratinized squamous epithelium in the floor of the mouth, and there is no loss due to gastric degradation. Furthermore, venous drainage does not enter the hepatic portal system for first-pass metabolism. However, one cannot predict the portion of a sublingual dose that is swallowed and

What is the Standard of Care for Anesthesia? Who Determines it?
Joel M. WeaverDDS, PhD
Article Category: Research Article
Volume/Issue: Volume 56: Issue 1
Online Publication Date: Jan 01, 2009
DOI: 10.2344/0003-3006-56.1.1
Page Range: 1 – 2

general practice dental residency program that he heads. This definitely is not the standard of care in dentistry or medicine, as is evidenced by the 2007 guidelines for evaluation of patients with cardiovascular disease for noncardiac surgery. 2 I have heard oral surgeons testify that it is below the standard of care to use intravenous diazepam instead of midazolam or halothane instead of sevoflurane or oral triazolam because it does not have an FDA indication for dental sedation. Undoubtedly, some experts have a reputation of stating as fact whatever the attorney

Alarm Fatigue Can Decrease the Safety of Dental Office Sedation and Anesthesia
Joel M. WeaverDDS, PhD
Article Category: Other
Volume/Issue: Volume 60: Issue 3
Online Publication Date: Jan 01, 2013
DOI: 10.2344/0003-3006-60.3.93
Page Range: 93 – 94

-pressure ventilation was all that was needed despite the pulse oximeter and blood pressure alarms because the ECG was still reasonably normal and the ECG monitor had not yet sounded. As an example of a less-trained sedationist, a general dentist trained during a weekend-type oral sedation course testified that during sedation with multiple doses of oral triazolam and nitrous oxide–oxygen, the pulse oximeter sounded so frequently that it was difficult to concentrate on the placement of multiple dental implants, so the pulse oximeter was turned off for multiple periods of time during

Practice Characteristics Among Dental Anesthesia Providers in the United States
Sean G. BoynesDMD,
Paul A. MooreDMD, PhD, MPH,
Peter M. Tan Jr, and
Jayme ZovkoRHD, BS
Article Category: Research Article
Volume/Issue: Volume 57: Issue 2
Online Publication Date: Jan 01, 2010
DOI: 10.2344/0003-3006-57.2.52
Page Range: 52 – 58

the most frequently reported agent was oral triazolam (18.0%, n  =  717). However, it should be noted that the most common response to this question was that respondents did not use any premedication agents (38.2%, n  =  717). Additional analysis was completed to compare the most commonly used premedication agents among the various categories of main practice activity. Table 2 provides a detailed examination of the agents used most frequently among sedation/anesthesia providers according to their described main practice activity. Triazolam, given