Triazolam (Halcion) was first approved in the Netherlands in 1977. Reports of bizarre side effects (anxiety, paranoia, hallucinations and aggression) led Dutch regulators to restrict higher doses of the drug in 1980, after which the Upjohn drug company withdrew it from the Dutch market. Despite something of a cloud hanging over this sleeping pill, the FDA approved Halcion at a lower dose (0.5 mg) in 1982. Because it is fast acting, Halcion became very popular. This reader has used Halcion for sleep for more than 27 years.
Why Does This Lawyer Love Halcion for Sleep?
Q. I was a trial lawyer in Texas for more than 50 years. Like all litigators, I had substantial stress over those decades.
My wife had trouble falling asleep, and she was prescribed Halcion. Around 1995, I too had trouble sleeping and took some of hers. It worked wonders.
In 2000, my cardiologist told me I should get off it because I would become dependent on it and have to increase the amount needed to achieve the same result. I did not follow his advice. Instead, I have taken the same ½ mg tablet every night for the last 27 years. From midnight to 9:00 am, I sleep soundly.
I have had coronary artery disease since the 90s, with an MI in 1998. I also have Afib but no other health problems. The articles I’ve read say don’t take a sleeping pill but use non-medicinal techniques.
Sorry, but based on my experience I say take Halcion and you will have a terrific life. I am convinced getting a great night’s sleep over the last 27 years has been the source of my long and happy life.
A. The benzodiazepine triazolam (Halcion) has been on the market for 40 years. After its introduction, it quickly became the most popular prescription sleeping pill on the market.
Triazolam has long been controversial. Even before it was approved, experts were concerned about side effects of confusion and incoordination as well as rebound insomnia upon withdrawal. Moreover, some people reported “anterograde amnesia.” There were cases of individuals who could not recall their actions the day after they had taken triazolam.
Here is a syndicated newspaper column we wrote over 30 years ago:
Anterograde Amnesia After Taking Halcion for Sleep:
“Insomnia can be a curse. Sleepless nights sap your energy and enthusiasm. No wonder people who are having trouble getting a good night’s sleep are likely to beg their doctors for help.
“When patients are desperate, doctors want to come to the rescue. And often, they write a prescription for sleeping pills.
“Dalmane (flurazepam) has long been a popular answer to insomnia, but it tends to linger in the body and build up over time. Fears of “morning hangover,” interactions with other drugs, or driving difficulties have prompted many physicians to consider a shorter-acting sleeping pill called Halcion (triazolam).
“While it is far less likely to cause drowsiness in the morning, Halcion is turning out to have a few quirks of its own. Several weeks ago we reported that Halcion may occasionally provoke episodes of amnesia for events that occur the following day.
“Doctors have started reporting on their own experiences with this type of amnesia when they use Halcion to minimize jet lag. Some scientists had absolutely no recall for having given their speeches at international conferences the day after using this sleeping pill.
“Our readers report that you don’t have to be a researcher or hop continents for scientific conventions to experience unsettling instances of Halcion-related amnesia.
“One young professional wrote about what happened to him:
“A few years ago I had a pretty bad upper respiratory infection and had not slept well far at least four nights. So when I got the antibiotics, my doctor gave me three Halcion pills so I could get some sleep.
“I took them at bedtime as prescribed for three nights, starting on Thursday. Oddly, I have virtually no recollection of Friday, Saturday or Sunday.
“I knew there was a problem the next week when I told my boss that I wanted to drop by his house since I hadn’t seen his family for a long time; he told me I had been over just that weekend to pick up my briefcase (which he had brought home from the office at my request). I had wondered why my briefcase was at home.
“Then the picture-framer called and said that the prints I had brought in that weekend were ready. What prints? I thought I had misplaced them.
“So I started asking around the apartment complex to find out what else I had done. I had eaten Chinese food with one of my neighbors and his girlfriend on Saturday night. (I went out to pick up the order.)
“On Sunday, the prettiest girl in the building invited me over for breakfast. I had been trying to get a date with her for months! Well, I guess she thought I wasn’t interested since I didn’t follow through, even though I have explained about my amnesia (amnesia, sure, tell me another one). If there was ever a time I wanted to sue for malpractice.
“I had driven all over the city, talked pretty coherently with a lot of people, even did some work for the office, and don’t remember any of it to speak of. Three days gone; it’s pretty scary.
“The really odd thing was that I’m not sure I would have ever known that I didn’t remember anything had it not been for my boss and the picture-framer reminding me of things I had done.”
What Happened to Halcion for Sleep?
In Europe, a post-approval evaluation led regulators to emphasize the maximum dose of 0.25 mg and duration of not more than ten days. In addition, the UK took the drug off the market completely in 1993.
The official prescribing information in the US states:
“Prescriptions for Halcion should be written for short-term use (7 to 10 days) and it should not be prescribed in quantities exceeding a 1-month supply.”
Triazolam Is Still Prescribed for Insomnia:
Doctors can still prescribe Halcion for sleep. According to GoodRx, a 30-day supply has an average retail price of about $198. The generic drug cost of triazolam (0.25 mg) for the same number of pills is around $34 with a GoodRx coupon.
The price information comes with this caution:
“It is only for short-term use, and should generally be used for no more than 2 to 3 weeks.”
The Controversy Around Triazolam:
In 1996 we wrote a revised edition of The People’s Pharmacy. In it we wrote this about Halcion:
“The spontaneous reporting system at the FDA was accumulating some intriguing statistics. Compared to two well-established sleeping pills, Dalmane (flurazepam) and Restoril (temazepam), Halcion was producing far more side effects (8 to 30 times more adverse reaction reports). People were complaining about forgetfulness and amnesia, aggressiveness, confusion, rebound insomnia, agitation, personality changes, daytime anxiety, panic attacks, hallucinations, and other psychological problems.
“Equally disconcerting were questions about pivotal studies conducted in the 1970s to determine safety and efficacy. One private physician hired by Upjohn to do clinical investigations apparently falsified data.
“Despite serious questions about incomplete and inaccurate data, “transcription errors” by Upjohn, and their own internal reports of a higher incidence of adverse reactions linked to Halcion, federal officials chose to downplay the controversy. An FDA internal report stated that Upjohn ‘engaged in an ongoing pattern of misconduct with Halcion,’ but no penalties or official actions were taken against the company. Even after regulatory agencies in five countries (including England, Norway, and Finland) banned Halcion, FDA authorities defended the drug. And a fraud investigation was cut short by agency insiders.
“Dr. Anthony Kales is one of our heroes. He is chairman of psychiatry at Pennsylvania State University Medical School and one of the country’s leading sleep researchers. His conclusion:
‘This is a very dangerous drug. No other benzodiazepine has such a narrow margin of safety. The only justification for keeping it on the market is to ensure the company’s profitability. From a public health standpoint, there is no reason at all.’” (Cowley, Geoffrey, et al. “Sweet Dreams or Nightmare?” Newsweek, 1991; August 19:44-51)