Three cases of fatal triazolam poisoning.

Triazolam, which is widely prescribed as a hypnotic, is considered to be safe even in overdose. In elderly patients, however, overdose may be fatal, particularly in patients taking concomitant drug treatment or with serious disease. Case reports Case I-A 76 year old woman with bone pain from osteomalacia due to renal tubular acidosis had been treated with alfacalcidol, calcium supplements, sodium bicarbonate, and dihydrocodeine; she was receiving triazolam 0-25 mg as a hypnotic. 'She was found dead with a note indicating her intention to take her life. Her bottle of triazolam tablets was empty, but she had not taken an overdose of the other drugs. Necropsy showed early pneumonia and chronic bowel obstruction; these lesions were considered to be capable of having caused her death. In view of the suicide note samples were referred for toxicological analysis. This showed a blood triazolam concentration of 47 nmol/l, which is substantially above mean peak therapeutic concentrations.`3 The equivalent of at least five tablets was found in the stomach. Dihydrocodeine was found in therapeutic concentration; analysis for other drugs yielded negative results. Case 2-A 59 year old depressed woman had spoken frequently of suicide. A year before her death she had been prescribed triazolam several times; three days before her death she showed someone a hoard of tablets and spoke of taking her life. She was found dead with a partly consumed bottle of whisky. Necropsy did not show any anatomical lesions that might have accounted for her death. Toxicological analysis showed a blood triazolam concentration of 58 nmol/l and temazepam concentration of 3 ,umol/l (the upper end of the therapeutic range).4 Small quantities of both drugs were found in her stomach. Her blood alcohol concentration was 45 mmol/l and urine alcohol concentration 18 mmol. Tests for other drugs yielded negative results. Case 3-A 75 year old woman with schizophrenia and depression had been admitted to hospital several times after drug overdoses and had tried to slash her wrists. She was being treated by depot haloperidol injections monthly and was taking orphenadrine 50 mg twice daily and triazolam 0 5 mg at night. She was found dead with two empty bottles of triazolam tablets beside her. Three days before her death she had acquired two prescriptions, each for 60 tablets of 0 25 mg triazolam. Necropsy showed severe degenera-tive narrowing of coronary arteries and other changes due to aging. Her blood triazolam concentration …