Zolpidem
Zolpidem
Definition
Zolpidem is classified as a hypnotic drug. These drugs help people sleep. In the United States, zolpidem is available as tablets under the brand name Ambien.
Purpose
Zolpidem is a drug that is used to treat insomnia. Zolpidem is especially helpful for people who have trouble falling asleep. However, once individuals have fallen asleep, zolpidem also helps them continue to sleep rest-fully. Zolpidem should be used only for short periods, approximately seven to ten days. If sleeping pills are needed for a long period, an evaluation by a physician is recommended to determine if another medical condition is responsible for the insomnia.
Description
Although the way zolpidem helps people sleep is not entirely understood, it is believed to mimic a chemical in the brain called gamma-aminobutyric acid (GABA) that naturally helps to facilitate sleep. Zolpidem is a central nervous system depressant. This means that it slows down the nervous system. Unlike some sleeping pills, zolpidem does not interfere with the quality of sleep or usually leave the user feeling sedated in the morning. As a result, most people using zolpidem usually awake feeling refreshed.
Recommended dosage
The usual dose of zolpidem in adults is 5–10 mg. For healthy adults, 10 mg is commonly recommended. However, people taking other drugs that cause drowsiness, people who have severe health problems, especially liver disease, and older people (over age 65) should take a lower dose, usually 5 mg. Zolpidem should be taken immediately before bedtime and only if the person can count on getting seven or eight hours of uninterrupted sleep. It usually takes only about 30 minutes for the sleep-inducing actions of zolpidem to be felt. Unlike some sleeping pills, the sleep-facilitating effects appear to last six to eight hours.
If zolpidem is taken with a meal, it will take longer to work. For the fastest sleep onset, it should be taken on an empty stomach. The maximum dose for one day is 10 mg. People who miss a dose of zolpidem should skip the missed dose, and take the next dose at the regularly scheduled time. Under no circumstances should a person take more than 10 mg in one day.
Zolpidem should be taken exactly as directed by the prescribing physician.
Precautions
Because zolpidem is used to help people fall asleep, it should not be used with other drugs (either over-the-counter, herbal, or prescription) that also cause drowsiness (for example, antihistamines or alcohol). Zolpidem should be used only with close physician supervision in people with liver disease and in the elderly, because these individuals are especially sensitive to the sedative properties of zolpidem. Zolpidem should not be used before driving, operating machinery, or performing activities that require mental alertness. People with a history of drug abuse, psychiatric disorders, or depression should be carefully monitored when using zolpidem since zolpidem may worsen symptoms of some psychiatric disorders.
If zolpidem is needed for more than seven to ten days, patients should be reevaluated by a physician to determine if another disorder is causing their difficulty in sleeping. When zolpidem or other sleeping pills are used every night for more than a few weeks, they begin to lose their effectiveness and/or people may become dependent upon them to fall asleep. Zolpidem can be habit-forming when taken over a long period. People using zolpidem should not stop taking the drug suddenly, but gradually reduce the dose over a few days before quitting, even if zolpidem has been used only a for short time.
Side effects
Some sleeping pills such as zolpidem can cause aggressiveness, agitation, hallucinations, and amnesia (partial or complete loss of memory), rapid, racing
KEY TERMS
Amnesia —A general medical term for loss of memory that is not due to ordinary forgetfulness. Amnesia can be caused by head injuries, brain disease, or epilepsy as well as by dissociation.
Antidepressant —A medication used to treat the symptoms of depression.
Antihistamine —A medication used to alleviate allergy or cold symptoms such as runny nose, itching, hives, watering eyes, or sneezing.
Antipsychotic —A medication used to treat psychotic symptoms of schizophrenia such as hallucinations, delusions, and delirium. May be used to treat symptoms in other disorders, as well.
Milligram (mg) —One-thousandth of a gram. A gram is the metric measure that equals approximately 0.035 ounces.
Tuberculosis —An infection caused by the bacteria Mycobacterium tuberculosis that usually affects the lungs. Individuals with tuberculosis may have nighttime sweating, fever, weight loss, cough, and may spit up blood and mucus.
heartbeat, and chest pains. These side effects are rare, but the patient should call a physician immediately if they occur.
Side effects that occur in more than 5% of patients are headache, nausea, muscle aches, and drowsiness. Although drowsiness is desired when trying to fall asleep, a few people continue to be drowsy the next day. Daytime drowsiness may cause people, especially the elderly, to be less coordinated and more susceptible to falls. Other less common side effects are anxiety, confusion, dizziness, and stomach upset.
Interactions
Any drug that causes drowsiness may lead to substantially decreased mental alertness and impaired motor skills when taken with zolpidem. Some examples include alcohol, antidepressants such as imipramine or paroxetine, antipsychotics such as thioridazine, and antihistamines (commonly found in allergy and cold medications).
The effectiveness of zolpidem may be reduced if taken with rifampin, an antibiotic that is commonly used to treat tuberculosis infections.
Resources
BOOKS
Facts and Comparisons Staff. Drug Facts and Comparisons, 6th ed. St. Louis: Facts and Comparisons, 2002.
Medical Economics Co. Staff. Physician’s Desk Reference, 56th ed. Montvale, NJ: Medical Economics Company, 2002.
Preston, John D. John H. O’Neal, and Mary C. Talaga. Handbook of Clinical Psychopharmacology for Therapists, 4th ed. Oakland, CA: New Harbinger Publications, 2004.
PERIODICALS
Conn, David K. and Robert Madan. “Use of Sleep-Promoting Medications in Nursing Home Residents: Risks versus Benefits.” Drugs and Aging 23.4 (2006): 271–87.
Glass, Jennifer, Krista L. Lanctôt, Nathan Herrmann, Beth A. Sproule, and Usoa E. Busto. “Sedative Hypnotics in Older People with Insomnia: Meta-Analysis of Risks and Benefits.” British Medical Journal 331.7526 (Nov. 2005): 1–7.
Hart, Carl L., Margaret Haney, Jennifer Nasser, and Richard W. Foltin. “Combined Effects of Metham-phetamine and Zolpidem on Performance and Mood During Simulated Night Shift Work.” Pharmacology, Biochemistry and Behavior 81.3 (July 2005): 559–68.
Lucchesi, Ligia M., and others “Acute Neurophysiological Effects of the Hypnotic Zolpidem in Healthy Volunteers.” Progress in Neuro-Psychopharmacology and Biological Psychiatry 29.4 (May 2005): 557–64.
Meléndez, Jaime, and others. “Zolpidem and Triazolam Do Not Affect the Nocturnal Sleep-Induced Memory Improvement.” Psychopharmacology 181.1 (Aug. 2005): 21–26.
Moen, Marit D. and Greg L. Plosker. “Zolpidem Extended Release in Insomnia: Profile Report.” Drugs and Aging 23.10 (2006): 843–46.
Rosenberg, Russell P. “Sleep Maintenance Insomnia:
Strengths and Weaknesses of Current Pharmacologic Therapies.” Annals of Clinical Psychiatry 18.1 (Jan.–Mar. 2006): 49–56.
Staner, Luc; Stéphane Ertlé, Peter Boeijinga, Gilbert Rinaudo, Marie Agnès Arnal, Alain Muzet, and, Rémy Luthringer. “Next-Day Residual Effects of hypnotics in DSM-IV Primary Insomnia: A Driving Simulator Study with Simultaneous Electroencephalogram Monitoring.” Psychopharmacology 181.4 (Oct. 2005): 790–98.
Wesensten, Nancy Jo, Thomas J. Balkin, Rebecca M.
Reichardt, Mary A. Kautz, George A. Saviolakis, and Gregory Belenky. “Daytime Sleep and Performance Following a Zolpidem and Melatonin Cocktail.” Sleep: Journal of Sleep and Sleep Disorders Research 28.1 (2005): 93–103.
Wong, Shelley. “Long-Term Use of Zolpidem ER May Benefit Patients with Chronic Insomnia.” CNS Spectrums 11.9 (Sept. 2006): 662–64.
Kelly Karpa, R.Ph., PhD
Ruth A. Wienclaw, PhD
Zolpidem
Zolpidem
Definition
Zolpidem is classified as a hypnotic drug. These drugs help people sleep. In the United States, zolpidem is available as tablets under the brand name of Ambien.
Purpose
Zolpidem is a drug that is used to treat insomnia . Zolpidem is especially helpful for people who have trouble falling asleep. However, once individuals have fallen asleep, zolpidem also helps them continue to sleep restfully. Zolpidem should be used only for short periods, approximately seven to ten days. If sleeping pills are needed for a long period, an evaluation by a physician is recommended to determine if another medical condition is responsible for the insomnia.
Description
Although the way zolpidem helps people sleep is not entirely understood, it is believed to mimic a chemical in the brain called gamma-aminobutyric acid (GABA) that naturally helps to facilitate sleep. Zolpidem is a central nervous system depressant. This means that it slows down the nervous system. Unlike some sleeping pills, zolpidem does not interfere with the quality of sleep or usually leave the user feeling sedated in the morning. As a result, most people using zolpidem usually awake feeling refreshed in the morning.
Recommended dosage
The usual dose of zolpidem in adults is 5–10 mg. For healthy adults, 10 mg is commonly recommended. However, people taking other drugs that cause drowsiness, people who have severe health problems, especially liver disease, and older people (over age 65) should take a lower dose, usually 5 mg. Zolpidem should be taken immediately before bedtime and only if the person can count on getting seven or eight hours of uninterrupted sleep. It usually takes only about 30 minutes for the sleep-inducing actions of zolpidem to be felt. Unlike some sleeping pills, the sleep-facilitating effects appear to last six to eight hours.
If zolpidem is taken with a meal, it will take longer to work. For the fastest sleep onset, it should be taken on an empty stomach. The maximum dose for one day is 10 mg. People who miss a dose of zolpidem should skip the missed dose, and take the next dose at the regularly scheduled time. Under no circumstances should a person take more than 10 mg in one day. Zolpidem should be taken exactly as directed by the prescribing physician.
Precautions
Because zolpidem is used to help people fall asleep, it should not be used with other drugs (either over-thecounter, herbal, or prescription) that also cause drowsiness (for example, antihistamines or alcohol). Zolpidem should be used only with close physician supervision in people with liver disease and in the elderly, because these individuals are especially sensitive to the sedative properties of zolpidem. Zolpidem should not be used before driving, operating machinery, or performing activities that require mental alertness. People with a history of drug abuse, psychiatric disorders, or depression should be carefully monitored when using zolpidem since zolpidem may worsen symptoms of some psychiatric disorders.
If zolpidem is needed for more than seven to ten days, patients should be re-evaluated by a physician to determine if another disorder is causing their difficulty sleeping. When zolpidem or other sleeping pills are used every night for more than a few weeks, they begin to lose their effectiveness and/or people may become dependent upon them to fall asleep. Zolpidem can be habit-forming when taken over a long period. People using zolpidem should not stop taking the drug suddenly, but gradually reduce the dose over a few days before quitting, even if zolpidem has been used only a for short time.
Side effects
Some sleeping pills such as zolpidem can cause aggressiveness, agitation, hallucinations , and amnesia (memory problems), rapid, racing heartbeat, and chest pains. These side effects are rare, but the patient should call a physician immediately if they occur.
Side effects that occur in more than 5% of patients are headache, nausea, muscle aches, and drowsiness. Although drowsiness is desired when trying to fall asleep, a few people continue to be drowsy the next day. Daytime drowsiness may cause people, especially the elderly, to be less coordinated and more susceptible to falls. Other less common side effects are anxiety, confusion, dizziness, and stomach upset.
Interactions
Any drug that causes drowsiness may lead to substantially decreased mental alertness and impaired motor skills when taken with zolpidem. Some examples include alcohol, antidepressants such as imipramine or paroxetine , antipsychotics such as thioridazine , and antihistamines (commonly found in allergy and cold medications).
The effectiveness of zolpidem may be reduced if taken with rifampin, an antibiotic that is commonly used to treat tuberculosis infections.
Resources
BOOKS
Ellsworth, Allan J., and others. Mosby's Medical Drug Reference. St. Louis, MO: Mosby, Inc, 1999.
Facts and Comparisons Staff. Drug Facts and Comparisons. 6th Edition. St. Louis, MO: Facts and Comparisons,2002.
Medical Economics Co. Staff. Physician's Desk Reference. 56th edition. Montvale, NJ: Medical Economics Company, 2002.
Kelly Karpa, RPh, Ph.D.
Zolpidem
Zolpidem
Definition
Zolpidem is a medicine that helps a person get to sleep and stay asleep. The brand name of zolpidem in the U.S. is Ambien.
Purpose
Zolpidem is a sleep medication. It is intended for the short-term treatment of insomnia. Zolpidem may be particularly useful for people who have trouble falling asleep.
Description
Sleep medications are called sedatives or hypnotics. Zolpidem affects brain chemicals, resulting in sleep. It is somewhat similar in its actions on sleep to the group of drugs known as benzodiazepines. Zolpidem is only intended for short term use (seven-10 days). Although there is some information published about effectiveness with longer use, some side effects may increase with longer use.
Recommended dosage
The usual dose is 10 mg before bedtime in adults and 5 mg before bedtime in the elderly and in people with liver disease. The onset of effect occurs within about 30 minutes and the effects on sleep last for 6-8 hours.
Precautions
It is suggested that zolpidem not be discontinued abruptly after regular use (that is daily use for even as short a time as one week). Instead, the drug should be gradually tapered. The tapering is recommended to avoid the possibility of a withdrawal syndrome as well as to avoid the possibility of a rebound worsening of insomnia.
Side effects
The most common side effects of zolpidem include drowsiness, dizziness, and headache. Drowsiness, of course, is desirable when it occurs at bedtime. Daytime drowsiness that is left over from the night before would be considered a side effect. Other side effects include diarrhea , nausea and vomiting , and muscle aches. Rarely, amnesia, confusion, falls, and tremor are seen. Falls probably result from the drowsiness or dizziness.
Interactions
Increased effects of zolpidem (eg. more drowsiness, confusion) may be seen with alcohol consumption and with other drugs known to cause drowsiness.
Bob Kirsch