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.