ZOLPIDEM
(zol′-pi-dem)
Ambien, Ambien CR, Edluar, Intermezzo, Zolpimist
Classifications: SEDATIVEHYPNOTIC, NON-BENZODIAZEPINE; ANXIOLYTIC
Therapeutic: SEDATIVE-HYPNOTIC; ANTIANXIETY
Pregnancy Category: C
Controlled Substance: Schedule IV
AVAILABILITY
Tablet; extended release tablet; sublingual tablet
ACTION & THERAPEUTIC EFFECT
An agonist that binds the gammaaminobutyric acid (GABA)-A receptor chloride channel, thus inhibiting its action potential in the cortical region of the brain. Effective as a sedative.
USES
Short-term treatment of insomnia.
CONTRAINDICATIONS
Hypersensitivity of zolpidem including angioedema; suicidal ideation, worsening of depression; labor or obstetric delivery.
CAUTIOUS USE
Depressed patients, psychiatric disorders; history of suical tendencies; hepatic/renal impairment, alcohol or drug abuse; patients with compromised respiratory status, COPD, sleep apnea; chronic depression; older adults; pregnancy (category C). Safe use in children younger than 18 y is not established.
ROUTE AND DOSAGE
Short-Term Treatment of Insomnia
Adult: PO Immediate release/ sublingual: 10 mg OR Extended. release: 12.5 mg at bedtime. Spray 1–2 sprays before bedtime. Insomnia (Intermezzo Only)
Adult: PO 1.75 mg (women) or 3.5 mg (men) once/night if needed
Geriatric: PO Immediate release/ sublingual: 5 mg OR Extended. release: 6.25 mg at bedtime. Spray 1 spray before bedtime (max: 2 sprays)
Hepatic Impairment
Dosage Adjustment
Immediate release: 5 mg OR
Extended release: 6.25 mg at bedtime
- Give immediately before bedtime; for more rapid sleep onset, do NOT give with or immediately after a meal.
- Ensure that sublingual tablets are not swallowed.
- Extended release tablets should be swallowed whole. Ensure that they are not crushed or chewed.
- Store at room temperature, 15°–30° C (59°–86° F).
ADVERSE EFFECTS
(≥1%) CNS: Headache on awakening, drowsiness or fatigue, lethargy, drugged feeling, depression, anxiety, irritability, dizziness, double vision. Confusion and falls reported in elderly. Doses greater than 10 mg may be associated with anterograde amnesia or memory impairment.
GI: Dyspepsia, nausea, vomiting.
Other: Myalgia.
INTERACTIONS
Drug: CNS DEPRESSANTS, alcohol, PHENOTHIAZINES by augmenting CNS depression. Food: Extent and rate of absorption of zolpidem are significantly decreased.
PHARMACOKINETICS
Absorption: Readily from GI tract. 70% reaches systemic circulation.
Onset: 7–27 min.
Peak: 0.5–2.3 h.
Duration: 6–8 h.
Distribution: Highly protein bound. Lowest concentrations in CNS, highest concentrations in glandular tissue
and fat. Crosses placenta.
Metabolism: In the liver to 3 inactive metabolites.
Elimination: 79–96% in the bile, urine, and feces.
Half-Life: 1.7–2.5 h.
NURSING IMPLICATIONS
Assessment & Drug Effects
- Assess respiratory function in patients with compromised respiratory status. Report immediately to prescriber significantly depressed respiratory rate (less than 12/min).
- Monitor patients for S&S of depression (see Appendix F); zolpidem may increase level of depression.
- Monitor closely older adult or debilitated patients for impaired cognitive or motor function and unusual sensitivity to the drug’s effects.
Patient & Family Education
- Avoid taking alcohol or other CNS depressants while on zolpidem. Do not drive or engage in other potentially hazardous activities until response to drug is known.
- Report vision changes to prescriber.
- Note: Onset of drug is more rapid when taken on an empty stomach.
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