zolpidem tartrate

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zolpidem tartrate

Ambien, Ambien CR, Edluar, Intermezzo, Stilnoct (UK), Zolpimist

Pharmacologic class: Imidazopyridine

Therapeutic class: Sedative-hypnotic

Controlled substance schedule IV

Pregnancy risk category B

Action

Depresses CNS by binding to gamma-aminobutyric acid receptors

Availability

Oral spray: 5 mg/actuation

Tablets: 5 mg, 6.25 mg, 10 mg, 12.5 mg

Tablets (sublingual): 1.75 mg, 3.5 mg, 5 mg, 10 mg

Indications and dosages

Insomnia

Adults: 10 mg P.O. (Ambien) or 12.5 mg P.O.(Ambien CR), or 10 mg (Edluar) sublingual, or 10 mg oral spray (two sprays) immediately before bedtime

As-needed use for treatment of insomnia when middle-of-the-night awakening is followed by difficulty returning to sleep

Adults: 1.75 mg (Intermezzo) sublingually for women and 3.5 mg (Intermezzo) sublingually for men, taken only once per night if needed

Dosage adjustment

• Hepatic impairment

• Concurrent use of CNS depressants

• Elderly or debilitated patients

Off-label uses

• Long-term treatment of insomnia

• Insomnia related to selective serotonin reuptake inhibitors

• Postoperative sedation

Contraindications

• Hypersensitivity to drug

Precautions

Use cautiously in:

• pulmonary disease, hepatic or severe renal impairment

• history of psychiatric illness, suicide attempt, or substance abuse

• elderly or debilitated patients

• pregnant or breastfeeding patients

• children (safety not established).

Administration

• Don't give with or immediately after a meal.

Adverse reactions

CNS: amnesia, ataxia, confusion, euphoria, vertigo, daytime drowsiness, dizziness, drugged feeling

EENT: diplopia, abnormal vision

GI: nausea, vomiting, diarrhea, dry mouth

Other: hypersensitivity reaction, physical or psychological drug dependence, drug tolerance

Interactions

Drug-drug. Antihistamines, opioid analgesics, phenothiazines, sedative-hypnotics, tricyclic antidepressants: increased CNS depression

Ketoconazole, ritonavir: increased blood level and enhanced effects of zolpidem

Rifampin: decreased zolpidem efficacy

Drug-herbs. Chamomile, hops, kava, skullcap, valerian: increased CNS depression

Drug-behaviors. Alcohol use: increased CNS depression

Patient monitoring

• Monitor for physical and psychological drug dependence. Watch for drug hoarding.

• Assess for adverse reactions, including confusion, ataxia, and amnesia.

Patient teaching

• Tell patient to take immediately before bedtime (and not after a meal), because it works quickly.

• Instruct patient to place sublingual tablet under the tongue, where it will disintegrate; tell patient not to swallow tablet and not to take it with water.

• Instruct patient that oral spray pump needs to be primed initially and after not using spray for 14 days. Tell patient to fully press down on pump to make sure a full dose (5 mg) of oral spray is sprayed directly into the mouth over the tongue with each spray.

• Advise patient to take only when he is able to get a full night's sleep (7 to 8 hours) before he needs to be active again. Tell patient to use oral spray only if 4 hours of bedtime remain before planned time of waking.

• Stress that drug is meant only for short-term use (7 to 10 days).

• Tell patient rebound insomnia may occur for 1 to 2 nights after he discontinues drug.

• Inform patient that drug may cause amnesia, drowsiness, and a drugged feeling the next day.

• Caution patient to avoid driving and other hazardous activities while under drug's influence.

• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, herbs, and behaviors mentioned above.

References in periodicals archive ?
The availability of Intermezzo is an important treatment option for patients who suffer with this form of insomnia and want a treatment that they can use as needed to fall back to sleep in the middle of the night when they have difficulty returning to sleep.
Snatches of the folksong melody intertwine with other musical material in the Intermezzo, coming to rest on sustained chords before the vocal entrance on "Mm, Ah.
Jacob Frasch, a graduate of the Oberlin Conservatory in Ohio and the Peabody Institute in Baltimore, played--very well--Johannes Brahms' Intermezzo in A major, Op.
Intermezzo she thought of it, when it happened, what
This chapter concludes with a third intermezzo on later guidebooks that emphasized the cacophonous image of the royal gardens.
An autograph orchestral score of an Intermezzo for cello and orchestra exists in a private American collection, but at present there is no way to determine whether it is identical with this work.
However lovely, it felt like a meringue after an ample main course in an all-Feld evening, particularly Intermezzo No.
In lighter vein, the Intermezzo held some delightful pizzicato, while the drama of the concluding Presto-Adagio gave way to the sweet and quiet conclusion.
First up was Ribero (100-30) under Lester Piggott and the following year it was the turn of crack Aussie pilot Ron Hutchinson who triumphed on Intermezzo (7-1).
Intermezzo-quick is the newest addition to the successful Intermezzo line from Dr.
Intermezzo has been designed as a quick and convenient snack that fills a niche in the frozen category.