zolpidem tartrate

zol·pi·dem tartrate (zlp-dm)

n.

A nonbenzodiazepine hypnotic drug used to treat insomnia.

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zolpidem tartrate

Ambien, Ambien CR, Stilnoct (UK), Tovalt ODT

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

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

⊘Indications and dosages

➣ Insomnia

Adults: 10 mg P.O. (Ambien) or 12.5 mg P.O. (Ambien CR) immediately before bedtime

Dosage adjustment

• Hepatic impairment
• 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.
• Know that dosage may need to be decreased if patient's receiving other CNS depressants.

Route	Onset	Peak	Duration
P.O.	Rapid	30 min-2 hr	6-8 hr

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.
• Advise patient to take only when he's able to get a full night's sleep (7 to 8 hours) before he needs to be active again.
• 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.