ZOLPIDEM

ZOLPIDEM
(zol'-pi-dem)
Ambien, Ambien CR, Tovalt ODT
Classifications: anxiolytic; sedative-hypnotic, non-benzodiazepine;
Therapeutic: sedative-hypnotic
; antianxiety
Pregnancy Category: C
Controlled Substance: Schedule IV

Availability

5 mg, 10 mg tablets; 6.25 mg, 12.5 mg extended release tablets; 5 mg, 10 mg orally disintegrating tablets

Action

An agonist that binds to the BZD1 subunit on the gamma-aminobutyric acid (GABA)-A receptor chloride channel, thus inhibiting the action potential.

Therapeutic Effect

Sedative, anticonvulsant, and antianxiety effects thought to be due to GABA-A agonism.

Uses

Short-term treatment of insomnia.

Contraindications

Suicidal ideation; labor or obstetric delivery; pregnancy (category C), children <18 y.

Cautious Use

Depressed patients, hepatic/renal impairment, older adults, alcohol or drug abuse; patients with compromised respiratory status, COPD, sleep apnea; chronic depression.

Route & Dosage

Short-Term Treatment of Insomnia
Adult: PO 10 mg (immediate release/ODT) OR 12.5 mg (extended release) at bedtime
Geriatric: PO 5 mg (immediate release) or 6.25 mg (extended release) at bedtime

Hepatic Impairment
5 mg (immediate release) or 6.25 mg (extended release) at bedtime

Administration

Oral
  • Give immediately before bedtime; for more rapid sleep onset, do NOT give with or immediately after a meal.
  • Extended release tablets should be swallowed whole. Ensure that they are not crushed or chewed.
  • Use reduced dosage of 5 mg in older adult or debilitated patients.
  • 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 >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. Food decreases rate and extent of absorption. 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, very small amounts (<0.02%) distributed into breast milk. Metabolism: In the liver to 3 inactive metabolites. Elimination: 79–96% of dose appears as metabolites 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 physician significantly depressed respiratory rate (<12/min).
  • Monitor patients for S&S of depression (see Appendix F); zolpidem may increase level of depression.
  • Monitor older adult or debilitated patients closely 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 physician.
  • Note: Onset of drug is more rapid when taken on an empty stomach.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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