Zolpidem
Administration
- Type: Sedative/Hypnotic (benzodiazepine-like "Z-drug")
- Dosage Forms:
- Routes of Administration: PO, sublingual
- Common Trade Names: Ambien, Intermezzo
Adult Dosing
- Immediate release: 5-10mg PO immediately prior to bedtime, 7-8h prior to planned awakening
- Extended release: 6.25-12.5mg PO immediately prior to bedtime, 7-8h prior to planned awakening
- Intermezzo (for insomnia in middle of night): 1.75-3.5mg SL once per night
Pediatric Dosing
Safety/efficacy not established
Special Populations
Pregnancy Rating
- Pregnancy category C (fetal risk cannot be ruled out)
Lactation risk
- Infant risk cannot be ruled out
Renal Dosing
- Adult: No adjustment
Hepatic Dosing
- Adult:
- Mild-moderate impairment: max 5mg PO nightly
- Severe impairment: avoid use (may precipitate hepatic encephalopathy)
Contraindications
- Allergy to class/drug
- Caution with:
- Elderly patients (minimal improvement in sleep latency, increased risk of adverse effects)
- Concomitant use of CNS depressants (e.g. ETOH, other sedatives, opioids
- Sleep apnea, myasthenia gravis (risk of respiratory depression)
Adverse Reactions
Serious
- Tachycardia, chest pain
- Hepatic encephalopathy
- Anaphylaxis, angioedema (rare)
- Complex behavioral mannerisms (e.g. driving, making food, having sex while asleep with no recollection after the fact)
- Worsening depression, suicidality
Common
Pharmacology
- Half-life: 2-3 hours (up to 9.9h in cirrhotics)
- Metabolism: Liver
- Excretion: <1% renal
Mechanism of Action
- Positive GABA-A receptor modulator, inhibits neuronal excitation
Comments
See Also
References
- Micromedex