zolpidem

Absorption: Rapidly absorbed following oral administration. Controlled-release formulation releases 10 mg immediately, then another 2.5 mg later.

Distribution: Unknown.

Metabolism/Excretion: Converted to inactive metabolites, which are excreted by the kidneys; clearance of sublingual tablet lower in women than in men.

Half-Life: 2.5–3 hr (↑ in older adults and patients with hepatic impairment).

Time/Action Profile ⬆ ⬇

(sedation)

ROUTE	ONSET	PEAK*	DURATION
PO	rapid	30 min–2 hr	6–8 hr
PO-ER	rapid	2–4 hr	6–8 hr
SL	rapid	unknown	unknown

*Food delays peak levels and effects.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
History of experiencing complex sleep behaviors with zolpidem
;
Severe hepatic impairment (↑ risk of hepatic encephalopathy).

Use Cautiously in:

History of previous psychiatric illness, suicide attempt, or drug or alcohol abuse;
Pulmonary disease;
Sleep apnea;
Myasthenia gravis;
Mild or moderate hepatic impairment (↑ risk of hepatic encephalopathy; ↓ initial dose);
OB: May ↑ risk of respiratory depression in neonates after birth;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk in infants;
Pedi: Safety and effectiveness not established in children;
Geri: Appears on Beers list. ↑ risk of cognitive impairment, delirium, falls, fractures, and motor vehicle accidents in older adults. Avoid use in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

EENT: blurred vision, double vision

GI: diarrhea, nausea, vomiting

Neuro: daytime drowsiness, dizziness, abnormal thinking, agitation, amnesia, behavior changes, COMPLEX SLEEP BEHAVIORS (INCLUDING SLEEP-DRIVING, SLEEP-WALKING, OR ENGAGING IN OTHER ACTIVITIES WHILE SLEEPING), delirium, hallucinations, prolonged reaction time

Resp: respiratory depression

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS), physical dependence, psychological dependence, tolerance

Interactions ⬆ ⬇

Drug-drug:

↑risk of CNS and respiratory depression with sedatives/hypnotics, alcohol, phenothiazines, tricyclicantidepressants, opioids, or antihistamines.
CYP3A4 inducers, including rifampin, may ↓ levels and effectiveness.
CYP3A4 inhibitors, including ketoconazole, may ↑ levels and risk of toxicity; consider ↓ zolpidem dose.

Drug-Natural Products:

Kava-kava, valerian, or chamomile can ↑ risk of CNS depression.
St. John's wort may ↓ levels and effectiveness; avoid concurrent use

Drug-Food:

Food↓ and delays absorption.

Route/Dosage ⬆ ⬇

PO SL (Adults ): Tablets or SL tablets (Edluar): 5 mg (for women) and 5–10 mg (for men) at bedtime; may ↑ to 10 mg at bedtime if 5-mg dose not effective; SL tablets (generic): 1.75 mg (for women) or 3.5 mg (for men) once upon awakening in the middle of the night; Extended-release tablets: 6.25 mg (for women) and 6.25–12.5 mg (for men) at bedtime; may ↑ to 12.5 mg at bedtime if 6.25-mg dose not effective.
PO SL Geriatric Patients , Debilitated Patients, or Patients With Mild/Moderate Hepatic Impairment): Tablets or SL tablets (Edluar): Do not exceed dose of 5 mg at bedtime; Extended-release tablets: Do not exceed dose of 6.25 mg at bedtime.
SL Geriatric Patients , Patients Taking Concurrent CNS Depressants, or Patients With Mild/Moderate Hepatic Impairment): SL tablets (generic): Do not exceed dose of 1.75 mg at bedtime (in either men or women).

Availability ⬆ ⬇

(Generic available)

Immediate-release tablets: 5 mg; 10 mg
Immediate-release capsules: 7.5 mg
Extended-release tablets: 6.25 mg; 12.5 mg
Sublingual tablets (Edluar): 5 mg; 10 mg
Sublingual tablets: 1.75 mg; 3.5 mg

Assessment ⬆ ⬇

Assess mental status, sleep patterns, and potential for abuse prior to administration. Prolonged use for >7–10 days may lead to physical and psychological dependence. Limit amount of drug available to the patient.
Assess alertness at time of peak effect. Notify health care provider if desired sedation does not occur.
Assess for pain. Medicate as needed. Untreated pain ↓ sedative effects.
Monitor respiratory status; ↑ risk of respiratory depression should be considered before prescribing zolpidem in patients with respiratory impairment, including sleep apnea and myasthenia gravis, or with concurrent opioid use.
Assess for complex sleep behaviors (sleep-walking, sleep-driving, or engaging in activities while not fully awake). May cause serious injuries and even death; if these behaviors occur, discontinue immediately if identified.

Implementation ⬆ ⬇

High Alert: Do not confuse Ambien with ambrisentan. Do not confuse zolpidem with Zyloprim.
Before administering, ↓ external stimuli and provide comfort measures to ↑ effectiveness of medication.
- Implement safety measures to protect patient from injury.
- Use lowest effective dose.
PO: Swallow tablets whole with full glass of water. For faster onset of sleep, do not administer with or immediately after a meal.
- DNC: Swallow extended-release tablets whole; do not crush, break, or chew.
SL: To open the blister pack, separate the individual blisters at the perforations. Peel off top layer of paper and push tablet through foil. Place the tablet under the tongue; allow to disintegrate; do not swallow or take with water.
- Only take if ≥4 hr left before awakening.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy. Instruct patient to take as directed. Take as a single dose and do not readminister during the same night. Advise patient not to take zolpidem unless able to stay in bed a full night (7–8 hr) before being active again. Do not take more than the amount prescribed because of the habit-forming potential. Not recommended for use >7–10 days. If used for >2 wk, abrupt withdrawal may result in fatigue, nausea, flushing, light-headedness, uncontrolled crying, vomiting, GI upset, panic attack, or nervousness.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other medications.
Because of rapid onset, advise patient to go to bed immediately after taking zolpidem.
May cause daytime drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to this medication is known.
Caution patient that complex sleep-related behaviors (sleep-driving, making phone calls, preparing and eating food, having sex, sleep walking) may occur while asleep. Inform patient to notify health care provider if sleep-related behaviors occur.
Advise patient to notify health care provider immediately if signs/symptoms of anaphylaxis (swelling of the tongue or throat, trouble breathing, nausea, vomiting) occur.
Caution patient to avoid concurrent use of alcohol or other CNS depressants, including opioids.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding. Monitor neonates exposed to zolpidem during pregnancy and breastfeeding for signs of excess sedation, hypotonia, and respiratory depression.

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆ ⬇

Canadian Brand Names ⬆ ⬇

Contr. Subst. Schedule ⬆ ⬇

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