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Name: zolpidem (zole PI dem)
Brand Names: Ambien, Ambien CR, Edluar, Intermezzo, Zolpimist
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Important Information about Ambien
Zolpidem, sold under the brand name Ambien, among others, is a medication primarily used for the short term treatment of sleeping problems. Guidelines recommend that it be used only after counseling and behavioral changes have been tried. It decreases the time to sleep onset by about 15 minutes and at larger doses helps people stay asleep longer. It is taken by mouth and is available in conventional tablets or sublingual tablets and oral spray.
Common side effects include daytime sleepiness, headache, nausea, and diarrhea. Other side effects include memory problems, hallucinations, and abuse. The recommended dose was decreased in 2013 due to next-morning impairment. Additionally driving the next morning is not recommended with either higher doses or the long acting formulation. While flumazenil can reverse zolpidem’s effects, usually supportive care is all that is recommended in overdose.
Zolpidem is a hypnotic and a nonbenzodiazepine of the imidazopyridine class. Zolpidem is a type A GABA receptor agonist. It works by increasing GABA effects in the central nervous system by binding to GABAA receptors at the same location as benzodiazepines. It generally has a half-life of two to three hours. This, however, is increased in those with liver problems.
Zolpidem is labelled for short-term (usually about two to six weeks) treatment of insomnia at the lowest possible dose. It may be used for both improving sleep onset and staying asleep.
Guidelines from NICE, the European Sleep Research Society, and the American College of Physicians recommend medication for insomnia (including possibly zolpidem) only as a second line treatment after nonpharmacological treatment options (e.g. cognitive behavioral therapy for insomnia). This is based in part on a 2012 review which found that zolpidem’s effectiveness is nearly as much due to psychological effects as to the medication itself.
A lower-dose version (3.5 mg for men and 1.75 mg for women) is given as a tablet under the tongue and used for middle-of-the night awakenings. It can be taken if there are at least 4 hours between the time of administration and when the person must be awake
Overdose can lead to coma or death. When overdose occurs, there are often other drugs in the person’s system.
Zolpidem overdose can be treated with the benzodiazepine receptor antagonist flumazenil, which displaces zolpidem from its binding site on the benzodiazepine receptor to rapidly reverse the effects of the zolpidem. It is unknown if dialysis is helpful.
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