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

• Dizziness, headache, visual disturbance
• Somnolence, fatigue
• Nausea, diarrhea

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

See Also

• Insomnia
• Benzodiazepine toxicity

References

• Micromedex