Zolpidem tartrate

Generic Name : zolpidem tartrate Brand Name: Ambien, Ambien CR Classification: Sedative or hypnotic (nonbarbiturate) Pregnancy Category B (immediate-release) Pregnancy Category C (extended-release) Controlled Substance C-IV

Dosage & Route

Available forms :Tablets5, 10 mg; ER tablets6.25, 12.5 mg ADULTS

10 mg PO at bedtime. Do not exceed 10 mg/day. ER tablets12.5 mg/day PO.

PEDIATRIC PATIENTS

Safety and efficacy not established.

GERIATRIC PATIENTS

Increased chance of confusion, acute brain syndrome; initiate treatment with 5 mg PO or 6.25 mg/day PO ER tablets.

Therapeutic actions
Zolpidem acts by binding to the benzodiazepine (BZD) receptors of the GABA receptor complex. It has a selective affinity to BZD receptors prevalent in the cerebellum (omega-1 receptors). It has strong sedative actions but only minor anxiolytic properties. It has also less effects on skeletal muscle and seizure threshold. Zolpidem has a rapid onset but short duration of hypnotic action.

Indications
Short-term treatment of insomnia

Treatment of insomnia in adults who experience difficulties with sleep onset and sleep maintenance (ER tablets)

Adverse effects
Amnesia, drowsiness, dizziness, diarrhea, nausea, vomiting, abnormal thinking and behavior, drugged feelings, back pain, ataxia, hiccups, confusion, euphoria, insomnia, vertigo, diplopia, abnormal vision. Potentially Fatal: Hepatitis, anaphylactic reactions, sleep-driving (driving while not fully awake after drug ingestion, with no recollection of the event).

Contraindications
Severe hepatic insufficiency.

Nursing considerations
Assessment

History: Hypersensitivity to zolpidem, acute intermittent porphyria, impaired hepatic or renal function, addiction-prone patients, lactation, pregnancy Physical: T; skin color, lesions; orientation, affect, reflexes, vision examination; P, BP; bowel sounds, normal output, liver evaluation; CBC with differential; LFTs, renal function tests

Interventions

WARNING: Limit amount of drug dispensed to patients who are depressed or suicidal. WARNING: Withdraw drug gradually if patient has used drug long-term or if patient has developed tolerance. Supportive therapy similar to that for withdrawal from barbiturates may be necessary to prevent dangerous withdrawal symptoms.

Teaching points

Take this drug exactly as prescribed. Do not exceed prescribed dosage. Long-term use is not recommended. You may experience these side effects: Drowsiness, dizziness, blurred vision (avoid driving or performing tasks requiring alertness or visual acuity); GI upset (eat frequent small meals). Report rash, sore throat, fever, bruising, complex sleep disorders.