zolpidem tartrate

zolpidem tartrate

(zol' pih dem)

Ambien, Ambien CR

Pregnancy Category B

Controlled Substance C-IV

Drug class

Sedative or hypnotic (nonbarbiturate)

Therapeutic actions

Modulates GABA receptors to cause suppression of neurons, leading to sedation, anticonvulsant, anxiolytic, and relaxant properties.

Indication

·        Short-term treatment of insomnia

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

Contraindications and cautions

·        Contraindicated with hypersensitivity to zolpidem.

·        Use cautiously with acute intermittent porphyria, impaired hepatic or renal function, addiction-prone patients, pregnancy, lactation.

Available forms

Tablets—5, 10 mg; ER tablets—12.5 mg

Dosages

ADULTS

10 mg PO hs. Do not exceed 10 mg/day. ER tablets—12.5 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.

Pharmacokinetics

Route	Onset	Peak
Oral	45 min	1.6 hr

Metabolism: Hepatic; T_1/2: 2.6 hr

Distribution: Crosses placenta; may enter breast milk

Excretion: Urine

Adverse effects

·        CNS: Seizures, hallucinations, ataxia, EEG changes, pyrexia, morning drowsiness, hangover, headache, dizziness, vertigo, acute brain syndrome and confusion; paradoxical excitation, anxiety, depression, nightmares, dreaming, diplopia, blurred vision, suppression of REM sleep; REM rebound when drug is discontinued

·        GI: Esophagitis, vomiting, nausea, diarrhea, constipation

·        Hypersensitivity: Generalized allergic reactions; pruritus, rash

·        Other: Influenza-like symptoms, dry mouth, infection

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.

Adverse effects in Italic are most common; those in Bold are life-threatening.