Zolpidem
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Trade Name
Ambien (immediate-release), Ambien CR (extended-release); generic zolpidem
Classification
Nonbenzodiazepine hypnotic; sedative-hypnotic; Schedule IV controlled substance
Dosage/Route
- * Dosage:
- – Immediate-release (IR): 5 mg, 10 mg tablets
- – Extended-release (CR): 6.25 mg, 12.5 mg tablets
- – Sublingual (Edluar, Intermezzo): 1.75 mg, 3.5 mg, 5 mg, 10 mg
- * Route: Oral (PO); sublingual (SL)
Usual Dosage
- * Adults:
- – IR: 5 mg (women) or 10 mg (men) PO at bedtime; max 10 mg/day.
- – CR: 6.25 mg (women) or 12.5 mg (men) PO at bedtime; max 12.5 mg/day.
- – SL (Intermezzo): 1.75 mg (women) or 3.5 mg (men) for middle-of-night awakening.
- * Elderly/Debilitated: Start 5 mg (IR) or 6.25 mg (CR); lower doses due to sensitivity.
- * Take only if ≥7-8 hours of sleep time remain
Mechanism of Action
Binds selectively to GABA-A receptor (omega-1 subtype) in the CNS, enhancing GABA’s inhibitory effects. Promotes sleep onset and maintenance without significant muscle relaxation or anticonvulsant action (unlike benzodiazepines)
Side Effects & Adverse Effects
- * Side Effects: Drowsiness, dizziness, headache, nausea
- * Adverse Effects:
- – Complex sleep behaviors (e.g., sleepwalking, driving while asleep)
- – Next-day impairment (psychomotor slowing, esp. CR or higher doses)
- – Dependence/tolerance (Schedule IV risk)
- – Respiratory depression (rare, with overdose or CNS depressants)
Nursing Management (Implications & Teachings)
- * Implications:
- – Assess sleep patterns and fall risk (esp. elderly)
- – Monitor for abnormal behaviors (e.g., sleep-driving)
- – Avoid with alcohol/other CNS depressants (additive effects)
- – Ensure patient takes immediately before bed; no food 2 hours prior
- * Teachings:
- – Take only if 7-8 hours for sleep; avoid next-day driving if groggy
- – Report sleepwalking, confusion, or breathing changes
- – Avoid alcohol and OTC sleep aids
- – Don’t crush CR tablets; store securely (controlled substance)
Indication for This Patient
Short-term treatment of insomnia (difficulty falling asleep—IR; staying asleep—CR; middle-of-night waking—SL)
Time
- * Timing: At bedtime (IR/CR); middle of night (SL, with ≥4 hours sleep left)
- * Onset: 15-30 minutes
- * Peak: 1-2 hours (IR); 1.5-3 hours (CR)
- * Duration: 6-8 hours (IR); 7-10 hours (CR)
