Zolpidem

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. 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 nonbenzodiazepine sedative and hypnotic. Zolpidem is a type A GABA receptor agonist of the imidazopyridine class. 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 was approved for medical use in the United States in 1992. It became available as a generic medication in 2007. In the United States it has a monthly cost of about US$8 for immediate release and US$66 for controlled release medication, as of 2017. Zolpidem is a Schedule IV controlled substance under the Controlled Substances Act of 1970 (CSA). More than 10 million prescriptions are filled a year in the United States, making it one of the most commonly used treatments for sleeping 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. Zolpidem should not be taken by people with obstructive sleep apnea, myasthenia gravis, severe liver disease, respiratory depression, children, or people with psychotic illnesses. It should not be taken by people who are or have been addicted to other substances. Use of zolpidem may impair driving skills with a resultant increased risk of road traffic accidents. This adverse effect is not unique to zolpidem but also occurs with other hypnotic drugs. Caution should be exercised by motor vehicle drivers. In 2013 the FDA recommended the dose for women be reduced and that prescribers should consider lower doses for men due to impaired function the day after taking the drug.