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Questions and Answers
Which side effect of zolpidem may occur in 4% of individuals?
What effect has been observed in individuals with reported dependence and abuse of zolpidem?
What should not be used with zolpidem due to the potential increase in its sedative effect?
Which type of sleep parasomnias are possible effects of zolpidem use?
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What is a potential adverse effect of zolpidem use more prevalent in association with alcohol?
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For which condition has sublingual zolpidem shown to increase total sleep time without significant changes in other sleep parameters?
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What is the recommended initial dose of zolpidem for adults?
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For whom is the use of zolpidem not recommended?
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What is the function of zolpidem in the treatment of sleep-onset insomnia?
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Which population group requires starting zolpidem at a lower initial dose?
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What is a significant impact of zolpidem at doses of 7.5 and 10 mg?
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In which population group is zolpidem use contraindicated?
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Study Notes
Non-Benzo Hypnotics: Focus on Zolpidem
Zolpidem is a non-benzodiazepine hypnotic agent that is used to treat acute night-time insomnia. It belongs to the cyclopyrrolone family and is indicated for sleep-onset insomnia (immediate-release: 5 to 10 mg) and sleep maintenance in adults. This article will focus on the topic of non-benzodiazepine hypnotics, specifically zolpidem, its use, and its potential side effects.
Uses and Dosage
Zolpidem is prescribed for the treatment of sleep-onset insomnia, where it reduces sleep latency and increases the total sleep time. The recommended initial dose for adults is 5 to 10 mg, and for older adults, it is recommended to start with half this dose. The use of zolpidem is not recommended for children, adolescents, pregnant women, or during breastfeeding. Zolpidem is available in several formulations, including immediate-release, sublingual, and extended-release formulations, each with its own dosage and administration requirements.
Efficacy and Comparison with Other Formulations
In a meta-analysis, zolpidem resulted in increased total sleep time, reduced sleep latency, and improved sleep quality, with no difference in wake after sleep onset. Comparing different doses of zolpidem (5, 7.5, 10, 15, and 20 mg), doses of 7.5 and 10 mg decreased sleep-onset latency and the number of nighttime wakes and increased total sleep time without impact on psychomotor performance. Sublingual zolpidem (5 mg) reduced sleep onset latency by 8.6 minutes compared with oral zolpidem, with no differences in total sleep time and wake after sleep onset. In individuals with chronic insomnia, oral (10 mg) and sublingual (5 mg) zolpidem led to a similar reduction in the number of wakes and an increase in total sleep time, but with a greater reduction in sleep latency with sublingual zolpidem. For maintenance insomnia, sublingual zolpidem (5 mg) increased total sleep time, without significant changes in sleep latency, wake after sleep onset, or sleep quality. Extended-release zolpidem (12.5 mg) in individuals with chronic insomnia increased total sleep time and sleep efficiency, while reducing latency to persistent sleep, wakes, and wake after sleep onset, with no impairment of psychomotor performance the following morning.
Drug Interactions and Side Effects
Zolpidem is metabolized by cytochrome P450 (CYP) and should not be used with CYP3A4 inhibitors (fluvoxamine, ciprofloxacin, and ketoconazole) due to the potential increase in the sedative effect. Use with CYP3A4 inducers (rifampicin and St. John's wort) is not recommended due to the potential reduction in zolpidem levels. Side effects of zolpidem include sleepiness (5%), dizziness (5%), headache (3%), gastrointestinal symptoms (4%), sleepwalking (1%), nightmares (1-2%), and mental confusion (1-2%). The risk of falls and fractures is increased, especially among older people. Non-REM (NREM) sleep parasomnias, and behavioral changes (disinhibition, aggressiveness, impulsivity, visual and auditory hallucinations, driving) are possible effects, more prevalent in association with alcohol. There is an increased risk of suicide, especially with high doses and psychiatric comorbidities. Rebound insomnia with discontinuation of zolpidem may be observed with abrupt discontinuation of higher doses. Zolpidem can cause dependence syndrome, and abrupt interruption can be associated with headache, myalgia, irritability, anxiety, mental confusion, and, in more serious cases, derealization, depersonalization, hyperacusis, hypersensitivity to light, noise, and tactile stimuli, hallucinations, and epileptic seizures. Zolpidem abuse and the use of high doses have been observed, with tolerance, particularly in individuals with reported dependence and abuse of other drugs.
Measures to Combat Indiscriminate Use and Correct Assessment
In recent years, there has been a 161% growth in zolpidem sales in Brazil, reaching almost 22 million boxes sold in 2022. Measures to combat indiscriminate use and to assess and reassess patients during the use of zolpidem are priorities in the treatment of patients.
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Description
Explore the uses, dosage, efficacy, drug interactions, side effects, and measures to combat indiscriminate use of zolpidem, a non-benzodiazepine hypnotic agent used for insomnia treatment. Learn about its formulations, recommended doses, potential side effects, and critical considerations for its safe administration.
