Zolpidem is a hypnotic drug. It selectively binds to the omega-1 receptor subtype (also known as the benzodiazepine-1 subtype), which is the alpha unit of the GABAA receptor complex. Check what are the indications for the use of zolpidem and what side effects may occur.

Zolpidem operation

While benzodiazepines bind non-selectively to all three omega receptor subtypes, zolpidem has the ability to selectively bind to the omega-1 subtype. As a result, it shortens the latent sleep phase, reduces the number of night awakenings, extends the duration of sleep and improves its quality.

These effects are associated with a characteristic electroencephalographic profile which is different from that of benzodiazepines. Studies have shown that zolpidem prolongs both phase II and deep sleep phase. At the recommended doses, zolpidem does not affect the duration of the REM phase.

Indications for the use of zolpidem

Short-term treatment of insomnia in adults.

Contraindications to the use of zolpidem

The absolute contraindications are:

  • allergic to zolpidem,
  • severe muscle weakness (myasthenia gravis),
  • short-term respiratory arrest during sleep (sleep apnea, respiratory failure, liver failure).

Zolpidem should not be used in children and adolescents under 18 years of age.

Available preparations

The drug is available as 10 mg film-coated tablets.

Zolpidem dosage

The drug can only be obtained with a doctor's prescription. The usual recommended dose is 10 mg per 24 hours. In some patients (elderly or debilitated patients), the doctor may prescribe a lower dose (half a tablet). The drug should be taken immediately before going to bed.

The patient must allow at least 8 hours between taking the drug and starting any activities that require increased concentration.

Repeated use of the drug for several weeks may reduce its hypnotic effect. The duration of treatment should be as short as possible - from a few days to 2 weeks.

Side effects of zolpidem

When using zolpidem, it can often say:

  • headache,
  • dizziness,
  • intensificationinsomnia,
  • forgetfulness,
  • hallucinations,
  • arousal,
  • nightmares,
  • fatigue,
  • diarrhea,
  • nausea,
  • vomiting,
  • stomach ache.

The use of zolpidem can lead to the development of mental or physical abuse and dependence. The risk of dependence increases with increasing doses of the drug and the duration of treatment. Cases of addiction have been reported more frequently when such drug formulation was used for more than 4 weeks.

In cases where physical dependence has developed, abrupt discontinuation of treatment will be accompanied by withdrawal symptoms. They can occur:

  • headaches and muscle aches,
  • increased anxiety and mental tension,
  • anxiety,
  • entanglement
  • and irritability.

Interaction with other drugs and substances

  • Increasing the inhibitory effect of zolpidem on the central nervous system may occur in the case of concomitant use of drugs of this composition with antipsychotics (neuroleptics), other sleeping pills, anxiolytics and / or sedatives, antidepressants, narcotic analgesics, antiepileptic drugs, anesthetics and antihistamines with a sedative effect;
  • Concomitant use with paroxetine, bupropion, desipramine, fluoxetine, sertraline and venlafaxine may lead to delusions and brief hallucinations. It is clinically confirmed that sertraline, an inhibitor of CYP3A4, may also interact with zolpidem to increase somnolence;
  • Parallel use of zolpidem with opioid analgesics may lead to increased euphoria, which may facilitate the development of psychological dependence;
  • Rifampicin significantly reduces the concentration of zolpidem in the blood and reduces its hypnotic effect;
  • Zolpidem is mainly metabolised by the isoenzymes CYP3A4 and CYP1A2. Inhibitors of the cytochrome P-450 isoenzyme CYP3A4 (including ketoconazole) may increase the effect of the drug.

Driving and operating machinery

You should not drive or operate machinery after taking zolpidem. This medicine has a major influence on the ability to drive and use machines, and can cause incidents such as 'falling asleep at the wheel'.

In order to minimize the risk of the above-mentioned events, it is recommended to leave a break of at least 8 hours between taking zolpidem and driving, operating machinery and working at heights.

Pregnancy and breastfeedingbreastfeeding

The use of zolpidem during pregnancy is not recommended. Zolpidem crosses the placenta. The use of zolpidem in late pregnancy or during childbirth has been associated with symptoms such as decreased muscle tone ("floppy baby syndrome") and feeding difficulties and respiratory depression in the fetus.

Cases of severe respiratory depression in newborns have also been reported. The use of zolpidem during lactation is not recommended as it has been found to be excreted in human milk in small amounts.

Zolpidem storage

There are no special storage requirements for drugs of this composition. They must not be stored above 25 ° C. Also, make sure that they are out of the sight and reach of children.

Sources:

  1. Characteristics of the Stilnox medicinal product (https://www.sanofi.pl/-/media/Project/One-Sanofi-Web/Websites/Europe/Sanofi-PL/Home/Nasze-produkty/Leki-na- recipe / Stilnox / Stilnox-ChPL-072019.pdf? la=pl)
  2. Characteristics of Zolpic medicinal product (https://www.polfawarszawa.pl/products/chpl/smpc-zolpic-2019-02pl.pdf )

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