Medication: Ambien (Zolpidem)
Dosage: 10 mg
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Ambien (Zolpidem)

Zolpidem tartrate, classified as a nonbenzodiazepine receptor modulator, serves as a key component in FDA-approved short-term insomnia treatments, specifically tailored for patients struggling with initial sleep onset. Classified as a Class C IV controlled substance, its distribution is closely regulated by the Drug Enforcement Agency.

Notably, it enhances both the speed at which sleep is initiated and its overall duration while reducing instances of nocturnal awakenings, particularly beneficial for those experiencing transient insomnia. Additionally, it has demonstrated efficacy in enhancing sleep quality among individuals grappling with chronic insomnia, with potential adjunctive effects as a mild muscle relaxant.

Notably, studies have indicated its rapid and effective restoration of brain function among patients in a vegetative state post-brain injury. This restorative capacity, akin to Ambien, may either completely or partially reverse aberrant metabolic activity in damaged brain cells.

Notwithstanding, optimal recovery is typically achievable unless the injury directly affects the brain stem.

Use of the drug Ambien

In order to minimize the possibility of developing anterograde amnesia and other undesirable effects, Ambien is taken only if it is possible to obtain 7-8 hours of sleep after its use. To promote sleep onset more quickly, zolpidem should be taken on an empty stomach. Usually prescribed at a dose of 10 mg orally at bedtime.

The maximum daily dose for adults is up to 20 mg. Weakened patients, patients with impaired liver or kidney function, and elderly people are prescribed a reduced initial dose - of 5 mg at bedtime, the dose is adjusted taking into account individual tolerance.

Side effects

Some side effects of Ambien include anaphylaxis, behavioral changes, withdrawal symptoms, and central nervous system (CNS) depression. In rare situations, patients have reported swelling of the tongue, larynx, or glottis in the form of angioedema. Patients also reported difficulty breathing, airway obstruction, nausea, and vomiting.

If patients report this, the drug should not be re-administered to the patient. Patients who experience a blockage in the throat, glottis, or larynx should be referred to the emergency department.

Reports have surfaced regarding changes in behavior and aberrant thinking patterns associated with the use of the medication. Notably, patients have exhibited heightened aggressiveness and extroversion, behaviors diverging from typical human conduct. Individuals with alcohol or substance toxicity have presented with auditory and visual hallucinations, often accompanied by unusual behaviors and agitation.

Additionally, instances of sleep-driving, wherein a patient operates a vehicle while not fully conscious after ingesting a sedative-hypnotic substance, have been documented, with subsequent lack of recollection. Concurrent use of alcohol or other central nervous system depressants has been found to exacerbate these effects by intensifying sedation. Consequently, discontinuation of the medication is imperative in such scenarios.

Moreover, individuals grappling with depression are advised against using Ambien, as it may exacerbate depressive symptoms and precipitate suicidal ideation and behaviors.

Contraindications

Ambien is contraindicated only in patients with a known allergy to the drug or inactive ingredients in the formula. In addition, other causes of sleep deprivation, such as any existing physical or psychiatric history, should be assessed before prescribing zolpidem.

Caution should be exercised in patients taking drugs that affect drug metabolism via cytochrome P450. Consider prescribing a lower dose of zolpidem as patients may experience increased sedation. Additionally, patients taking imipramine and chlorpromazine should avoid Ambien. When combined, these drugs cause decreased alertness and psychomotor performance.

Worsening of depression and/or suicidal ideation may occur with Ambien therapy. Therefore, doctors should prescribe as few tablets as possible to avoid intentionally overdosing on Ambien. Consider this risk of respiratory depression before prescribing Ambien to patients with compromised respiratory function.

Withdrawal symptoms may occur if the dose of Ambien is quickly reduced or stopped. Therefore, it is recommended to gradually reduce the dose to avoid unnecessary withdrawal and adverse reactions in chronic Ambien users.

Pregnant women

Because zolpidem can cross the placenta, maternal use of Ambien during the third trimester of pregnancy or during labor may result in respiratory depression and sedation in the neonate at birth.

Therefore, it is recommended that neonates exposed to maternal zolpidem be monitored and managed for signs of hypotension, excessive sedation, and respiratory depression.

However, published data from post-marketing surveillance, observational studies, case reports, and birth registries of maternal use of Ambien during pregnancy have not demonstrated a clear association between Ambien use and major congenital disorders.

After birth, a limited number of cases of moderate to severe respiratory depression have been reported in neonates requiring intratracheal intubation or mechanical ventilation. However, most of these newborns recovered within hours or weeks of birth following treatment.