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ZOLPIDEM
A Controversial Sleep Aid

Zolpidem Tartrate (marketed under the brand name of Ambien) is a non-benzodiazepine agent which acts on the same brain receptors as benzodiazepines (GABA receptors), inhibiting the function of the central nervous system.

  • Ambien is a fast-acting drug with short duration of action. It is used for the short-term treatment (2-6 weeks) of insomnia characterized by difficulty falling asleep (as opposed to difficulty staying asleep - where Ambien would have little or no effect, given its short duration of action).
  • Onset of action is within 10-15 minutes of oral administration, and effects last for 2-3 hours.
  • Ambien comes in tablets of 5 mg and 10 mg. The recommended dose for insomnia is 5-10 mg in adults, and 5 mg in the elderly or those with impaired liver function. The total daily dose should not exceed 10 mg. Due to its rapid onset of action, Ambien should be taken immediately prior to bedtime.
  • By and large, Ambien is very similar to benzodiazepines in terms of its effects and adverse reactions. However, the high incidence of certain side effects (see below) have raised concerns as to the overall safety of this drug.

Side Effects:

  • If used for more than 6 weeks, Zolpidem (Ambien) can cause physical dependence and withdrawal symptoms just like benzodiazepines.
  • Ambien should not be taken with alcohol, since the two have additive effects and may cause excessive sedation and possibly coma.
  • Ambien may cause increased appetite, which is an undesired effect in a weight control program.
  • Similar to benzodiazepines, Ambien may cause daytime drowsiness, impaired performance of daily tasks, attention deficit and amnesia (memory lapses). Overall, the incidence of these side effects appears to be greater with Ambien as compared to other sleep aids. Some people have reported sleepwalking, and even performing daily activities in this state, with no ulterior memory of the events.
  • Ambien may cause motor incoordination (ataxia), which can predispose to falls especially in the elderly.
  • Increased impulsivity, altered thought patterns, and decreased libido are other side effects of Ambien.
  • Upon discontinuation of Ambien, rebound insomnia may occur.

Ambien-CR contains the same active substance as Ambien (Zolpidem Tartrate), but is different from Ambien in that it is a 2 layer tablet: The first layer dissolves quickly, releasing Zolpidem in the body to induce sleep, while the second layer dissolves gradually to help the person maintain sleep. As such, Ambien-CR is useful for both people with difficulties falling asleep, and for those with difficulties staying asleep. Overall, Ambien-CR is believed to ensure a better quality sleep as compared to Ambien, since the active ingredient is present in the blood at a more stable concentration throughout the night.

  • Ambien-CR should be swallowed whole, and not crushed or chewed. It comes in tablets of 6.25 mg and 12.5 mg. The recommended dose for insomnia is 12.5 mg in adults and 6.25 mg in the elderly or those with impaired liver function.
  • Ambien-CR has the same side effects as Ambien, but studies suggest the intensity of these side effects may be milder with Ambien-CR.

Conclusion:

As far as the efficacy of Zolpidem in treating insomnia, there is no doubt this is a highly effective drug. However, the high incidence of impaired daytime performance, especially memory lapses involving large blocks of time (i.e., no recollection of one's daily activities over extended periods), make this a rather controversial sleep aid.


 

Disclaimer: The information on this page is correct to the best of our knowledge, but please note that it is not exhaustive and its accuracy is not guaranteed. For complete information on Zolpidem (Ambien and Ambien-CR), please consult a pharmacology monograph.



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