Ambien

1 What is Ambien?

Brand: Ambien, Ambien CR

Generic: Zolpidem

Ambien is an imidazolepyridine which preferentially acts on the alpha-1 subunit containing subtype of benzodiazepine (BZD) receptors that are important in mediating the hypnotic effect. 

This drug is categorized into newer nonbenzodiazepine hypnotics. Its hypnotic effect is pronounced in insomniacs because of shortened sleep latency and prolonged sleep duration. 

Zolpidem is almost completely metabolized in liver. It is commonly indicated for short-term sleep onset insomnia. Because of short duration of action, next day sedation or morning hangover effect is minimal.

2 What To Know Before Using

Ambien actually belongs to those which are considered as Sedative-Hypnotics. Sedative is a drug that subdues excitement and calms the subject without inducing sleep, though drowsiness may be pronounced. 

On the contrary, hypnotic is a drug that induces and/or maintains sleep, similar to normal sleep. This is not to be confused with ‘hypnosis’ meaning a trans-like state in which the subject becomes passive and highly suggestible. 

The sedatives and hypnotics are more or less general CNS depressants. A hypnotic at lower dose may act as sedative. Thus, sedation –hypnosis –general anesthesia may be regarded as increasing grades of CHS depression. 

Hypnotics given in high doses can produce general anesthesia. Treatment of insomnia is the most important use of this class of drugs. Currently, Zolpidem is one of the most frequently prescribed drugs. 

It has also been combined with other drugs with a view to improve efficacy by relieving attendant anxiety. Its advantages are more pronounced over any other sedative-hypnotics. Zolpidem has minimal hangover effect and there is fading of hypnotic action on repeated nightly use. 

Relatively no or little rebound insomnia is noticed on discontinuation. Moreover, Zolpidem does not produce tolerance or physical dependence and there is low abuse potential combined with safety in overdose like BZDs.

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3 Proper Usage

To use Ambien properly, you must follow all instructions given by your doctor.Insomnia arises under a variety of circumstances. It could be a long-term (months-years), short-term (weeks) or transient (a day or two, mostly situational) problem. 

Short-term management of insomnia requires 5-10 mg tablet (max 20 mg) immediately before bedtime. When Zolpidem is taken as an extended release tablet, 6.25-12.5 mg should be administered at bedtime. 

The duration of drug therapy should be of max 4 weeks including tapering. ½ of usual dose is preferred in elderly and liver disease patients.

The dosing of this medicine may vary from patients to patients. You should follow your doctor's directions as well as the advices in order to become benefitted. The dosage of the medicine that you are advised depends upon the disease condition and the strength of the drug as well. 

Always try to take your medicine according to your doctor’s prescription. You should store the medicine in a cool and dry place, away from heat, moisture, and direct light. Moreover, all types of drugs should be kept out of the reach of children. Outdated medicine should be destroyed in a proper way.

4 Precautions To Take

In using Ambien, you must be careful and take some precautions as advised by your doctor. 

A hypnotic should not be casually prescribed for every case of insomnia. Understanding the cause of insomnia and use of a variety of other measures can eliminate unnecessary use of hypnotic medication. 

When drugs are truly needed, BZDs or the newer non-BZDs like zolpidem, zopiclone, zaleplon are the hypnotics of choice.

Some important outlines that should be known before starting such medications are given below:

  • A hypnotic may be used to shorten sleep latency, to reduce nocturnal awakenings, or to provide anxiolytic effect the next day when insomnia is accompanied with marked anxiety.
    In the use of hypnotics, consideration must be given to onset and duration of action of the drug. The most suitable pharmacokinetic profile drug should be chosen.
  • Impaired performance on the next day is largely related to the dose and pharmacokinetic profile of a drug. The next day effects are either due to prolonged sedation (longer acting drugs) or rebound anxiety (shorter acting drugs).
  • After regular use for a few days, hypnotics (probably except zolpidem-like drugs) become useless and even harmful also.
  • Avoid abrupt withdrawal and rapid dose reduction after prolonged therapy.
  • If insomnia fails to remit after 7-10 days therapy, you should re-evaluate as this may indicate the presence of underlying psychiatric and/or medical condition.
  • Patients should be warned about performing activities involving mental alertness or physical coordination after drug intake.
  • This drug is contraindicated in severe hepatic impairment.
  • You should be aware of not using some drugs along with zolpidem. Those are: 
    • Flumazenil – reverses the sedative/hypnotic effect of zolpidem.
    • Imipramine and Chlorpromazine – additive effect on decreased alertness and psychomotor performance.
    • Ritonavir – increased risk of prolonged sedation and respiratory depression.
    • Rifampicin – reduces hypnotic effect of zolpidem.
    • Itraconazole and Ketoconazole – inhibit metabolism of zolpidem resulting in increased plasma concentration.

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

5 Potential Side Effects

Zolpidem is responsible for few side effects. But mostly these effects are not prominent. Even large doses do not markedly depress respiration. 

Morning sedation or prolongation of reaction-time can occur if zolpidem is taken late at night.

Other side effects possible are:

  • Vertigo
  • Dizziness
  • Nausea
  • Vomiting
  • Hepatitis
  • Angioedema
  • Anaphylactic reactions
  • Atypical thinking and behavior
  • Hallucination
  • Nightmare
  • Ataxia
  • Rebound insomnia
  • Amnesia
  • Upper and lower respiratory tract infection
  • Fatigue
  • Visual disturbances etc. may occur but rarely
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