Generic Name

Zolpidem Tartrate

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Classification

FDA Approved Indications

• Short-term treatment of insomnia characterized by difficulty with sleep initiation

Mechanism of Action

Zolpidem binds selectively to the alpha-1 subunit of the GABA-A receptor complex, enhancing GABAergic inhibition and leading to sedative effects.

Dosage and Administration

Adult: 5-10 mg at bedtime, with adjustments based on response and tolerability

Pediatric: Not approved for pediatric use

Geriatric: Start with lower doses, typically 5 mg, due to increased sensitivity

Renal Impairment: Use lower dose; monitor closely

Hepatic Impairment: Start with 5 mg; avoid in severe impairment

Pharmacokinetics

Absorption: Rapid absorption, peak plasma levels in about 2 hours

Distribution: Widely distributed, crosses the blood-brain barrier

Metabolism: Primarily hepatic via CYP3A4 enzyme

Excretion: Metabolites excreted in urine

Half Life: 2-3 hours in healthy adults, may be extended in elderly

Contraindications

• Hypersensitivity to zolpidem or any component of the formulation
• History of complex sleep behaviors (e.g., sleepwalking, sleep driving)

Precautions

• Use with caution in patients with a history of substance abuse, hepatic impairment, or respiratory impairment; avoid alcohol and CNS depressants during therapy

Adverse Reactions - Common

• Dizziness (Common)
• Drowsiness (Common)
• Headache (Common)

Adverse Reactions - Serious

• Complex sleep behaviors (e.g., sleepwalking, sleep-driving) (Serious but rare)
• Anaphylaxis or angioedema (Rare)
• Bitter taste, nausea, or allergic reactions (Rare)

Drug-Drug Interactions

• CNS depressants, including alcohol, antidepressants, other sedatives/hypnotics, opioids

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Take medication exactly as prescribed. Do not increase dose or frequency.
• Avoid alcohol and other CNS depressants.
• Be cautious of activities requiring full alertness (e.g., driving) after waking.
• Report any complex sleep behaviors or unusual reactions.

Special Considerations

Black Box Warnings:

• Complex sleep behaviors (e.g., sleepwalking, sleep eating, sleep driving)

Genetic Factors: None specified

Lab Test Interference: None

Overdose Management

Signs/Symptoms: Excessive sedation, confusion, ataxia, coma

Treatment: Supportive care, airway management, activated charcoal if ingested recently, and specific antagonist (flumazenil) in certain cases under close monitoring

Storage and Handling

Storage: Store at room temperature, away from moisture and light

Stability: Stable under recommended storage conditions for the duration specified by the manufacturer