Zolpidem (Ambien)

A non-benzodiazipine hypnotic.

Intermittent use favored because of long term use is associated with risk of tolerance, and withdrawal.

May be associated with increase in an number of malignancies (Kao CH et al).

Associated with morning impairment, even after 7-8 hours of sleep.

Associated with a greater than three fold increased hazard of death.

The most commonly prescribed hypnotic agent in the US.

Significantly increases the risk of falls among hospitalized patients.

Fall rate is approximately 3 per hundred patients (Kolla BP et al).

Patients with depression may develop suicidal tendencies.

Tolerance independence have caused some patients to become addicted.

Zolpidem is associated with gait unsteadiness, increased traffic accidents, increased falls in community-based and skilled nursing facilities, increased falls in hospitalized patients, amnestied sleep related eating, sleep driving, amnestic sleep related sexual activities and other complex related behaviors.

Utilization of this drug occasionally, frequently, and long-term is associated with increased risks of head injuries or fractures associated with hospitalization.

The risk of serious injury among users of this drug is approximate 60% greater than that of controls for both young and older patients.

The hazard ratio for falls increases in a dose dependent fashion.

For the elderly or patients who have hepatic impairment 5 mg nocturnal dose is the recommended one.

Ambien CR at 12.5 mg dose id used for patients who have insomnia characterized by difficulty falling asleep, difficulty staying asleep, or both.

Intermezzo Is a sublingual low-dose tablet for difficulty falling back to sleep after middle of the night awakening.

Intermezzo doses are 3.5 mg for men and 1.75 mg for women.

Women clear zolpidem more slowly the men.

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