This drug lately has been in the market for inducing sleep in patients with difficulty in sleeping due to illnesses like depression and anxiety. However, this article (mentioned in title slide) explains the con effects of the drug, Zolpidem. An highly abused drug, learn more about its effects on health.

1. Zolpidem for
Insomnia
Presented By
Anjali Bodapunti
Guided By Dr. Leefmans
Daniel Bouchette et al (NCBI Bookshelf)

2. Zolpidem
 A non-benzodiazepine receptor modulator
(sedative) used on treating short term insomnia.
Improves measures of sleep duration and
reduces awakenings.
 Introduced in 1980s to overcome disadvantages
of BZDs like next day sedation, daytime
sleepiness, dependence and withdrawal
syndrome.
 USFDA approved 13 generic versions of
zolpidem tartrate.
 Studies have been made to check if the tartrate
salt of this drug is useful for Tuberculosis.
“Further optimization of the core may put TB to
rest.”
 “Not so safe” drug frequently involved in both
misuse/abuse and withdrawal issues.
https://www.acs.org/molecule-of-the-week/archive/z/zolpidem.html
https://www.ncbi.nlm.nih.gov/books/NBK442008/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077048/

3. Indications
MOA and
Adverse effects
Improve Care
Goals/Objectives
https://www.ncbi.nlm.nih.gov/books/NBK442008

4.  Mimics GABA, a receptor chloride channel
agonist that Increases GABA inhibition, leading
to sedation.
 GABA-a found in cortex, globus pallidus, inferior
colliculus, pons, ventral thalamus, olfactory bulb,
cerebellum and substantial in brain.
 Zolpidem acts on these receptors initiating
preservation of deep sleep.
 In vitro, drug binds to and activates BZ-1 receptor
with high affinity ratio of a1 and a5 subunits.
 Selective binding is why there is relative absence
of myorelaxant and anticonvulsant effect.
Mechanism
of Action
https://www.ncbi.nlm.nih.gov/books/NBK442008

5. Administration
Dosage Forms
Oral (tablet, extended release tablet, Oral Spray, Sublingual tablet)correctly in
PowerPoint, download and install the fonts we used
Dosage 5mg (women, elderly, 5mg-10mg (men) OD HS, 7 hrs before awakening
Metabolism Cytochrome P450 (CYP3A4, CYP1A2, CYP2C9, 7,10)
Excretion Inactive metabolite excreted by kidneys
Contraindications With or after food slows the effect of drug
Clearance Lesser in women
https://www.ncbi.nlm.nih.gov/books/NBK442008

6. Administration
Methods
Hepatic
Impairment
Renal
Impairment
Not required, dose
to be watched
Dose to be altered
Breastfeeding
Temporary
interruption during
treatment
Pregnant
women
Monitor and
manage for signs
In children, hallucinations might occur. However, no studies found yet.
https://www.ncbi.nlm.nih.gov/books/NBK442008

7. Adverse
Effects
 Anaphylaxis, changes in behavior, withdrawal
and CNS depression.
 Studies show rare signs of angioedema of
tongue, larynx and glottis. If closure occurs,
immediately taken to emergency department.
 If SOB, airway closure, nausea and vomiting are
reported, immediate cessation.
 Changes in behavior: aggression, extroversion,
abnormal thinking
 Pts with alcohol abuse experienced auditory and
visual hallucinations with strange behaviour and
agitations, “sleep driving”. Sedation increased
with drug and alcohol.
 Not to be prescribed for depression, increases
risk of suicidal ideations and actions.
https://www.ncbi.nlm.nih.gov/books/NBK442008/

8.  Before prescribing, other causes to be
evaluated.
 Allergic to drug or ingredients of dosage.
 With drugs that effect CYP450 metabolism.
 Imipramine and chlorpromazine combined with
zolpidem as decreases alertness and
psychomotor performance.
 In depression as worsening of suicidal thoughts.
 Risk of respiratory depression in pts with
compromised respiratory function.
 Withdrawal symptoms with discontinuation.
Instead, tapper off slowly.
Contraindications
https://www.ncbi.nlm.nih.gov/books/NBK442008

9. Monitoring
 Half life: 2.6 hours
 Elimination: 2.5hrs
 Highly binds to protein
 Remains unchanged substantially following linear kinetics at dose 5mg-20mg.
 High potential for abuse
 Pts with higher doses or drug abuse history should be monitored carefully.
 Higher plasma concentrations leads to anterograde amnesia causing consolidated memory
loss.
Toxicity:
 Pts with symptoms needs gastric lavage within one hour of ingestion.
 Administration of flumazenil (reversal agent to BZs) and IV fluids
 Vitals to be monitored in the event of drug toxicity.
https://www.ncbi.nlm.nih.gov/books/NBK442008

10. Not usually prescribed for general
population as first line treatment
because of its high potential for
drug abuse.
Drugs like controlled release
melatonin and doxepin to be used
as first line therapy with proper
sleep hygiene and cognitive
behavioural therapy for patients
with insomnia.
Conclusions
https://www.ncbi.nlm.nih.gov/books/NBK442008

11.  Insomnia and zolpidem use to be managed by
interprofessional team of HCPs.
 Possibility of addiction and withdrawal symptoms
drive the prescription of zolpidem.
 Monitor for DDIs.
 Pts to be councelled by HCPs to avoid alcohol
and other CNS depressants while on zolpidem
treatment.
 Nurses to verify dose, while pharmacists perform
medication reconciliation to optimize and
enhance patient outcomes.
Complications
https://www.ncbi.nlm.nih.gov/books/NBK442008

12. Thank
you!
Please keep this slide for attribution