zolpidem tartrate Nursing Considerations & Management

 Drug Name

Generic Name : zolpidem tartrate

Brand Name: Ambien, Ambien CR

Classification: Sedative or hypnotic (nonbarbiturate)

Pregnancy Category B (immediate-release)
Pregnancy Category C (extended-release)
Controlled Substance C-IV 

Dosage & Route

Available forms :Tablets—5, 10 mg; ER tablets—6.25, 12.5 mg

ADULTS
  • 10 mg PO at bedtime. Do not exceed 10 mg/day. ER tablets—12.5 mg/day PO.
PEDIATRIC PATIENTS
  • Safety and efficacy not established.
GERIATRIC PATIENTS
  • Increased chance of confusion, acute brain syndrome; initiate treatment with 5 mg PO or 6.25 mg/day PO ER tablets.
Therapeutic actions
  • Zolpidem acts by binding to the benzodiazepine (BZD) receptors of the GABA receptor complex. It has a selective affinity to BZD receptors prevalent in the cerebellum (omega-1 receptors). It has strong sedative actions but only minor anxiolytic properties. It has also less effects on skeletal muscle and seizure threshold. Zolpidem has a rapid onset but short duration of hypnotic action.
Indications
  • Short-term treatment of insomnia
  • Treatment of insomnia in adults who experience difficulties with sleep onset and sleep maintenance (ER tablets)
Adverse effects
  • Amnesia, drowsiness, dizziness, diarrhea, nausea, vomiting, abnormal thinking and behavior, drugged feelings, back pain, ataxia, hiccups, confusion, euphoria, insomnia, vertigo, diplopia, abnormal vision.
  • Potentially Fatal: Hepatitis, anaphylactic reactions, sleep-driving (driving while not fully awake after drug ingestion, with no recollection of the event).
Contraindications
  • Severe hepatic insufficiency.
Nursing considerations
Assessment
  • History: Hypersensitivity to zolpidem, acute intermittent porphyria, impaired hepatic or renal function, addiction-prone patients, lactation, pregnancy
  • Physical: T; skin color, lesions; orientation, affect, reflexes, vision examination; P, BP; bowel sounds, normal output, liver evaluation; CBC with differential; LFTs, renal function tests
Interventions
  • WARNING: Limit amount of drug dispensed to patients who are depressed or suicidal.
  • WARNING: Withdraw drug gradually if patient has used drug long-term or if patient has developed tolerance. Supportive therapy similar to that for withdrawal from barbiturates may be necessary to prevent dangerous withdrawal symptoms.
Teaching points
  • Take this drug exactly as prescribed. Do not exceed prescribed dosage. Long-term use is not recommended.
  • You may experience these side effects: Drowsiness, dizziness, blurred vision (avoid driving or performing tasks requiring alertness or visual acuity); GI upset (eat frequent small meals).
  • Report rash, sore throat, fever, bruising, complex sleep disorders.