![]() 1 “Insomnia” generally refers to chronic insomnia, characterized by symptoms persisting for greater than one month with associated daytime dysfunction. Insomnia is a common type of sleep disorder that is defined by an ongoing difficulty initiating or maintaining sleep or nonrestorative sleep with subsequent daytime impairment. Decisions for whether or not to prescribe it and the dosage should be made on a case-by-case basis, considering both the psychical and psychiatric risks posed to the patient with insomnia versus if the patient were to take zolpidem to treat their condition. Even so, zolpidem could be a suitable pharmacological treatment for insomnia. The most concerning adverse effects, which are often the most publicized, include the complex behaviors that have been seen in patients taking Zolpidem, such as sleeping, hallucinations, increased suicidality, driving cars while asleep, and even a few cases of committing homicide. Still, zolpidem is considered a reasonable choice of therapy because it has a lower incidence of residual daytime sleepiness and risk of falls when compared to other drugs. When prescribed to elderly patients, the dose should be adjusted to account for their slower drug metabolism. Zolpidem is a helpful drug for the treatment of insomnia in conjunction with cognitive-behavioral therapy. Optimal therapy can aid patients in returning to baseline and increase their quality of life. Insomnia is linked to fatigue, distractibility, mood instability, decreased satisfaction, and overall decreased quality of life. The rate of congenital abnormalities was not significantly increased with zolpidem (0.48 vs 0.65% P = 0.329). ![]() In the mothers exposed to zolpidem, there was an increased incidence of low birth weight (OR = 1.39 P<0.001), preterm delivery (OR 1.49 P<0.001), small for gestational age (SGA) babies (OR = 1.34 P<0.001), and cesarean deliveries (OR =1.74 P<0.001). The FDA has classified zolpidem as a category C drug based on adverse outcomes seen in animal fetal development. Women had a non-significantly higher mean plasma concentration than men after 8 hours for the 10mg IR (28 vs. 20 ng/mL) and the 12.5mg MR (33 vs. 28ng/mL). Sleep onset latency has been demonstrated to be significantly increased on the first night after stopping zolpidem (13.0 minutes 95% CI 4.3-21.7 P<0.01). Rebound insomnia has been a concern to prescribers of zolpidem. Most cases have demonstrated that withdrawal seizures occurred in patients taking daily dosages of around 450-600mg/day, but some reported them as low as 160mg/day. There have been multiple cases reported of seizures following the withdrawal of zolpidem. Suicide attempts and completion have been successfully linked with zolpidem use (OR 2.08 95% CI 1.83-2.63) in patients regardless of the presence of comorbid psychiatric illness. A systematic review of 24 previous studies of sleepwalking associated with zolpidem demonstrated that the association was not dependent on age, dose, medical history, or even a history of sleepwalking at any time before zolpidem use. A case series of 119 inpatients aged 50 or older demonstrated that a majority (80.8%) of ADRs were central nervous system (CNS)-related such as confusion, dizziness, and daytime sleepiness. ![]() The relative risk (RR) for hip fractures in patients taking zolpidem was described as 1.92 (95% CI 1.65-2.24 P<0.001), with hip fractures being the most commonly seen. Zolpidem has been associated with an increased risk of falls in hospitalized patients with an OR of 4.28 (P <0.001) when prescribed short-term for insomnia. However, zolpidem has a wide variety of adverse effects and has some special considerations noted in the literature. One of the most used of these hypnotics is zolpidem. Non-benzodiazepine hypnotics such as zolpidem, eszopiclone, zaleplon are the most used as adjunctive treatment. The most effective therapies utilize cognitive behavioral therapy in conjunction with pharmacotherapy to minimize the needed dose and any resulting side effects. ![]() The treatment of insomnia should involve a multi-disciplinary approach, focusing on implementing behavioral interventions, improving sleep hygiene, managing psychological stressors, hypnotic treatment, and pharmacological therapy. Insomnia can significantly impact daytime functioning resulting in decreased workplace productivity, proneness to errors and accidents, inability to concentrate, frequent daytime naps, and poor quality of life. The sleep disturbances in insomnia usually manifest as difficulty in falling asleep, maintaining the continuity of sleep, or waking up too early in the morning well before the desired time, irrespective of the adequate circumstances to sleep every night. Insomnia is a common type of sleep disorder defined by an ongoing difficulty initiating or maintaining sleep or nonrestorative sleep with subsequent daytime impairment. ![]()
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |