Zolpidem 82626-48-0

Indications

Insomnia

Zolpidem is approved for the short-term (usually about two to six weeks) treatment of insomnia, and it has been studied for nightly use up to six months in a single-blind trial published in 1991, an open-label study lasting 180 days published in 1992 (with continued efficacy in patients who had kept taking it as of 180 days after the end of the trial), and in an open-label trial lasting 179 days published in 1993. Zolpidem has not proven effective in maintaining sleep and is more used for sleep initiation problems.

Brain injury

A case study performed at the Toulouse University Hospital using PET showed zolpidem repeatably improves brain function and mobility of a patient immobilized by akinetic mutism caused by hypoxia. Recently, zolpidem has been cited in various medical reports mainly in the United Kingdom as waking persistent vegetative state (PVS) patients, and dramatically improving the conditions of people with brain injuries. It may be that zolpidem's ability to stimulate the brain, particularly in the semi-comatose, may be related to one of its side-effects, which sometimes causes sleepwalking and other activity while asleep, that appears to observers to be fully conscious activity.

Miscellaneous off-label

Zolpidem is also used off-label to treat restless leg syndrome and as an antiemetic. As is the case with many prescription sedative/hypnotic drugs, it is sometimes used by stimulant users to "come down" after the use of stimulants such as amphetamines, methamphetamine, cocaine, and MDMA (ecstasy).

Side effects

Side-effects at any dose may include:

• Anterograde amnesia
• Hallucinations, through all physical senses, of varying intensity
• Delusions
• Altered thought patterns
• Ataxia or poor motor coordination, difficulty maintaining balance
• Euphoria and/or dysphoria
• Increased appetite
• Decreased libido
• Amnesia
• Impaired judgment and reasoning
• Uninhibited extroversion in social or interpersonal settings
• Increased impulsivity
• When stopped, rebound insomnia may occur
• Headaches in some people
• Short term memory loss

Some users take zolpidem recreationally for some of these side-effects, notably sedation, hallucinations and euphoria. Zolpidem becomes addictive if taken for extended periods of time, due to drug tolerance and physical dependence or the euphoria it can sometimes produce. Under the influence of the drug, patients may take more zolpidem than is necessary, due to either forgetting that one has already taken a pill (elderly users are particularly at risk here) or knowingly taking more than the prescribed dosage. The release of AmbienCR (zolpidem tartrate extended release) in the United States renewed interest in the drug among recreational drug users. Some users have reported unexplained sleepwalking while using zolpidem, and a few have reported driving, binge eating, sleep talking, and performing other daily tasks while sleeping. Research by Australia's National Prescribing Service found that these events mostly occur after the first dosage taken or within a few days of starting therapy. Rare reports of sexual parasomnia episodes related to zolpidem intake have also been reported. The sleepwalker can sometimes perform these tasks as normally as they might if they were awake. They can sometimes carry on complex conversations and respond appropriately to questions or statements so much so that the observer may believe the sleepwalker to be awake. This is similar to, but unlike, typical sleep talking, which can usually be identified easily and is characterised by incoherent speech that often has no relevance to the situation or that is so disorganised as to be completely unintelligible. A person under the influence of this medication may seem fully aware of their environment even though they are still asleep. This can bring about concerns for the safety of the sleepwalker and others. These side-effects may be related to the mechanism that also causes zolpidem to produce its hypnotic properties. It is unclear whether the drug is responsible for the behavior, but a class-action lawsuit was filed against Sanofi-Aventis in March 2006 on behalf of those that reported symptoms. Residual 'hangover' effects such as sleepiness, impaired psychomotor and cognitive after nighttime administration may persist into the next day which may impair the ability of users to drive safely, increase risks of falls and hip fractures. The Sydney Morning Herald in Australia reported in 2007 that a man who fell 30 meters to his death from a high-rise unit balcony may have been sleepwalking under the influence of Stilnox. The coverage prompted over 40 readers to contact the newspaper with their own accounts of Stilnox-related automatism, and {{as of

March 2007

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