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What is Zolpidem

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Zolpidem is a drug indicated for short-term use in the treatment of insomnia. Introduced into the market in 1992 by the FDA, the drug is marketed under the brand name Ambien; it acts by increasing the effect of GABA which is a neurotransmitter that brings about sleep.

The current research indicates that Zolpidem should be taken cautiously beyond one week to ten days because longer use can result in dependence and other complications.

Zolpidem is a drug mainly used to cure insomnia, a condition whereby an individual is unable to sleep or has difficulty maintaining sleep [1]. It is in a group of drugs known as sedative-hypnotics that cause the brain to slow down and help one to sleep. Zolpidem is usually used in the short term because its long-term use results in tolerance, dependence, and side effects.

Known by brand names such as Ambien, Zolpidem has become a popular treatment for sleep disorders, especially in patients experiencing short-term insomnia. It comes as regular and extended-release tablets and sometimes as sublingual tablets that dissolve under the tongue.

How Does Zolpidem Work

Zolpidem is a sedative-hypnotic drug that produces its therapeutic effects by increasing the effectiveness of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain [1]. Zolpidem works by attaching to GABA receptors and thus helps to quiet the brain and the muscles, allowing the individual to fall asleep. The immediate-release form of the drug is meant to put you to sleep, and the extended-release form is meant to keep you asleep.

The onset of action of Zolpidem is very quick, it takes approximately 30 minutes to show its effect and that is why it is used in the treatment of short-term insomnia [2]. But it is a good sleep aid, although its use has its dangers, especially if one abuses it or uses it for a long time.

Zolpidem is primarily FDA-approved for use in the management of insomnia specifically the short-term type. The drug is usually given to patients who have difficulty falling asleep at the start of the night (sleep-onset insomnia) or those who wake up in the middle of the night.

The extended-release dosage form is beneficial in ensuring that one stays asleep at night, especially for those with sleep maintenance issues.

Zolpidem is useful in the management of short-term insomnia but should not be used for chronic insomnia or long periods [2]. This is possible because the body is likely to build tolerance to the drug and hence reduce the effectiveness of the drug over time.

Also, the use of Zolpidem for an extended period leads to dependency and can cause side effects when the drug is discontinued.

Even though Zolpidem is normally used to treat insomnia, physicians sometimes prescribe it for other uses. Off-label use refers to the use of a drug or other treatment outside the terms of the manufacturer’s license but may be appropriate for particular patients in particular circumstances. Zolpidem is also used off-label to treat sleep disorders in patients with Parkinson’s disease because the drug improves sleep disturbances resulting from the disease.

In some cases, Zolpidem was used for minimally conscious patients to regain consciousness. Moreover, there are documented cases of patients who had shown short-lived gains in better awareness and communication skills when given Zolpidem. However, the efficacy of Zolpidem in these cases has not been fully explained and needs further studies.

The use of Zolpidem for off-label purposes should be taken under the prescription of a doctor because the benefit that is derived might be counterproductive. It can be abused, and even when used for the right reasons, it can be dangerous to one’s health.

Side Effects Of Zolpidem

Zolpidem, like any other drug, may produce side effects when taken. The usual side effects are usually not serious and may disappear as your body gets used to the drug.

Some of the most frequent side effects include:

Excessive daytime sleepiness and drowsiness
Dizziness or lightheadedness
Nausea or upset stomach
Fatigue or feeling sluggish
Headache
Dry mouth

These side effects are usually because Zolpidem reduces brain activity not only at night but also at times during the following day. These side effects can however be prevented and this can only be done by adhering to the correct dosage.

Some of the measures that may be taken to minimize the risk of the side effects include refraining from activities that demand full alertness for example driving soon after taking the drug.

Rare But Dangerous Side Effects Of Zolpidem

However, some patients may develop severe side effects while using Zolpidem. Even though they are not very frequent they can be dangerous and should not be ignored. Some of the more dangerous side effects include:

Sleepwalking or performing activities while asleep: Some people have said that they have been known to eat, walk, or even drive while not being completely awake after taking Zolpidem [2]. This is very risky because the person does not recall what happened to them when they wake up.

Memory loss or confusion: It is also known to affect memory, particularly the patient may have trouble remembering things that have happened recently especially when they have taken large doses of the drug.

Mood changes or depression: Some of the side effects that can be seen include; depression, anxiety, and even suicidal thoughts and tendencies especially when using Zolpidem [1]. Any such change in moods should however be dealt with by seeking the services of a doctor.

Allergic reactions: While this is quite a rare occurrence, some people may suffer anaphylaxis, which has symptoms that include swelling of the face, throat, or tongue, difficulty breathing, or hives. This needs the attention of a doctor.

The risk for such side effects is also heightened if one takes Zolpidem in quantities greater than that recommended or if he or she takes the medication with alcohol or other depressants. In case of severe side effects, the medication should be stopped and a doctor should be consulted.

Recent Studies On The Complications Of Zolpidem Use

Over the recent past, more efforts have been made to establish the risks that are associated with the use of Zolpidem. Research has revealed that using the drug in a long or large quantity can cause the user to develop some level of memory loss and lack of concentration. These dysfunctions are frequently not overt but can impact on the individual’s ability to perform activities of daily living, especially in the elderly.

In a study published in Sleep Medicine in 2021, the author determined that patients aged 65 and above who are using this drug are at high risk of falling and fracturing bones. The side effects of drowsiness together with other factors such as reduced muscle tone and coordination, common in the elderly, make the patients more prone to falls, especially at night when the drug is most likely to be active.

Another issue of interest is the possibility of the emergence of so-called “complex behaviors” during the use of Zolpidem. Some of the side effects include sleepwalking, sleep eating, and even sleep driving as has been identified in some research. These behaviors are dangerous not only for the person who takes the drug but also for other people around him or her.

Zolpidem And Long-Term Health Risks: What Research Says

Side effects of using Zolpidem are known to occur in the long term, and the most affected areas are the brain and mental health. The side effect of the medication includes the worsening of cognitive functions or dementia, particularly in the elderly. The researchers compared the groups of chronic Zolpidem users with those who used it for a short time; the Chronic users had more cognitive impairment.

Besides, studies have also pointed out possible neuropsychiatric adverse events, including worsening or induction of depression and anxiety. These side effects may worsen with time or when the drug is taken with other psychiatric drugs.

Specifically, certain research works have suggested that users of high doses of sedative-hypnotic drugs including Zolpidem are likely to develop cancer and may also die. However, Zolpidem has not been directly associated with cancer, this again raises the need to use the drug carefully and only when necessary for the shortest time possible.

How To Safely Take Zolpidem: Tips For Reducing Risks

To reduce the chances of side effects and other problems it is important to use Zolpidem correctly. To take Zolpidem safely, consider the following tips:

Follow the prescribed dosage: Do not take Zolpidem in larger or smaller amounts than prescribed by your doctor. Do not take more than the prescribed dose and do not take it more often than prescribed.

Take it right before bed: Zolpidem should not be taken if the patient is planning on being active and should be taken right before bedtime.

Avoid alcohol: When taken together with alcohol, Zolpidem can make the consumer more sedated, and can cause difficulty in coordination, and may result in engaging in unsafe practices such as sleepwalking [3].

Limit long-term use: Zolpidem is mainly used for short-term treatment of insomnia and therefore should not be used for long periods without consulting your doctor. This minimizes the chances of having tolerance, dependence, and cognitive impairments among the users of the product.

Inform your doctor of other medications: Zolpidem is known to have an additive effect when taken together with other drugs that affect the central nervous system including painkillers, anxiety medications, or antihistamines. It is always important to inform your doctor of any other medication you are taking.

What To Do When You Have Side Effects Of Zolpidem

If you have any side effects, no matter if they are the most frequent ones or the rarest ones, you should not neglect them.

Here are the steps you can take:

Mild side effects: The following day if you feel drowsy or dizzy, do not engage in tasks that demand complete focus such as driving. You can also tell your doctor whether taking a smaller amount of the drug would be sufficient for you.

Severe side effects: If you have sleepwalking, memory problems, or severe allergic reactions, stop using it and consult with a doctor. Some of the following symptoms may imply that you are not safe taking Zolpidem.

Talk to your doctor about alternatives: If you experience side effects with Zolpidem, or if they are severe or bothersome, talk to your doctor about other medications. Cognitive behavioral therapy for insomnia (CBT-I) and changes in behavior are useful complementary approaches for the treatment of insomnia rather than taking medication.

Recommendations On Zolpidem Use

It is noteworthy that for the treatment with Zolpidem, strict recommendations are followed by the physicians to minimize the risk for the patients.

Most doctors advise that the lowest possible dose should be taken for the shortest possible time to avoid side effects, developing tolerance, and dependence. The maximum recommended course of Zolpidem is two to four weeks; however, the specific duration may be adjusted according to the specific patient.

The patient is also screened for the following: A history of substance abuse, a history of mental health disorders, and the use of other medications that may likely cause an interaction with the Zolpidem. In cases of long-term treatment of insomnia, some doctors may prescribe alternative treatments such as non-pharmacological or other drugs with relatively low-risk profiles.

How Doctors Track Zolpidem Side Effects And Patient Health

When a patient is put on Zolpidem, a close follow-up is always made to see if the patient is benefiting from the drug or if they are having adverse effects on the body.

This monitoring process includes:

Regular follow-up appointments: When seeing the patient during the follow-up, the doctor checks if the patient has noticed an improvement in sleep and if there are any side effects or issues. In case of need, the dosage may be changed or the type of treatment may be switched to another one.

Assessing mental and physical health: As Zolpidem has an impact on cognitive and mental health, doctors need to monitor memory loss, changes in mood, or any other cognitive problem. Further, if side effects are experienced they may lower the dose or advise the patient to stop the medication.

Evaluation for dependence: Physicians are also on the lookout for symptoms of addiction; for instance, if the patient needs more of the drug or if the patient cannot sleep without it. In such cases, it may be advisable for the patient’s dose to be gradually reduced, or for a change to be made to non-pharmacological treatments.

The doctors also stress the fact that Zolpidem should be used in the correct dosage and only as recommended by the doctor and if patients are informed about the dangers of using Zolpidem for lengthy periods or in large amounts. They may also help patients to make changes in their daily routine and regress to better sleep to increase the efficacy of the treatment.

Can Zolpidem Cause Dependence

The side effect that is most commonly reported with Zolpidem is drug dependence. Although Zolpidem is believed to be safer than some of the older sedatives for instance benzodiazepine dependence is observable through long-term use of the drug.

It refers to a condition in which the body is compelled to use the drug and the consumer cannot sleep without it. In the long run, the person may require the use of more resources to get the same results or even get irrelevant results with the same resources, a situation known as tolerance. This cycle of raising the dosage to keep the drug effective creates a form of dependence on the drug.

Physical dependence may also develop when the user feels that he cannot sleep or get relief without using Zolpidem. This can be a major problem for patients with chronic insomnia as it may be the only way they can get enough rest and perform their daily activities.

Warning Signs Of Zolpidem Addiction

Though dependence is more likely a side effect of Zolpidem, addiction is also possible when the drug is abused or taken for a long time. Addiction is characterized by the drug user’s inability to quit using the drug even when there are adverse effects on his or her health, family, or work.

Some warning signs of Zolpidem addiction include:

Increased tolerance: These include; The patient requiring higher quantities of the sedative to produce the desired effects or the use of Zolpidem beyond the recommended frequency.

Difficulty stopping use: Having the sensation that you cannot stop or decrease the use even if you wish to, and having anxiousness or rage if you try.

Craving the drug: Desiring to take Zolpidem a lot of the time, particularly during stressful times or when one has no time to sleep.

Using Zolpidem for non-medical reasons: Using the medication for purposes other than the management of sleep for instance to soothe, calm, or escape stress.

Withdrawal symptoms: Feeling annoyed, sick to the stomach, having difficulty falling asleep again, or shaking when not taking Zolpidem.

If someone is demonstrating symptoms of addiction or dependence, then it is necessary to get help from a specialist. The doctors can suggest the following; gradually reducing the dosage to avoid withdrawal symptoms or referring the patient to a therapist to address the sleep problems without having to take medication.

1. Medline Plus. Zolpidem. https://medlineplus.gov/druginfo/meds/a693025.html

2. Web MD. Zolpidem TARTRATE – Uses, Side Effects, and More. https://www.webmd.com/drugs/2/drug-8862-8110/zolpidem-oral/zolpidem-oral/details

3. Cleveland Clinic. Zolpidem Tablets. https://my.clevelandclinic.org/health/drugs/20871-zolpidem-tablets

FAQs

What Are The Side Effects Of Zolpidem 10 Mg Compared To Lower Doses?

Zolpidem 10 mg is quite a high dose and is usually prescribed for those patients, who failed to respond to the 5 mg medicine. The side effects of Zolpidem 10 mg are generally more pronounced and may include:
Feeling more tired or sleepy than usual
Higher probability of dizziness or fainting
Greater memory loss such as inability to focus or getting easily confused
It also poses a risk to certain sleep-related activities like sleepwalking and sleep eating.
This is because Zolpidem 10 mg has much stronger sedative effects which means that it should only be taken as recommended and for a short period to avoid building tolerance or suffering other complications.

Can Zolpidem Cause Next-Day Side Effects Like Drowsiness Or Impaired Alertness?

Yes, Zolpidem may cause next-day grogginess, and this is especially true for patients who take large doses or those who take the extended-release form. Common next-day side effects include:
Feeling sleepy or having a heavy head
Lack of coordination and reduced speed of responding poses a great risk while driving or using machinery.
Trouble focusing or having a cloudy mind
Continued feeling of dizziness or of being unsteady on one’s feet.
These side effects are common when the drug is not eliminated by the time the patient wakes up, particularly if the patient has not slept for 7-8 hours.

Does Zolpidem Cause Memory Loss Or Transient Amnesia

Yes, amnesia or memory loss may be a side effect of Zolpidem especially if the drug is taken at the wrong time. Others may have problems remembering what took place during the time of use, especially if they are awake for a while after use.
This is more so especially if the patient combines Zolpidem with alcohol or other sedatives or even if the patient takes the drug and continues to engage in other activities. On the extreme, people may wake up one morning and cannot recall what they did the previous day, whether they took a bath, ate, or drove a car.

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