Drug reference
Insomnia (short-term use) ▶BY MOUTH ▶Adult: 10 mg daily for up to 4 weeks, dose to be taken at bedtime, for debilitated patients, use elderly dose ▶Elderly: 5 mg daily for up to 4 weeks, dose to be taken at bedtime
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Acute respiratory depression. marked neuromuscular respiratory weakness. obstructive sleep apnoea. psychotic illness. severe respiratory depression. unstable myasthenia gravis
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Avoid prolonged use (and abrupt withdrawal thereafter). depression. elderly. history of alcohol abuse. history of drug abuse. muscle weakness. myasthenia gravis CAUTIONS, FURTHER INFORMATION ▶Elderly For hypnotic Z-drugs, prescription potentially inappropriate (STOPP criteria) in elderly (may cause protracted daytime sedation and/or ataxia). See also Prescribing in the elderly p. 33.
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NICE decisions ▶Guidance on the use of zaleplon, zolpidem, and zopiclone for the short-term management of insomnia (April 2004) NICE TA77 Zolpidem is recommended for the short-term management of severe insomnia that interferes with normal daily life, and should be prescribed for short periods of time only. www.nice.org.uk/guidance/ta77
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→Appendix 1: zolpidem
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▶Common or very common Abdominal pain. anterograde amnesia. anxiety. back pain. diarrhoea. dizziness. fatigue . hallucination. headache. increased risk of infection. nausea. sleep disorders. vomiting ▶Uncommon Confusion. diplopia. irritability ▶Frequency not known Angioedema. behaviour abnormal. concentration impaired. delusions. depression. drug dependence. fall. gait abnormal. hepatic disorders. hyperhidrosis. level of consciousness decreased. libido disorder. muscle weakness. psychosis. respiratory depression. skin reactions. speech disorder. withdrawal syndrome
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Avoid regular use (risk of neonatal withdrawal symptoms); high doses during late pregnancy or labour may cause neonatal hypothermia, hypotonia, and respiratory depression.
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Small amounts present in milk—avoid.
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Manufacturer advises caution in mild to moderate impairment (risk of decreased clearance); avoid in severe impairment. Dose adjustments Manufacturer advises initial dose reduction to 5 mg daily in mild to moderate impairment.
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Use with caution.
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There can be variation in the licensing of different medicines containing the same drug. Tablet CAUTIONARY AND ADVISORY LABELS 19 ▶Zolpidem tartrate (Non-proprietary) Zolpidem tartrate 5 mg Zolpidem 5mg tablets | 28 tablet P £3.08 DT = £2.90 d Zolpidem tartrate 10 mg Zolpidem 10mg tablets | 28 tablet P £4.48 DT = £1.52 d ▶Stilnoct (Sanofi) Zolpidem tartrate 5 mg Stilnoct 5mg tablets | 28 tablet P £1.10 DT = £2.90 d Zolpidem tartrate 10 mg Stilnoct 10mg tablets | 28 tablet P £1.00 DT = £1.52 d
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Driving and skilled tasks Drowsiness may persist the next day—leave at least 8 hours between taking zolpidem and performing skilled tasks (e.g. driving, or operating machinery); effects of alcohol and other CNS depressants enhanced.
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10 mg daily for up to 4 weeks, dose to be taken at
First-line fragment. Read the complete Indications and Dose section above.
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