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Getting sound sleep is very much important for relaxing our mind and brain, and amid this lockdown, it has become a serious concern among the general population.
Zolpidem commonly sold under the Proprietary/ brand name of Ambien.

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Basically, Ambien is widely used for treating those who face difficulty in falling asleep or other sleep problems Zolpidem belongs to a group known as Sedative-Hypnotics classified under the class- non-benzodiazepine. Zolpidem being structurally a non-benzodiazepine, also have an agonist affect on the benzodiazepine receptors which imparts it a hypnotic effect. So, in this article we are going to cover each and every point that’s important for one to know who is going to take Ambien or on Ambien therapy, under the following headings:

Table of Contents
o Why is Ambien prescribed?-Ambien Uses:
o How Ambien Works? -Mechanism of action:
o Mode of administration:
o What is the direction of Usage:
o What is the Safe Dose for Ambien?-Dosage:
o What are the Side effects of Ambien?

 Common side-effects:
 Rare side effects:

o What are the Drug interactions related to Ambien?
o When one should not take Ambien?- Contraindications:
o What Precautions should be taken while taking Ambien?
o In case of Ambien Emergency/overdose:
o What are Available brands/Alternatives of Ambien?

o FREQUENTLY ASKED QUESTIONS FOR AMBIEN:

o Q1. Can I take Ambien without Prescription?
o Q2. Are there any OTC(over-the-counter) sleep medications that I can have?
o Q3. Can I drive after consuming it?
o Q4. What should I do if I forget a dose?
o Q5. Is Ambien an Addictive drug?
o Q6. Are there any special Dietary instructions?
o Q7. What should I know about storage and disposal of this medication?
o Q8. What to do if I consumed Expired Medication?

Why is Ambien prescribed?-Ambien Uses:
Ambien is prescribed to individuals with sleep disorders (Insomnia) like -difficulty in falling asleep fast or not able to have a sound sleep. Ambien may also be prescribed by your physician if you are undergoing Cognitive Behavioral therapy. – as it promotes sleep and gives time for your body for proper rest thus reducing anxiety and other psychological symptoms.

How Ambien Works? -Mechanism of action:

Its hypnotic effects mainly help in- decreasing the sleep latency (the time required to fall asleep) and also it prolongs the duration of sleep in insomniacs.

Advantages of Zolpidem over Benzodiazepine:

 It produces sleep like BZD but does not affect REM sleep.
 It causes a minimal hangover and rebound insomnia.
 It is less likely to produce tolerant and drug dependence.
 Also anticonvulsant, muscle relaxant and antianxiety effects are not that evidently reported.

Being a non-BZD hypnotics it acts selectively on alpha-1 subunit-containing benzodiazepine receptors and produces effects like hypnosis and amnesia.

What are the modes of administrations?

Ambien is available as
Tablets: Ambien 5mg/10mg Tablets.
Extended release tablets: Ambien CR

What is the direction of Usage?

Oral– Tablet/capsules should be administered as a whole, it should not be crushed/split/dissolved/chewed. Anyone who is taking the medication is strongly advised to take it accordingly as prescribed. Generally, it is prescribed as one tablet is taken orally at night before going to sleep. It should be kept in mind that one should take it before 7-8 hrs. before awakening. It is found that Ambien is taken on an empty stomach or after a meal or as directed by your physician/pharmacist. Its absorption increases when it is is taken with food. What is the Safe Dose for Ambien?-Dosage:
Depending upon the age/ gender/ severity/ requirement as prescribed by your physician.
One should start with the lowest effective dose. That is, if one does not respond to 5mg then only the dose should be increased to 10mg. But do not take more than 10 mg per day. Further, they should not be used for more than 1 to 2 weeks. Due to their shorter duration of action, they are being preferred over BZDs for the short-term treatment of insomnia. Thus Non-benzodiazepine like Zolpidem has lower abuse potential than hypnotic BZDs.

What are the Side effects of Ambien?

Common side-effects:
 Dizziness
 Drowsiness
 Headache
 Nausea/ vomiting

NOTE: Every medicine have some or the other side effects due to its action on the body but this does not mean it will harm you or be fatal to your body, keep in mind that your doctor knows that its benefits are much more than its the risk of its side effects. Remember these are mild side effect which goes easily as soon as the medication course completes.

Rare side effects:
 Memory loss/unable to recall things.
 Depression
 Hallucinations
 Confusion

 Agitation
 Anxiety

NOTE: If you show some side effects given below you should IMMEDIATELY consult your doctor.

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What are the Drug interactions related to Ambien?

Absorption and metabolism of any drug affected by the presence of other pharmacological agents. That’s why it’s important to take complete- drug history of the patient.

Ambien Interactions with other drugs [CAUTION]:
Opioids: Zolpidem when given with Opioids can cause Psychological Dependence. Use of opioids with zolpidem can increase the risk of respiratory depression and can result into death.
Anti-fungal Drugs: Certain medications like Anti-fungal agents increase the excretion of Zolpidem from the body so they can lower the effectiveness of the dose.
Other agents: They should not be given with other agents/drugs like-codeine/hydrocodone/antihistamines, etc as they both give a cumulative CNS suppressing effect.
>Ambien Interactions with Alcohol[UNSAFE]: Drinking alcohol with ongoing Ambien medication will lead to serious other complications as alcohol and Ambien both are CNS depressants which will further decrease the brain activity to such an extent that may result dangerous health problems like- excessive sleepiness, seizures, in severe cases of overdose coma, death may occur.
>Ambien Interactions with Food [SAFE]: Ambien can be taken with food, does not have a significant effect on Ambien pharmacotherapy.
When one should not take Ambien?-
Contraindications:
In following conditions Ambien should be avoided:
Driving/Operating heavy machinery: As it alters the consciousness and the alertness of the brain thus during activities which require a high level of alertness it may give rise to accident or casualties.
Alcohol addicts: Intake of alcohol with Ambien will lead to severe dizziness or drowsiness and other health complications as stated above.
Past history of Suicide and Depression– In patients with past history of Suicidal attempts/depression Ambien should be used cautiously only under professional guidance.
Liver diseases: As Zolpidem is metabolized in the liver so persons with serious liver disease should avoid intake of Ambien.
Kidney diseases: Zolpidem is mainly excreted by Kidneys so it should avoided in persons with acute/chronic kidney diseases.
What Precautions should be taken while taking Ambien?
Take Extra care of yourself: Depending upon the dose and metabolism of the drug by your body it should be kept in mind that there may be chances that you may feel drowsy/dizzy even after taking complete rest. So, be extra cautious of yourself to prevent a fall.
Diet: Consume proper diet and plenty of water so as to prevent symptoms like-dry mouth or throat. We all know that a healthy diet with proper nutrients will help us to have a sound sleep.

Previous Drug history: Always inform the physician about the complete history of medications that you are taking, so you can avoid any unwanted effects from drug interaction.
Take Proper 7-8Hrs of Sleep: It is advised to take it 8 to 10 hrs. before involving in any kind of activity which require a high level of alertness like driving/operating heavy machinery.

In Older Adults Population- with various other co-morbid conditions like- kidney, liver, breathing problems or any psychological disorders are more prone to its side effects.
Contact your doctor immediately: If you show any of the severe symptoms stated above.
Take doses as directed by the physician: Only one tablet should be taken that too in the night. Avoid over dosage of Ambien.
In case of Ambien Emergency/overdose:
Normal maximum dosage:
Should not exceed 10 mg per day.
Symptoms of Ambien overdose:

Symptoms can be physiological as well as Psychological like-
Sleepiness, shallow breathing, confusion feeling light-headed, fainting, or coma.

What to do if you overdose on Ambien?

In case of emergency/overdose use of certain drugs should be done which reverses their action. BZD antagonist example-flumazenil can reverse their action thus can be used to treat their overdose/toxicity.
Along with it, you should also inform your family members, or someone who is frequently around (caregiver), that if they observe any unusual symptoms of overdose they can follow the emergency protocols, should call for medical help and until the help arrives under the medical guidance can give you at least a dose flumazenil so as it can save you from serious health problems.
What is Available brands/Alternatives of Ambien?
 Edluar
 Intermezzo
 Zolsleep
 Zolfresh
 Zolpimist
 Ambulax Z
 Zolly

FREQUENTLY ASKED QUESTIONS FOR AMBIEN:

Q1. Can I take Ambien without Prescription?
A. Ideally, Ambien should not be taken without the prescription of a doctor.

Q2. Are there any OTC (over-the-counter) sleep medications that I can have?

A. Yes, there are some OTC sleep aids that can help you fall asleep and stay asleep with a minimum of side effects.

 1. Kirkland Sleep Aid
 2. Unisom Sleep Gels
 3. Natrol Melatonin
 4. Luna Natural Sleep Aid
It should be kept in mind that these should not be taken for a long period of time.

Q3. Can I drive after consuming it?
A. No, Ambien has a suppressing effect on the brain activity and cause drowsiness so driving, operating heavy machinery or any other work which requires high alertness or has the risk of casualties should be completely avoided.

Q4. What should I do if I forget a dose?
A.Generally, as it is taken before bed there are fewer chances of missed dose but if you missed the dose you should have 7-8 hrs minimum for rest till its effect last. Otherwise should take it on the next scheduled time.

Q5. Is Ambien an Addictive drug?
A. Long term use of Ambien may show some dependence so it is advised that it should be taken not more than 2 weeks.

Q6. Are there any special Dietary instructions?
A. No, there are no such special dietary instructions unless mentioned by your doctor/pharmacist. But having proper food and water in the diet will naturally promote your sleep.

Q7. What should I know about storage and disposal of this medication?
 Store in a cool and dry place away from moisture, do not refrigerate it, and keep out of reach of children.
 Expired and unused medications should be disposed of carefully so as it is not consumed by pets or other children
accidentally.
 For proper disposal, you can also contact you nearby pharmacist or read about the disposal method given by U.S F.D.A.

Q8. What to do if I consumed Expired Medication?
A. Consuming a single dose of Ambien will not affect an individual that much, but if you develop any hypersensitivity reaction immediately contact your doctor.

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