Long-term zolpidem

Monti JM, Monti D, Estevez F, Giusti M (1996) Sleep in patients with chronic primary insomnia during long-term zolpidem administration and after its withdrawal. Int Clin Psychopharmacol 11 255-263... 

Petursson H, Lader MH Benzodiazepine dependence. BrJ Addict 76 133—143,1981a Petursson H, Lader MH Withdrawal from long-term benzodiazepine treatment. Br Med J (Clin Res Ed) 283 643—643, 1981b Pichard L, Gillet G, Bonfils C, et al Oxidative metabolism of zolpidem by human liver... 

Walker BM, Ettenberg A The effects of alprazolam on conditioned place preferences produced by intravenous heroin. Pharmacol Biochem Behav 75 75 80, 2003 Weens EM, Griffiths RR Zolpidem self-injection with concurrent physical dependence under conditions of long-term continuous availability in baboons. Behav Pharmacol 9 285—297, 1998... 

One principal difference between the medications is half-life, that is, the time required to metabolize 50% of the compound present in the body. Zolpidem has a half-life of 1.4-4.5 honrs, zaleplon has a half-life of 0.9-1.1 hours, and eszopiclone has a half-life of abont 6 honrs. The key is the markedly shorter half-lives that are displayed by many other sedative-hypnotics, as shown in Eigure 9.1. Only eszopiclone has been shown effective for the long-term (np to 6 months) treatment of chronic insomnia. 

Do not abruptly stop zolpidem after long-term use... 

Differences in the development of tolerance and the occurrence of rebound insomnia have been well established with rapidly versus slowly eliminated BZD hypnotics. A meta-analysis of sleep laboratory studies has recently shown that tolerance with intermediate and long-term use clearly developed with triazolam but only marginally with midazolam and zolpidem. Rebound insomnia on the first withdrawal night was intense with triazolam and mild with zolpidem. The data led to the... 

Perlis ML, McCall WV, Krystal AD, Walsh JK (2004) Long-term, non-nightly administration of zolpidem in the treatment of patients with primary insomnia. J Clin Psychiatry 65 1128-1137... 

Several studies have evaluated the usefulness of zolpidem in facilitating withdrawal from long-term benzodiazepine use (e.g., [43, 44]). It appears that most patients on long-term hypnotics can be transferred to zolpidem and that the subsequent withdrawal from zolpidem is much easier. By and large, such strategies should only be resorted to if simple tapering of the benzodiazepine dosage has proven unsuccessful. 

Schlich D, L Heritier C, Coquelin JP, Attali P, Kryrein HJ (1991) Long-term treatment of insomnia with zolpidem a multicentre general practitioner study of 107 patients. J Int Med Res 19 271-279... 

Allain H, Rahola JG (1996) Switching to zolpidem in patients habituated to long-term benzodiazepine use. In H Freeman, AJ Puech, T Roth (eds) Zolpidem an update of its pharmacological properties and therapeutic place in the management of insomnia. Elsevier, Paris, 176-182... 

Diazepam is better indicated if insomnia is associated with daytime anxiety. Other benzodiazepines prescribed for insomnia include nitrazepam, flur-azepam, loprazolam, lormetazepam and temazepam. The non-benzodiazepine hypnotics zaleplon, zolpidem and zopiclone are not licensed for long-term use. The sedative antipsychotic promethazine hydrochloride is sometimes used to facilitate sleep, with a 25-50 mg recommended dose. Melatonin has proved effective for some clients, mostly in regulating the sleep/waking cycle. Although evidence of efficacy is limited, some clients use herbs such as valerian and chamomile. If Mr AB will finally be diagnosed with depression, a trial with an antidepressant will be indicated. 

Long-term adaptations of zolpidem not well studied, but chronic studies of other alpha 1 selective non-benzodiazepine hypnotics suggest lack of notable tolerance or dependence developing overtime... 

Long-term effects of zolpidem in children/adolescents are unknown... 

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