Zolpidem

What is Zolpidem?

Zolpidem is a Prescription Only Medicine widely used for the short-term treatment of insomnia. It is primarily prescribed to help patients who experience difficulty with sleep initiation, allowing them to fall asleep more quickly.

As a non-benzodiazepine hypnotic, commonly referred to as a 'Z-drug', zolpidem differs from traditional benzodiazepines by selectively targeting the alpha-1 subunit of the GABA-A receptor. This specialized chemical synthesis provides strong sedative properties with fewer muscle-relaxant or anti-anxiety effects compared to older sedative classes.

Generic Names:

• Zolpidem: The standard generic name utilized globally for this hypnotic agent.

Global Brand Names:

Zolpidem is distributed under several brand names globally and in Hong Kong:

• Stilnox (思諾思): The primary brand of Zolpidem available in Hong Kong hospitals and private clinics.
• Zolnoxs: A generic version manufactured by Actavis available in the Hong Kong market.
• Zoldem: A locally available generic brand in Hong Kong.

These names all refer to the same medication. It's important to note that while the active ingredient is the same, different countries may have different regulations and available medication formulations.

What is Zolpidem used for?

Zolpidem is used to relieve:

• Difficulty falling asleep (sleep-onset insomnia)
• Short-term insomnia

How do you use Zolpidem?

Availability:

• Immediate-release tablets (5mg and 10mg)
• Extended-release tablets

Dosage Information:

• Adult Men: 5mg to 10mg taken once daily immediately before bedtime.
• Adult Women: 5mg taken once daily immediately before bedtime.
• Elderly: 5mg taken once daily to minimize risks of dizziness and falls.

Suitability:

• Adults: Yes, for short-term use.
• Elderly: Yes, with caution and lower starting doses.
• Children and Infants: No, not recommended.

Who cannot take Zolpidem?

Allergies and unsuitability:

• Rare, but possible severe allergic reactions such as anaphylaxis.

Conditions where the drug should not be used:

• Severe hepatic insufficiency
• Acute or severe respiratory insufficiency (e.g., sleep apnea, COPD)
• Myasthenia gravis
• History of complex sleep behaviors after taking zolpidem
• Known hypersensitivity to zolpidem

Common side effects of zolpidem include dizziness, daytime drowsiness, headaches, nausea, diarrhea, and a lingering 'drugged' feeling. Some individuals may also experience a bitter or metallic taste. Higher doses increase the likelihood of next-day mental and motor impairment, which can affect driving and alertness even if the person feels fully awake.

Severe adverse reactions require immediate attention, notably complex sleep behaviors where patients engage in activities like sleep-walking or sleep-driving without memory of the event. Other rare but serious risks include anaphylaxis, hallucinations, agitation, and an increased risk of physical or psychological dependence if used beyond the recommended short-term duration.

• Do not consume alcohol while using this medication to prevent extreme sedation and respiratory depression.
• Avoid other central nervous system depressants, opioids, and anti-anxiety medications to reduce the risk of severe respiratory depression.
• Take immediately before bedtime and ensure a full 7 to 8 hours of sleep to minimize next-day cognitive impairment.
• Do not exceed the prescribed dose or duration to avoid physical and psychological dependence.
• Do not stop abruptly after prolonged use to prevent withdrawal symptoms such as tremors and rebound insomnia.
• Check with a doctor if you are prescribed CYP3A4 inhibitors like ketoconazole or inducers like rifampin, as they alter zolpidem blood levels.
• Avoid taking zolpidem with or immediately after a heavy meal to prevent delayed onset of sleep.

Storage information:

• Store at controlled room temperature between 20°C and 25°C.
• Keep the medication in its original blister pack or container to protect it from light and moisture.
• Keep out of reach of children and store securely to prevent misuse or theft.

Handling instructions:

• Swallow the tablet whole with a glass of water.
• Do not crush or chew extended-release formulations.
• Take the dose right before getting into bed, not earlier in the evening.

Where is Zolpidem available in Hong Kong?

Zolpidem is classified as a Prescription Only Medicine in Hong Kong. It is tightly regulated under the Pharmacy and Poisons Ordinance due to its effects on the central nervous system.

To obtain zolpidem, patients must present a valid prescription from a registered doctor. It can be purchased at registered dispensaries and pharmacies displaying the "Rx" logo, or dispensed directly at hospitals and private medical clinics.