Zolpidem

Cases of recovery from vegetative and minimally conscious state after the administration of various pharmacological agents have been recently reported. These agents include CNS depressants (zolpidem, baclofen, lamotrigine) and CNS stimulants (tricyclic anti-depressants, selective serotonin reuptake inhibitors, dopaminergic agents, methylphenidate). The action of CNS depressants as awakening agents sounds paradoxical, as they are commonly prescribed to slow down brain activity in the management of anxiety, muscle tension, pain, insomnia and seizures. How these drugs may improve the level of consciousness in some brain-injured patients is the subject of intense debate. Here we hypothesize that CNS depressants may promote consciousness recovery by reversing a condition of GABA impairment in the injured brain, restoring the normal ratio between synaptic excitation and inhibition, which is the prerequisite for any transition from a resting state to goal-oriented activities (GABA impairment hypothesis). Alternative or complementary mechanisms underlying the improvement of consciousness may include the reversal of a neurodormant state within areas affected by diaschisis (diaschisis hypothesis) and the modulation of an informative overload to the cortex as a consequence of filter failure in the injured brain (informative overload hypothesis). A better understanding of how single agents act on neural networks, whose functioning is critical for recovery, may help to advance a tailored pharmacological approach in the treatment of severely brain injured patients.

Cognitive behavioral therapy (CBT) and hypnotic medications are efficacious for short-term treatment of insomnia, but few patients achieve complete remission with any single treatment. It is unclear whether combined or maintenance therapies would enhance outcome.
To evaluate the added value of medication over CBT alone for acute treatment of insomnia and the effects of maintenance therapies on long-term outcome.
Prospective, randomized controlled trial involving 2-stage therapy for 160 adults with persistent insomnia treated at a university hospital sleep center in Canada between January 2002 and April 2005.
Participants received CBT alone or CBT plus 10 mg/d (taken at bedtime) of zolpidem for an initial 6-week therapy, followed by extended 6-month therapy. Patients initially treated with CBT attended monthly maintenance CBT for 6 months or received no additional treatment and those initially treated with combined therapy (CBT plus 10 mg/d of zolpidem) continued with CBT plus intermittent use of zolpidem or CBT only.
Sleep onset latency, time awake after sleep onset, total sleep time, and sleep efficiency derived from daily diaries (primary outcomes); treatment response and remission rates derived from the Insomnia Severity Index (secondary outcomes).
Cognitive behavioral therapy used singly or in combination with zolpidem produced significant improvements in sleep latency, time awake after sleep onset, and sleep efficiency during initial therapy (all P<.001); a larger increase of sleep time was obtained with the combined approach (P = .04). Both CBT alone and CBT plus zolpidem produced similar rates of treatment responders (60% [45/75] vs 61% [45/74], respectively; P = .84) and treatment remissions (39% [29/75] vs 44% [33/74], respectively; P = .52) with the 6-week acute treatment, but combined therapy produced a higher remission rate compared with CBT alone during the 6-month extended therapy phase and the 6-month follow-up period (56% [43/74 and 32/59] vs 43% [34/75 and 28/68]; P = .05). The best long-term outcome was obtained with patients treated with combined therapy initially, followed by CBT alone, as evidenced by higher remission rates at the 6-month follow-up compared with patients who continued to take zolpidem during extended therapy (68% [20/30] vs 42% [12/29]; P = .04).
In patients with persistent insomnia, the addition of medication to CBT produced added benefits during acute therapy, but long-term outcome was optimized when medication is discontinued during maintenance CBT.
clinicaltrials.gov Identifier: NCT00042146.

A single 10 mg dose of zolpidem, an imidazopyridine hypnotic, was administered to young, healthy male volunteers prior to bedtime. The drug reduced REM sleep but did not significantly affect other sleep stages and subjective sleep parameters. All-night spectral analysis of the EEG revealed that power density in nonREM sleep was reduced in the low-frequency range (1.25–2.5 Hz; 5.25–10.0 Hz) and increased in the spindle frequency range (12.25–13.0 Hz). Significant changes in the EEG spectrum were present in the first 4 h of sleep. The pattern of the spectral changes was similar to those induced by other hypnotics that bind to the GABAA/benzodiazepine receptor complex. There were no residual effects of zolpidem on psychomotor performance in the morning, on the self-rated state in the morning and at noon, and on sleep and EEG parameters in the subsequent drug-free night.

Introduction: Patients with cancer may have many complications involving their
psychosomatic systems, such as sleep disturbance, depression, and anxiety. Thus, many
research studies were conducted to reduce these complications. Zolpidem, as a short-term
non-benzodiazepine treatment of insomnia, and melatonin as a chronobiological functionregulatory hormone, are commonly used for improving sleep quality. This randomized clinical
trial aims to compare the effects of zolpidem and melatonin on sleep quality, depression, and
anxiety in patients with colorectal cancer.
Methods: In this single-blinded trial, 90 patients with colorectal cancer undergoing
chemotherapy who had obtained a score of 5 or higher on the Pittsburgh Sleep Quality Index
(PSQI) were randomly divided into two groups (n=45). One group was treated with 10 mg
zolpidem at bedtime, and the other group received 6 mg melatonin at bedtime for 30 days.
PSQI on weeks 0, 4, 8, Groningen sleep quality scale, Hamilton rating scale for depression, and
Hamilton anxiety rating scale questionnaires were performed to assess patients on weeks 0, 4,
and 8. The outcome was then analyzed, and P≤0.05 was considered statistically significant.
Results: Both zolpidem and melatonin had significant impacts on sleep quality in week 4
(P<0.05). After stopping the treatments, the conditions were noticeably reversed on week 8
(P<0.05). Zolpidem and melatonin were relatively similar in affecting sleep duration, latency,
efficiency, and disturbance. None of the two study medications had any considerable influence
on anxiety and depression.
Conclusion: Melatonin and zolpidem are promising agents for treating sleep complications
and, to some extent, depression, and anxiety in cancer patients, according to the present study.
However, further clinical trials are recommended to confirm the results of this study.

In the present era where diseases are prevalent in every country,
affecting every strata of population, expenditure on medication
creates a significant impact on an individual’s income. Cost of
drugs has to be given importance by health care professionals so
as not to affect the economic status of the patient. Since insomnia
is one of the prevalent diseases in India, a patient suffering from
chronic insomnia may need to take hypnotics on regular basis. Z-compounds are commonly prescribed drugs for insomnia. In the
following study, cost analysis of Z-drugs has been done in order to
assess the cost range.
Materials And Methods:  Five Z-drugs were included in this
study  -  Zolpidem, Zopiclone, Eszopiclone, Zonisamide and
Zaleplon. The cost of all the brands of these five Z-drugs available
in Monthly Index of Medical Specialities (MIMS) during October
2013 were collected. 6 Cost has been expressed as Indian National
Rupees per 10 tablets. Cost range, Cost ratio, Mean cost of
generic drug was calculated.
Observations And Results:  Single drug is available under
multiple brands having wide cost range. Example: Zoplidem is
available under 36 brands with cost range INR 26.67-78.00.
Conclusion:  Prescription of costly brand could adversely affect a
patient. Many times treating clinicians have no information about
drug cost. Cost consideration by the clinician would be an added
benefit for the patient.