Zolpidem has not adequately demonstrated effectiveness in maintaining sleep, however it is effective in initiating sleep. Its hypnotic effects are similar to those of the benzodiazepine class of drugs, but it is molecularly distinct from the classical benzodiazepine molecule and is classified as an imidazopyridine. Flumazenil, a benzodiazepine receptor antagonist, which is used for benzodiazepine overdose, can also reverse zolpidem's sedative/hypnotic and memory impairing effects.
As an anticonvulsant and muscle relaxant, the beneficial effects start to emerge at 10 and 20 times the dose required for sedation, respectively For that reason, it has never been approved for either muscle relaxation or seizure prevention. Such drastically increased doses are more inclined to induce one or more negative side-effects, including hallucinations and amnesia.
As an anticonvulsant and muscle relaxant, the beneficial effects start to emerge at 10 and 20 times the dose required for sedation, respectively.[12] For that reason, it has never been approved for either muscle relaxation or seizure prevention. Such drastically increased doses are more inclined to induce one or more negative side-effects, including hallucinations and amnesia.
Zolpidem is one of the most common benzodiazepine related sleeping medications prescribed in the Netherlands, with a total of 582,660 prescriptions dispensed in 2008.[13] The patent in the United States on zolpidem was held by the French pharmaceutical corporation Sanofi-Aventis.[14] On April 23, 2007 the U.S. Food and Drug Administration (FDA) approved 13 generic versions of zolpidem tartrate.[15] Zolpidem is available from several generic manufacturers in the UK, as a generic from Sandoz in South Africa, TEVA in Israel, as well as from other manufacturers such as Ratiopharm (Germany).
Zolpidem is approved for the short-term (usually about two to six weeks) treatment of insomnia, and it has been studied for nightly use up to six months in a single-blind trial published in 1991,[16] an open-label study lasting 180 days published in 1992 (with continued efficacy in patients who had kept taking it as of 180 days after the end of the trial),[17] and in an open-label trial lasting 179 days published in 1993.[18] Zolpidem has not proven effective in maintaining sleep and is more used for sleep initiation problems.[9]
The United States Air Force uses zolpidem as one of the hypnotics approved as "no-go pills" to help aviators and special duty personnel sleep in support of mission readiness. "Ground tests" are required prior to authorization being issued to use the medication in an operational situation.[19]
Therapeutic applications for brain injuries
A case study performed at the Toulouse University Hospital using PET showed zolpidem repeatably improves brain function and mobility of a patient immobilized by akinetic mutism caused by hypoxia.[20]Recently, zolpidem has been cited in various medical reports mainly in the United Kingdom as waking persistent vegetative state (PVS) patients, and dramatically improving the conditions of people with brain injuries. Results from phase IIa trials were expected in June 2007. The trials are being conducted by Regen Therapeutics of the UK, who have a patent pending on this new use for Zolpidem.
