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How to take Ambien? What are the consequences of an overdose?

Ambien must be taken orally with a liquid immediately before sleep and shortly after eating. Patients using Ambien should be able to afford 7-8 hours of uninterrupted sleep.

Doses and duration of treatment are determined by the physician. You should strictly adhere to the instructions of the doctor and not exceed the prescribed dose of Ambien.

The maximum daily dose for adults is 10 mg before sleep. For elderly (aged over 65) and immune-compromised patients, as well as those with liver failure, the initial dose is 5 mg; in case of necessity (insufficient clinical effect) and good tolerance, the drug dose can be increased to 10 mg.

The treatment course must not exceed 4 weeks. The recommended treatment course for transient insomnia is 2–5 days, and for situational insomnia- 2–3 weeks. Short treatment periods don’t require the gradual drug withdrawal.

In case of the long-term use of the drug, zolpidem withdrawal must be carried out gradually to reduce the risk of developing rebound insomnia (start with reducing the daily dose and then discontinue the drug).

Contraindications:

• increased sensitivity to zolpidem and auxiliary components of the drug;
• acute or chronic liver failure;
• sleep apnea;
• acute respiratory failure;
• pregnancy (I trimester) and lactation period;
• persons under 18 years of age (efficiency and safety in this group of patients have not been established);
• lactase deficiency, lactose intolerance and glucose-galactose malabsorption syndrome.

Patients with the following conditions should take the drug with caution: mild to moderate liver failure, depression, alcoholism, drug abuse and other types of addiction, pregnancy (II and III trimester), mild to moderate respiratory failure, severe myasthenia gravis and mental illnesses.

Overdose

In case of accidental Ambien overdose, seek medical attention immediately.

The symptoms are mainly due to CNS depression: impaired consciousness- from mild (confusion and lethargy) to severe (up to coma) forms, ataxia, low blood pressure and life-threatening respiratory depression.

Treatment: if there has been less than an hour after taking an excessive dose and the patient is awake, he/she should try to induce vomiting. If it’s impossible to induce vomiting or if the patient is unconscious, gastric lavage is recommended. 

If there has been over an hour after an accidental or deliberate drug overdose, the patient should be given activated carbon by mouth or by gavage (if unconscious) to reduce the absorption of zolpidem. In case of overdose, symptomatic therapy (in hospital settings) is carried out, aimed at maintaining the basic body functions, in particular the functions of respiratory and cardiovascular systems.

Sedatives shouldn’t be taken after zolpidem overdose, even in case of agitation.

In case of severe overdose, you should consider the introduction of flumazenil for differential diagnosis and/or treatment (benzodiazepine antagonists) in hospital settings; however, it should be remembered that the suppression of benzodiazepine receptors can cause neurological disorders (seizures), especially in patients with epilepsy.

Zolpidem is not removed by hemodialysis.