32: Sedatives/Hypnotics

What is the brand name for Eszopiclone

Lunesta

What is the generic name for Lunesta

Eszopiclone

What is the pharmacologic category for Eszopiclone (Lunesta)

Hypnotic, Nonbarbiturate

What is the brand name for Zolpidem

-Ambien
-Ambien CR
-Edluar
-Intermezzo
-Zolpimist

What is the generic name for Ambien, Ambien CR, Edluar, Intermezzo, Zolpimist

Zolpidem

What is the pharmacologic category for Zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, Zolpimist)

Hypnotic, Miscellaneous

What are the dosage forms for Eszopiclone (Lunesta)

-Tablet

What are the indications for Eszopiclone (Lunesta)

Insomnia

What is the MOA for Eszopiclone (Lunesta)

Binds to or interacts allosterically at the GABA-receptor complex domain.

What are the black box warning for Eszopiclone (Lunesta)

-Risk of Complete sleep behaviors

What are the contraindications for Eszopiclone (Lunesta)

-Hypersensitivity
-History of complex sleep behavior

What drug interacts with:

-CYP3A4/5 inducers/inhibitors
-Opioids
-Sedatives
-Hypnotics
-Benzodiazepines

Eszopiclone (Lunesta)

What are the common adverse reactions for Eszopiclone (Lunesta)

-Headache
-Taste Disorder

What are the efficacy monitoring parameters for Eszopiclone (Lunesta)

Improvement in sleep onset, duration, and quality.

What are the toxicity monitoring parameters for Eszopiclone (Lunesta)

Excessive sedation, impaired coordination

What are the counseling points for Eszopiclone (Lunesta)

Take immediately before bedtime and do not take with heavy/high-fat meal. Severe anaphylactic/anaphylactoid reactions, some fatal, have been reported. Be aware of the risk of “sleep-driving” and other complex behaviors (eg, preparing and eating food, making phone calls) when the patient is not fully awake. Risk is increased when drug is combined with alcohol or other CNS depressants. Avoid activities requiring mental alertness or coordination until drug effects are realized. Report insomnia that worsens or persists longer than 7-10 d. Report abnormal thoughts or behavior (confusion, agitation, hallucinations, suicidal thoughts, new or worsening depression), memory loss, or anxiety. Take drug only when experiencing insomnia. This drug should not be taken on a regular schedule when insomnia is not present. Do not drink alcohol while taking this drug. Avoid grapefruit products.

What are the dosage forms for Zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, Zolpimist)

-Tablet
-Tabler ER
-Capsule
-Sublingual Tablet
-Oromucosal Spray

What are the indications for Zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, Zolpimist)

-Insomnia

What is the MOA for Zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, Zolpimist)

Binds the benzodiazepine receptor but is structurally different from a benzodiazepine. Sedative and hypnotic effects are due to increased chloride conductance, neuronal hyperpolarization, inhibition of action potential, and decrease in neuronal excitability.

What is the black box warning for Zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, Zolpimist)

-Risk of complex sleep behavior

What are the contraindications for Zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, Zolpimist)

-Hypersensitivity
-History of complex sleep behavior

What drug interacts with:

-Benzodiazepines
-CNS depressants
-TCAs
-Bupropion
-Desipramine
-Sertraline
-Venlafaxine
-CYP3A4/5 inhibitors/inducers

Zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, Zolpimist)

What are the common adverse reactions for Zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, Zolpimist)

-Dizziness
-Drowsiness
-Headache

What are the efficacy monitoring parameters for Zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, Zolpimist)

Improved ability to fall asleep and sleep through the night. Increased daytime alertness.

What are the toxicity monitoring parameters for Zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, Zolpimist)

Seek medical attention if severe drowsiness, thoughts of suicide, allergic reaction, irregular respiratory rate, fast or irregular heartbeat.

What are the counseling point for Zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, Zolpimist)

Take on an empty stomach. May cause daytime drowsiness; avoid driving or other tasks requiring motor coordination. Avoid alcohol. Take immediately prior to bedtime. There is risk of “sleep-driving” and other complex behaviors (eg, preparing and eating food, making phone calls) when not fully awake; zolpidem should be discontinued if this occurs. Risk is increased when medication is combined with alcohol or other CNS depressants. Bed partner should monitor for irregular respiration.