Moderate Concomitant use of remifentanil with zolpidem can potentiate the effects of remifentanil on respiration, CNS depression, sedation, and hypotension. Geriatric patients and debilitated adults may be particularly sensitive to the effects of the drug. If you have taken a zolpidem product or a different type of sleeping pill at bedtime and you wake up in the middle of the night, you should not take a zolpidem sublingual tablet Intermezzo or any other sleeping pill. A dose reduction of either or both drugs should be considered to minimize additive sedative effects. Avoid zolpidem use in patients with severe hepatic impairment e.
Zolpidem will work faster if it is not taken with a meal or immediately after a meal. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use zolpidem exactly as directed. You will probably become very sleepy soon after you take zolpidem and will remain sleepy for some time after you take the medication.
Plan to go to bed right after you take zolpidem tablets, extended-release tablets, sublingual tablets Edluar , and oral spray and to stay in bed for 7 to 8 hours. Take zolpidem sublingual tablets Intermezzo only when you are already in bed and can remain in bed for at least 4 more hours. Do not take zolpidem if you will be unable to remain asleep for the required number of hours after taking the medication.
If you get up too soon after taking zolpidem, you may experience drowsiness and problems with memory, alertness, or coordination. Swallow the extended-release tablets whole; do not split, chew, or crush them. Tell your doctor or pharmacist if you cannot swallow tablets. Do not open the pouch that contains the sublingual tablet Intermezzo until you are ready to take the tablet. To remove the sublingual tablet Edluar from the blister pack, peel off the top layer of paper and push the tablet through the foil.
To take either brand of sublingual tablet, place the tablet under your tongue, and wait for it to dissolve. Do not swallow the tablet whole or take the tablet with water. Your sleep problems should improve within 7 to 10 days after you start taking zolpidem. Call your doctor if your sleep problems do not improve during this time or if they get worse at any time during your treatment.
Zolpidem should normally be taken for short periods of time. If you take zolpidem for 2 weeks or longer, zolpidem may not help you sleep as well as it did when you first began to take the medication. Talk to your doctor about the risks of taking zolpidem for 2 weeks or longer. Zolpidem may be habit forming. Do not take a larger dose of zolpidem, take it more often, or take it for a longer time than prescribed by your doctor.
Do not stop taking zolpidem without talking to your doctor, especially if you have taken it for longer than 2 weeks. If you suddenly stop taking zolpidem, you may develop unpleasant feelings or mood changes or you may experience other withdrawal symptoms such as shakiness, lightheadedness, stomach and muscle cramps, nausea, vomiting, sweating, flushing, tiredness, uncontrollable crying, nervousness, panic attack, difficulty falling asleep or staying asleep, uncontrollable shaking of a part of your body, and rarely, seizures.
You may have more difficulty falling asleep or staying asleep on the first night after you stop taking zolpidem than you did before you started taking the medication. This is normal and usually gets better without treatment after one or two nights. Your doctor or pharmacist will give you the manufacturer's patient information sheet Medication Guide when you begin treatment with zolpidem and each time you refill your prescription.
Read the information carefully and ask your doctor or pharmacist if you have any questions. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. This medication is taken as needed. You may take zolpidem even if it is later than the usual time, as long as you will be able to remain in bed for the required number of hours after you take it.
Zolpidem may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication. Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature, away from excess heat, light, and moisture not in the bathroom.
Do not freeze zolpidem oral spray. Store the zolpidem oral spray bottle upright. Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. It is important to keep all medication out of sight and reach of children as many containers such as weekly pill minders and those for eye drops, creams, patches, and inhalers are not child-resistant and young children can open them easily.
To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location — one that is up and away and out of their sight and reach. In case of overdose, call the poison control helpline at Information is also available online at https: If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at Do not let anyone else take your medication.
Zolpidem is a controlled substance. Prescriptions may be refilled only a limited number of times; ask your pharmacist if you have any questions. It is important for you to keep a written list of all of the prescription and nonprescription over-the-counter medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Zolpidem pronounced as zol' pi dem. Why is this medication prescribed? How should this medicine be used? Nel prescribed Stilnox, the brand name in South Africa for zolpidem. After about 25 minutes, I heard him making a sound like 'mmm'. He hadn't made a sound for five years. I said, 'Louis, can you hear me? I just cried and cried. Hughes was called over and other staff members gathered in disbelief. His mother was speechless and so were we.
It was a very emotional moment. Louis has now been given Stilnox every day for seven years. Although the effects of the drug are supposed to wear off after about two and a quarter hours, and zolpidem's power as a sedative means it cannot simply be taken every time a patient slips out of consciousness, his improvement continues as if long-dormant pathways in his brain are coming back to life.
I see Louis before his daily medication, yet he is conscious where once he would have been comatose. Almost blind because of a separate and deteriorating condition, there is a droop to one side of his mouth and brow because of brain damage. His right arm is twisted awkwardly into his side. Louis is given a pill, and I watch.
After nine minutes the grey pallor disappears and his face flushes. He starts smiling and laughing. After 10 minutes he begins asking questions. His speech is impaired because of the brain damage and the need, several years ago, to remove all his teeth, but I can understand him. A couple of minutes later, his right arm becomes less contorted and the facial drooping lessens.
After 15 minutes he reaches out to hug Sienie. He pulls off her wedding ring and asks what it is. And he says, "Well, if you're suffering, you should make a plan! Remember, Louis cannot see. Nel was as amazed at Louis' awakening as everyone else. A GP in Springs for 40 years, when he isn't seeing up to patients a day, he spends his time restoring vintage cars.
Married with three grown-up children, he has lived in the same house all his life. After Louis' awakening was publicised in the South African media, Dr Ralf Clauss, a physician of nuclear medicine - the use of radioactive isotopes in diagnostic scans - at the Medical University of Southern Africa, contacted Nel to suggest carrying out a scan on Louis.
Areas that appeared black and dead beforehand began to light up with activity afterwards. I was dumbfounded - and I still am. Clauss says immediate improvements in the left parietal lobe and the left lentiform nucleus were visible. In lay terms, these are important for motor function, sight, speech and hearing. No one yet knows exactly how a sleeping pill could wake up the seemingly dead brain cells, but Nel and Clauss have a hypothesis.
After the brain has suffered severe trauma, a chemical known as Gaba gamma amino butyric acid closes down brain functions in order to conserve energy and help cells survive. However, in such a long-term dormant state, the receptors in the brain cells that respond to Gaba become hypersensitive, and as Gaba is a depressant, it causes a persistent vegetative state.
It is thought that during this process the receptors are in some way changed or deformed so that they respond to zolpidem differently from normal receptors, thus breaking the hold of Gaba. This could mean that instead of sending patients to sleep as usual, it makes dormant areas of the brain function again and some comatose patients wake up.
In Kimberley, the once booming home of the De Beers diamond empire, Riaan Bolton's family heard of Nel's work after he and Clauss had papers published in the medical journal NeuroRehabilitation and the New England Journal of Medicine several months ago. Riaan suffered severe brain trauma when he was thrown from a car in a traffic accident in July A keen cricketer and rugby player, the year-old was studying to become an industrial engineer but still found time to play guitar in a band. Then they asked their doctor, Clive Holroyd, to contact Nel for advice.
His eyes went big and he began looking from left to right. He said, 'Look at me, Riaan' and Riaan looked straight at him and focused on his face. Then the doctor asked him to move his hand and he moved it. And then he lifted his head from the pillow and began looking around. I couldn't believe it. I watch as Riaan is given his medication.
As with Louis, his face flushes and his eyes begin to sparkle and focus within minutes. Gone is the 1,yard stare. He hugs his mother and looks at her face, but even though I am amazed, the family reckon this isn't his best day so far. They show me a number of DVDs they shot in July. In them, Riaan responds to questioning, nods and shakes his head, drinks through a straw, often laughs and says, 'Hello. It has been a very moving experience. And the mind-boggling thing about this is that it's done with a sleeping pill.
His mother insisted he should be, and look at him now. From now on, this will cause serious ethical issues over whether to let such coma victims die. Although these awakenings are the most dramatic aspect of the zolpidem phenomenon, Percy Lomax, the chief executive of ReGen Therapeutics, the British company funding the South African trials, believes Nel's work with less brain-damaged patients could be the most significant. Many stroke victims, patients with head injuries and those whose brains have been deprived of oxygen, such as near-drowning cases, have reported significant improvement in speech, motor functions and concentration after taking the drug.
The object of the clinical trial is to scientifically establish that the compound works in the way it has been shown to work in individual cases. It will be carried out on patients known to react well to zolpidem, and by lowering the dosage it is hoped that the sedative side-effects will be reduced but the brain stimulation will still continue. The company that first developed zolpidem, Sanofi-Aventis, was contacted by Nel and Clauss but appears to have chosen not to become involved in the trials or the use of the drug on brain-damaged patients.
Instead, the brain scans on up to 30 patients will be carried out at the Pretoria Academic Hospital by Professor Mike Sathekge, head of nuclear medicine, and Professor Ben Meyer, one of South Africa's most renowned physicians. But we know cells can go into hibernation in the heart and thyroid, so why not the brain? If there are hibernating cells in damaged brains, it may be that this drug helps to wake them in some people.
In South Africa, I meet a procession of brain-damaged patients who feel the drug has changed their lives for the better. There is year-old Miss X, who can't be named for legal reasons. She suffered four cardiac arrests and hypoxia, a lack of oxygen to the brain, when a hospital's apparent failure to diagnose a gall bladder problem resulted in her contracting septicaemia four years ago. She can barely stand, her arms are in spasm, she cannot speak - although her intelligence has not been affected - and the left side of her face droops.
She was given zolpidem for the first time just a week before I see her and her parents say the improvement was such that she has come back for more. Miss X is given a pill by Nel at 4. Ten minutes later, she stands up, stretches to her full height and claps her hands. Using a card keyboard, she spells out answers to questions I have for her. I am not coughing so much. I can swallow easier. I feel my limbs are much more relaxed. What is she hoping for?
I'd love to be able to call my cats to come to me. Then there is Wynand Claasens, 22, who suffered severe brain damage five years ago when he was assaulted outside his school. A series of subsequent strokes left him wheelchair-bound, depressed and aggressive. He used to be a long-distance runner. Nel gave him Stilnox for the first time in early July this year. The list goes on.