Resting better with more zolpidem info

"Seriously? ... Okay. Get a stat x-ray of the pelvis and hips and tell the family I’ll be up within 5 minutes."

You hang up the phone incredulous! After 4 weeks in the critical care unit, 2 weeks in a step-down unit, and an additional 8 days on the general medical ward, your patient was finally on the launching pad.

You had spent 90 minutes the night before meticulously reviewing every nursing note, physical therapy recommendation, and a myriad of consultants notes to make sure your discharge summary thoroughly reflected her very complicated hospital course. Last night, she was alert and chatting up a storm. At times, she did not even know if she would ever make it out of the hospital (and neither did you), and here it was, the long-awaited day of discharge, and she wakes up groggy and takes a bad fall on her way to the bathroom.

The list of possible explanations for her new-onset grogginess race through your mind. The likelihood of a stroke is remote. Her vital signs and morning labs are all normal. She was weaned off pain meds weeks ago, and her only complaint for the past few days had been insomnia, for which you ordered zolpidem PRN. Surely that could not be the culprit ... or could it?

Recent evidence shows that sleep aids containing the popular drug zolpidem may be linked to decreased alertness the morning after use, particularly the long-acting formulations. In some patients, blood levels of the drug may remain high enough to put patients at risk when performing tasks that require mental alertness. Evidence of this association was so compelling, the Food and Drug Administration recently announced that it is requiring manufacturers of Ambien, Ambien CR, Zolpimist, and Edluar, sleep aids that contain zolpidem, to lower recommended doses. Women are at particular risk, since they eliminate the drug more slowly than do men. Accordingly, the new FDA-recommended dose for women was cut in half – 5 mg for immediate-release products and 6.25 mg for extended-release products.

Of course, zolpidem is not alone in its propensity to cause grogginess. Virtually any sleep aid can do so because, well, that is what it they are designed to do – make patients sleepy.

This recent drug-safety information was so interesting because we often have a false sense of security when prescribing this drug, and we prescribe it very often. It is our "safer" alternative to valium-type medications. We are now encouraged to order a safer dose of this frequently prescribed drug.

I ordered a lower dose myself right after reading the latest FDA report.

The bottom line is that we need to be aware what this study showed so we can alter our prescribing habits and order the lower dose. All medications have the potential to have side effects in a minority of patients, but it is very important for us to know and react when new recommendations come out that have the potential to be so far reaching.

Dr. Hester is a hospitalist with Baltimore-Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.

"Seriously? ... Okay. Get a stat x-ray of the pelvis and hips and tell the family I’ll be up within 5 minutes."

You hang up the phone incredulous! After 4 weeks in the critical care unit, 2 weeks in a step-down unit, and an additional 8 days on the general medical ward, your patient was finally on the launching pad.

You had spent 90 minutes the night before meticulously reviewing every nursing note, physical therapy recommendation, and a myriad of consultants notes to make sure your discharge summary thoroughly reflected her very complicated hospital course. Last night, she was alert and chatting up a storm. At times, she did not even know if she would ever make it out of the hospital (and neither did you), and here it was, the long-awaited day of discharge, and she wakes up groggy and takes a bad fall on her way to the bathroom.

The list of possible explanations for her new-onset grogginess race through your mind. The likelihood of a stroke is remote. Her vital signs and morning labs are all normal. She was weaned off pain meds weeks ago, and her only complaint for the past few days had been insomnia, for which you ordered zolpidem PRN. Surely that could not be the culprit ... or could it?

Recent evidence shows that sleep aids containing the popular drug zolpidem may be linked to decreased alertness the morning after use, particularly the long-acting formulations. In some patients, blood levels of the drug may remain high enough to put patients at risk when performing tasks that require mental alertness. Evidence of this association was so compelling, the Food and Drug Administration recently announced that it is requiring manufacturers of Ambien, Ambien CR, Zolpimist, and Edluar, sleep aids that contain zolpidem, to lower recommended doses. Women are at particular risk, since they eliminate the drug more slowly than do men. Accordingly, the new FDA-recommended dose for women was cut in half – 5 mg for immediate-release products and 6.25 mg for extended-release products.

Of course, zolpidem is not alone in its propensity to cause grogginess. Virtually any sleep aid can do so because, well, that is what it they are designed to do – make patients sleepy.

This recent drug-safety information was so interesting because we often have a false sense of security when prescribing this drug, and we prescribe it very often. It is our "safer" alternative to valium-type medications. We are now encouraged to order a safer dose of this frequently prescribed drug.

I ordered a lower dose myself right after reading the latest FDA report.

The bottom line is that we need to be aware what this study showed so we can alter our prescribing habits and order the lower dose. All medications have the potential to have side effects in a minority of patients, but it is very important for us to know and react when new recommendations come out that have the potential to be so far reaching.

Dr. Hester is a hospitalist with Baltimore-Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.

"Seriously? ... Okay. Get a stat x-ray of the pelvis and hips and tell the family I’ll be up within 5 minutes."

You hang up the phone incredulous! After 4 weeks in the critical care unit, 2 weeks in a step-down unit, and an additional 8 days on the general medical ward, your patient was finally on the launching pad.

You had spent 90 minutes the night before meticulously reviewing every nursing note, physical therapy recommendation, and a myriad of consultants notes to make sure your discharge summary thoroughly reflected her very complicated hospital course. Last night, she was alert and chatting up a storm. At times, she did not even know if she would ever make it out of the hospital (and neither did you), and here it was, the long-awaited day of discharge, and she wakes up groggy and takes a bad fall on her way to the bathroom.

The list of possible explanations for her new-onset grogginess race through your mind. The likelihood of a stroke is remote. Her vital signs and morning labs are all normal. She was weaned off pain meds weeks ago, and her only complaint for the past few days had been insomnia, for which you ordered zolpidem PRN. Surely that could not be the culprit ... or could it?

Recent evidence shows that sleep aids containing the popular drug zolpidem may be linked to decreased alertness the morning after use, particularly the long-acting formulations. In some patients, blood levels of the drug may remain high enough to put patients at risk when performing tasks that require mental alertness. Evidence of this association was so compelling, the Food and Drug Administration recently announced that it is requiring manufacturers of Ambien, Ambien CR, Zolpimist, and Edluar, sleep aids that contain zolpidem, to lower recommended doses. Women are at particular risk, since they eliminate the drug more slowly than do men. Accordingly, the new FDA-recommended dose for women was cut in half – 5 mg for immediate-release products and 6.25 mg for extended-release products.

Of course, zolpidem is not alone in its propensity to cause grogginess. Virtually any sleep aid can do so because, well, that is what it they are designed to do – make patients sleepy.

This recent drug-safety information was so interesting because we often have a false sense of security when prescribing this drug, and we prescribe it very often. It is our "safer" alternative to valium-type medications. We are now encouraged to order a safer dose of this frequently prescribed drug.

I ordered a lower dose myself right after reading the latest FDA report.

The bottom line is that we need to be aware what this study showed so we can alter our prescribing habits and order the lower dose. All medications have the potential to have side effects in a minority of patients, but it is very important for us to know and react when new recommendations come out that have the potential to be so far reaching.

Dr. Hester is a hospitalist with Baltimore-Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.