Dosage and administration
Patients using Ambien should be able to afford continuous sleep for 7–8 hours. Take the drug with liquid before sleep, shortly after eating.
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The attending physician determines doses and duration of treatment. It is necessary to adhere to the doctor’s instructions strictly and not exceed the dose of Ambien prescribed by the doctor.
The maximum daily dose for adults is 10 mg before sleep. For elderly patients (over the age of 65), weakened patients, and those with liver failure, the initial dose is 5 mg; in case of need (insufficient clinical effect) and good tolerance to the drug, the dose can be increased to 10 mg.
The treatment course must not exceed 4 weeks. In case of transient insomnia, the recommended course of treatment — 2–5 days, and for situational insomnia — 2–3 weeks. Short terms of treatment don’t require gradual drug withdrawal.
In case of prolonged use of the drug, to reduce the possibility of developing rebound insomnia, Ambien must be withdrawn gradually (first reduce the daily dose and then discontinue the drug).
• Increased sensitivity to Ambien and auxiliary components of the drug;
• severe acute or chronic liver failure;
• sleep apnea;
• severe respiratory failure;
• pregnancy (I trimester) and lactation;
• age to 18 years (efficiency and safety aren’t established);
• lactase deficiency, lactose intolerance, and glucose-galactose malabsorption syndrome.
With caution: liver failure of mild to moderate severity, depression, alcoholism, drug and other types of addiction, pregnancy (II and III trimesters), respiratory failure of mild to moderate severity, severe myasthenia gravis, and patients with mental illness.
The frequency of Ambien side effects depends on the dosage. Adverse effects are more common in women than in men.
Central and peripheral nervous system: frequent — sleepiness, sense of drunkenness, headache, vertigo, increased insomnia, anterograde amnesia (the effects of amnesia may be associated with behavioral reactions), the risk of developing which increases in proportion to the dose, hallucinations (including visual and auditory), increased irritability, nightmares, emotional lability, and ataxia. Most adverse effects from the psyche are paradoxical reactions.
Digestive system: frequent— diarrhea; infrequent — sickness, vomiting, abdominal pain, dysphagia, flatulence, hiccup, gastroenteritis; rare — elevated liver enzymes.
Musculoskeletal system: very infrequent — muscle weakness and arthritis.
Skin and subcutaneous fat: infrequent — rash, itch, urticaria, excessive sweating; rare — paleness, Quincke’s disease.
Eyesight organs: infrequent — diplopia.
Respiratory system: infrequent: bronchitis, cough, and dyspnea.
Endocrine system: infrequent: hyperglycemia.
Other: frequent — fatigue; infrequent — traumas and falls (mainly in elderly patients), peripheral edema, and fever.
If any adverse effects (not listed in this instruction) occur, you should see a doctor.
The symptoms are mainly due to CNS depression: impaired consciousness- from the mild forms (such as confusion and numbness) to the severe ones (coma, ataxia, decrease in blood pressure, and life-threatening respiratory depression).
Treatment: if less than 1 hour has passed after taking an excessive dose, and the patient is conscious, you should try to induce vomiting. If it is impossible to do the latter, if the patient is unconscious, gastric lavage is recommended. If more than 1 hour has passed after an accidental or deliberate use of an excessive dose of the drug, the patient should be given an activated carbon, either orally or through a tube (in case of unconscious state), to reduce the absorption of zolpidem. In case of overdose, symptomatic therapy (in hospital settings) and treatment aimed at maintaining the basic functions of the body (in particular, the functions of respiration and circulatory system) are carried out.
Sedative must not be taken after an overdose of Ambien, even in case of agitation.
In case of severe overdose, for differential diagnosis or treatment, administration of flumazenil in hospital settings (benzodiazepine receptor antagonist) should be considered. However, it should be borne in mind that the suppression of benzodiazepine receptors can cause neurological disorders (cramps), especially in epileptic patients. Ambien isn’t excreted by hemodialysis.
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