Extra Focus Needed with Insomnia Rx

Insomnia medication led to more ER visits especially in women and the elderly

(RxWiki News) A common insomnia medication can be dangerous unless taken with care. Bad reactions between medications or not following instructions and warning labels can send users to the emergency room.

A recent report issued by the Substance Abuse and Mental Health Services Administration (SAMHSA) revealed the high number of emergency department visits due to bad reactions to zolpidem (Ambien).

More than half of the emergency department visits involved women, the elderly and other substances.

"Inform your MD about every Rx you take."

Researchers at the Center for Behavioral Health Statistics and Quality, a department within SAMHSA, looked closely at data from the Drug Abuse Warning Network (DAWN) from 2005 to 2010 concerning the negative health risks associated with the use of the insomnia medication zolpidem, which is the active ingredient in Ambien, Edluar and Zolpimist.

Bad reactions to zolpidem include dizziness, hallucinations, bizarre behavior, agitation, sleepwalking and sleepy driving. Alcohol and other sedative prescription medications can dangerously enhance the sedative effects of zolpidem, according to the study's authors.

Current US Food and Drug Administration (FDA) guidelines recommend halving the dose of zolpidem for women and the elderly.

In 2005, there were 6,111 emergency department visits due to bad reactions to zolpidem, which increased by 220 percent in 2010 with 19,487 emergency department visits.

When the researchers factored in the age of the patients, they discovered that 74 percent of emergency department visits due to zolpidem involved patients aged 45 or older and 32 percent involved patients 65 and older.

When the researchers factored in the gender of the patients, they discovered that 68 percent of emergency department visits due to bad reactions to zolpidem involved women. While emergency department visits due to zolpidem increased by 144 percent from 2005 to 2010 for men, they increased by 274 percent for women.  

Of the 19,487 emergency department visits in 2010, only 7,792 (40 percent) involved zolpidem alone. Half of the zolpidem visits involved other pharmaceuticals, including everything from painkillers to cardiovascular medications. The other 10 percent involved alcohol.

“Females and the elderly are two populations that have been found to be more sensitive to the effects of zolpidem,” said the study authors.

The report recommended that patients be sure to inform all of their doctors, nurses, mental health professionals and specialists about all medications, supplements, vitamins and dosages they are taking.

“Patients can safeguard against adverse reactions by using one pharmacy for all prescriptions and by advising their pharmacy of previous adverse reactions to any medications,” the report continued.

"It is important to remember that this study is based upon 2010 data, before the FDA recommended reductions were implemented. Ambien has been used safely and effectively by many patients for 20 years in the US, but the study does help highlight the importance of patient counseling on the use of zolpidem for insomnia," said Jason Poquette, BPharm, RPh. Dr. Poquette was not involved with this study.

"Ideally it should only be used for short-term management of insomnia. Patients should never take more than the recommended dose, nor mix zolpidem with alcohol or other sedating medications unless instructed to by their physician," said Dr. Poquette.

"Ambien should be taken right before bed, and only when you are able to stay in bed for a full 7-8 hours, to allow the medication time to wear off. Additionally, Ambien CR tablets should never be crushed or chewed, nor should they be taken immediately after a mean. Patients should contact their prescribers if they experience side effects such as abnormal thoughts or behavior, memory loss or anxiety," continued Dr. Poquette. 

Cost for zolpidem can vary based on insurance coverage and location. A one-month supply of zolpidem can run between $0 and $100.

This study was published in May on the Substance Abuse and Mental Health Services Administration website.  SAMHSA is a government funded agency. No conflicts of interest were found.

Review Date: 
May 8, 2013