Talk:Zolpidem

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Contents

[edit] Nothing Changed

[edit] Europe and the Tea in China

I didn't change the page, I just thought I'd add my opinion here. I think the erowid link should be put back up. The reasoning for removing it makes no sense...this site would have ZERO content if everything had to be written AND have sources in ALL the languages of the world. Shall we delete the whole site because nothing is translated into Lur? Gurani? Syriac? Algonquin? Klingon? What do the languages of Europe have to do with anything?

67.42.127.21 (talk) 01:15, 10 March 2008 (UTC)Christina


[edit] Claim regarding abuse editted

After having read the claim saying abuse of zolpidem has been rising, especially the Ambian brand with a link to the Erowid experience page of Zolpidem, I've erased the claim saying especially the abuse of the Ambien brand has risen with the link to Erowid which followed it. Erowid is an English site and none of the experiences on Erowid are written in another language than English. Because the only countries in Europe which are English speaking are Great-Brittain and Ireland, and because experience reports in other languages than English are not allowed on Erowid, it appears as if only the North American Ambien brand has risen in terms of abuse. This claim is definately not true, and the link to Erowid's experience page of Zolpidem isn't a reliable source to verify this claim, that's why I deleted both the claim and the link. Stilnoct brand Zolpidem has probaply risen even more in terms of abuse, as it's marketed throughout the whole world under this brand name, except for North America, but it's abuse has risen a lot in all Western Countries in recent years, not only in Europe, but in Japan and Australia as well. —Preceding unsigned comment added by 82.169.11.61 (talk) 04:48, 28 February 2008 (UTC)

[edit] POV issues

After reading the "recreation use and abuse" section I believe that some major editing is in order. The whole section stinks of biases and hearsay. Sections on recreational use and abuse must be written carfully. Terms such as "serious drug abusers", "young people" and any others that single out a particular group without evidence or are open to personal opinion (such as the line between use and abuse as in the case of "serious drug abusers") cannot be used without introducing bias. Aside from this there is the problem of the relaxed conversational tone used in this section. This entire section reads like a conversation between friends rather than an encyclopedia entry. Time permitting I will prune out some of the careless language and bias, however all users must be wary of sloppy and biased writting and help to keep it to a minimum. Foolishben 08:53, 14 August 2007 (UTC)

In actuality, and despite the recent hysteria, Ambien has a very low abuse potential. Of Drug abusing patients presenting to our Urban Tertiary Medical Center Emergency Department, Ambien abuse is rarely an issue. I would estimate that opiate abuse is several hundred times as common a presentation, followed closely by abuse of the benzodiazapenes, Xanax and Ativan. In many people, use of excessive doses of Ambien is associated with nausea and vomiting, making it difficult to abuse, (See PDR or packet insert). RandyK37922, MD, Emergency Physician

RandyK37922 (talk) 13:43, 24 December 2007 (UTC)


On the Recreational Use/Abuse it should be clarified that Zolpidem after it's coating being removed is insufflatable but any effects are primarily due to the "drip" produced into the mouth and not thought to be due to contact with the nasal membranes as Zolpidem has a low water solubility and therefore absorption throught these mucosal membranes would be minimal. Yet some have reported that insufflation does make Zolpidem's effects appear faster than orally and stronger than orally but the duration of it's effects are decreased.

On another note, it has been found that when more than 10mg (prescribed dose) is taken i.e. 2x Tablets of 10mg that taking the prescribed 10mg the next night had a reduced or no effect.

Some users after removing the coating on the tablet (some don't remove the coating) place the pill under their tongue (Sublingually) to gain a faster onset of effects (some think there is a stronger effect than when taken orally also).

Threre needs to be some further research done on the administration of zolpidem intranasally to establish if it does infact absorb through the mucosal membranes and if so this should be quantifiable, if not then the recreational use sections should state that intranasal use of zolpidem is ineffective. —Preceding unsigned comment added by Mountviewenterprises (talk • contribs) 00:22, 13 February 2008 (UTC)

[edit] Difference between Ambien (brand name) and Zolpidem (generic)

I heard today from a pt that during their first month of using the generic, they woke up several times during the night and felt heavier in the morning when they woke up. I asked the pharmacist if this was common and she confirmed that some people had been reporting these new effects. If anyone else had heard this as well, would it be helpful to post on the article? I don't have any references, so I was throwing this out there until someone could back it up. Albert109 06:35, 17 June 2007 (UTC)

http://www.drugs.com/forum/featured-drugs/generic-ambien-vs-brand-name-42830.html

[24 August 2007] I took Zolpidem (5mg) in 2001. After 28 days I was experiencing may of the side effects such as sleeplessness, nightmares, depression, paranoia and strange behaviour (I would get out of lifts two floors above/below the floor I wanted so I could check who was folowing me). It also affected my vision - I developed 'blind spots' but didn't realise it, which led to my pulling out in front of a car. I discussed these symptoms with my doctor and the doseage was increased to 10mg for 28 dyas; by the end of this period I was in trouble with the police and ended up with a criminal conviction which, in hind sight, was due to my altered behaviour whilst taking the drug. I can be contacted on rwrZolpidem at googlemail dot com; this email address will be disabled if I receive too much spam. —Preceding unsigned comment added by Rwr104 (talk • contribs) 13:45, August 24, 2007 (UTC)

[edit] BZ1/BZ2/Omega1 etc...

What is this? 1985? Molecular pharmacology has definitely replaced these largely unhelpful, completely non-functional terms. I suggest that they are removed, BZ1 99% = alpha1gamma2 containing receptors and am editing this page accordingly --Bilz0r 01:54, 21 May 2007 (UTC)

[edit] Miscellaneous Problems

"...single-blind, open-label trial..."

These two terms are mutally exclusive. However, I do not have a copy of the text that is referenced. Can anyone who does so please read up on the methods used and adjust it accordingly.

163.1.231.55 19:34, 20 November 2006 (UTC) It was a single blind trial. Fixed --Bilz0r 01:47, 21 May 2007 (UTC)


I read it and said "What superb writing! Everything you might want to know on one side of A4."

It may seem only technical but it is amply supplied with links which will take any reader in the direction they can cope with.

JK _______

The article, even as a stub, strikes me as far too technical. I have no formal training in the sciences, but consider myself reasonably well-read and am usually able to understand journal articles. Yet I feel like I can barely -- just barely -- grasp what this article is saying about how the drug actually works.

It seems to me that somebody -- a person with better understanding of pharmacology and biology -- should be able to "dumb" the article down to an intelligible level. A degree in biochemistry shouldn't be required to understand an article on Wikipedia.

Hmm...On second thought, I should clarify. I can understand why this information, such as it is, might be of use as a quick reference for an advanced undergrad, or whatever. But I think that an intelligible "translation" should follow, written for the layperson (e.g., me).

Don't know if the chart can be changed, but if Zolpidem is metabloized hepatically (i.e. via the liver), then it is more than likely excreted renally (i.e. via kidneys/urine).

The IUPAC name for Zolpidem is N,N-dimethyl-2-[4-methyl-8-(4-methylphenyl)-6,9-diazabicyclo[4.3.0]nona-2,4,7,9-tetraen-7-yl]-ethanamide shouldn't this be the one listed?Bartimaeus 02:02, 12 December 2005 (UTC)

I also find the need to have a 'dumbed down' picture of how this drug works. If it's supposed to help insomniacs how can it cause impulsivity and hallucinations? Where does GABA come from? Is it manufactured/synthesised in the synapse? If so how does zolpidem work if the body has not produced GABA? If not how does the body control the volume/strength of GABA? How is it trensmitted if it can't pass the blood/brain barrier? By CSF? By glial tissue? Is there any connection with GABA volume/strength and the circadian cycle? Don Nicol 11:30, 6 Jul 2007

[edit] Can't mention in the article...but...

It might be worth noting that half an Ambien can cause the mentioned effects under the Abuse heading, but will not put the subject to sleep at all, and thus no fighting is required. (I should know; I've done this a number of times.) Cernen Xanthine Katrena 09:24, 22 January 2006 (UTC)


[edit] Associated Patents

The article mentions that there are patents but the specific european/US patents are not linked to or mentioned. Also relevent would be the expiration date of the patent as this would spur introductions of Generic Ambien.

Content specifically relating to Ambien patent 4382938, which is listed on the FDA Orange Book site as expiring on OCT 21,2006, has been added to the article. That patent, is listed for indication "U-74, METHOD OF PROVIDING HYPNOTIC EFFECT."

[edit] What about Ambien Zombies?

17 March 2006 - Ambien Zombies are in the news. Need to have a Wikipedia entry on this.

[edit] Sensations that could lead to abuse

When I took the medication all was well for many weeks, then all of the sudden, I became stubborn and decided it was actually a pleasant sensation to fight off the effects and remain awake. One of the common feelings as the ambien gripped me was the a sensation that can only be described as taut skin or stone skin that made me feel that oh so common side effect of super human. Every time I took it, I would detect a change in my perception of my own shell of skin, and the texture.


Indeed, I found that it causes some alterations of bodily perceptions - this is the "body high". The visual hallucinations and confusion and euphoria were more fun.
Also, I think I should mention that whoever said it causes a 'drug induced psychosis' is WAY off. I've used it hundreds of times and never been paranoid that they were out to get me, just confused. Someone change that, please. 128.250.152.110 04:17, 4 May 2006 (UTC)
I added the bit about Ambien CR®'s street name. I figure that the name "A-" more than likely comes from the imprints the tablets carry. I recently received a prescription for these, and I found out the 6.25 mg tabs are pink, while the 12.5 mg tabs are blue, with both strengths being imprinted with an A~, which looks similar to an A-. --Drewamer 11:26, 22 July 2006 (UTC)

[edit] Salon.com article

This [1] describes a weird effect of Ambien.

Dead link. Nothing on google cache or archive.org. Anyone have it saved? 128.250.152.110 04:19, 4 May 2006 (UTC)
Salon.com must have moved the article (pretty silly for a news site to do) because I was able to find it using their search program, but unable to access it with the above citation. Here it be: [2] captbananas 17:01, 4 May 2006 (UTC)
This is fully 100% true. My brother totaled his Audi in the middle of the night and woke up being shaken by an EMT. He can't remember ever leaving the apartment, but he left his door wide open. Coolgamer 17:11, 20 November 2006 (UTC)

[edit] Treatment of "Persistent Vegetative State" patients

Nature today is reporting an "off label" use for this drug which bizzarely enough allows patients normally unresponsive to stimuli after brain injuries (i.e. in a PVS) to temporarily regain consciousness and communication. See http://www.nature.com/news/2006/060522/full/060522-9.html

  This story is likely to blow up pretty soon, when the "pro-life" people get hold of it and try to stop an incapable patient from having treatment withdrawn.

I think SlashDot deserve a stab at it too.


Here's another article: http://www.guardian.co.uk/medicine/story/0,,1870279,00.html --BillyTFried 01:41, 13 September 2006 (UTC)

I would like to add to this. Stilnox Abuse is done more easily than one thinks. There is in fact no 'fighting to stay awake', Its nothing like that. What Stilnox does is it makes you feel great so that you will go to bed and sleep amazingly. And it does that. It works for me beatifully. Strangely, sometimes I take STilnox and I suddenly find that i'm doing very pro-active things which i asumed this would definetetely not make me do. Its a bit opposit of what I expected! I've been doing some really strange things that I would never have done otherwise, like I decided to make a bookcase out of cardboard for ym studies! --165.146.173.164 23:53, 23 June 2006 (UTC)--165.146.173.164 23:53, 23 June 2006 (UTC)--165.146.173.164 23:53, 23 June 2006 (UTC)Maybe I'll put on the photo of the bookcase I decided to make to get my studues uner ccomplete control

I agree that there is no sleep-promoting effect. There may be a sleep-facilitating effect, but not in the sense that a real "hypnotic" has. What it will do, however, is make you write incoherently, make spelling errors, and do repeated empty edits. Having had the dubious "pleasure" of experiencing brief reactive psychosis, as well as medication-induced psychosis, I would say that zolpidem is not causing psychosis in the true sense of the word. However, it can cause stuff like borderline formal thought disorder along with the vivid multisensory hallucinations, in a dose dependent manner. 80.202.245.183 22:06, 16 February 2007 (UTC)

[edit] Appropriate content?

Is it really a good idea for that to be in a medical article? Seems a little bizarre for people that may come on here to look for real info. Monty2 20:15, 15 August 2006 (UTC)

[edit] half-life

It seems the 2-3 hour half life is different from a couple of kinetics studies I have read, which cite it as much higher (6+ hours). I wonder if anyone can clear this up.

i talk to this guy who has had hallucinations from it now 3 days in a row, he took 10mg 3 days ago —Preceding unsigned comment added by 83.254.133.100 (talk) 20:20, 14 October 2007 (UTC)

[edit] South African Medical Journal

I added a cite to the South African Medical Journal about its use in PVS, which was the peer-reviewed source for the Guardian and BBC articles. I checked the NEJM article, but it was about a different application. I'll see if it fits into the article.

I wince at a phrase like, "Widespread reproduction of these results would herald a medical revolution in the treatment of PVS." I've seen it before in a lot of drugs that didn't live up to their claims. I usually see this kind of language in drug company press releases, or newspaper articles that copy from those press releases. Would anybody mind if I changed it to something less enthusiastic, or deleted it entirely?

More significantly, what stage of development is it in? Phase I trials, Phase II, Phase III, or approval by the regulatory authorities? Nbauman 13:39, 20 November 2006 (UTC)

Although I've just edited it, I agree with your wincing. This sort of expression of "high hopes" for a drug are often (usually?) misplaced. So I agree that some rewording (hacking?) is in order. Further to the reference you just added, I found the following one on the Web of Knowledge. It's one of 93 so far this year on Zolpidem, but it's the only one I saw that's about PVS.
Clauss R., Nel W. (2006) Drug induced arousal from the permanent vegetative state Neurorehabilitation 21: 23-28
It's not from a journal we get here, but the abstract makes it sound like it should be cited in the main article. Have you come across it before? Cheers, --Plumbago 13:55, 20 November 2006 (UTC)
P.S. For completeness ... --Plumbago 13:55, 20 November 2006 (UTC)
Abstract:Background: Zolpidem is an omega 1 specific indirect GABA agonist that is used for insomnia, but may have efficacy in brain damage. The long term efficacy of zolpidem in the permanent vegetative state is described in three patients.
Method: Two motor vehicle accident patients and one near drowning patient, all of them in the permanent vegetative state for at least three years, were rated according to the Glasgow Coma and Rancho Los Amigos scale before and after zolpidem application. Long term response to daily application of this drug was monitored for 3 - 6 years.
Results: All patients were aroused transiently every morning after zolpidem. Glasgow Coma Scale scores ranged from 6 - 9/15 before to 10 - 15/15 after zolpidem. Rancho Los Amigos Cognitive scores ranged from I - II before to V - VII afterward. Drug efficacy did not decrease and there were no long term side effects after 3 - 6 years daily use.
Conclusion: Zolpidem appears an effective drug to restore brain function to some patients in the permanent vegetative state.

[edit] Registration mark (®)

Can somebody explain to me why you use the registration mark (®)?

Lawyers explained to me that for legal reasons, trademark holders are effectively required to use that symbol every time they use a trademark, in a work that's under their control, or otherwise they could lose the trademark, like Aspirin and Formica did. Other people who are not under the trademark holder's control have no obligation or reason to use the symbol. In fact, medical journals and textbooks never use the symbol if they use the JAMA style sheet. It makes it look like you're under the control of the trademark owner.

Do you want it like this, or would you rather delete it? Nbauman 13:46, 20 November 2006 (UTC)

Beats me. It was in there already when I edited earlier. I've left it in, but it may just be an artifact of someone cutting and pasting from a drug company website. Cheers, --Plumbago 13:55, 20 November 2006 (UTC)
Thanks for the link to MOS:TRADE. I think it's clear that we don't use the registration mark. I just checked my Merck Manual and they don't use it either, even for drugs like Adriamycin, which you have to identify because it's used in abbreviations like "CA". The Merck Manual refers to it as "doxorubicin (Adriamycin)". Nbauman 18:32, 3 November 2007 (UTC)

[edit] Permanent declines in memory and cognitive functioning?

Are there any studies that report permanent declines in memory and cognitive functioning after discontinuing use of Zolpidem? —Preceding unsigned comment added by 83.250.15.157 (talk) 18:14, 30 September 2007 (UTC)

[edit] Carcinogenicity

I have some real problems with the recently added section on carcinogenicity. The way it is written implies a proven causality between zolpidem and a raft of different cancers. The paper (which appears to be un-refereed and written by a long-term critic of sleeping pills) describes a meta-analysis of various studies in which cancers were incidentally reported among patients taking both the drug and the placebo, with the incidence of cancers higher among those on the drug. (It should be noted that zolpidem was only one of several drugs included in the analysis). The author himself points out that there is no proven causality, and that the use of trials which were not designed for this purpose leads to problems in the interpretation. I think reference to this paper should be included in the article, but claims such as zolpidem causes cancer should be deleted. Paul Fisher (talk) 09:58, 16 May 2008 (UTC)

The paper was refereed and peer reviewed. See [3] I agree that it should not say that zolpidem causes cancer as if it is definitively proven. I reworded the opening sentence to say "may cause an increased risk of cancer" which was the conclusion of the author.--Literaturegeek | T@1k? 11:46, 16 May 2008 (UTC)

Thanks - I think your changes are appropriate. Regarding the peer review, the website states "A description of each unit's peer review process accompanies every paper". However, there doesn't seem to be anything accompanying the paper in question. It also looks like the author is also the administrator of the website, so the independence is a little bit in doubt. Anyhow, this is a minor point that I don't want to get into an argument about. Paul Fisher (talk) 03:46, 17 May 2008 (UTC)

No arguments from me. I appreciate you raising these points. I think that they do need to be discussed. I see, perhaps it wasn't peer reviewed. I reduced the size of the reference in question in the article as its peer review status is in doubt and added in a peer reviewed article from the Journal of Clinical Sleep Medicine above it. At the bottom of the paper in question under acknowledgements it says the following; Dr. Kripke's research is supported by the U.S. National Institutes of Health (HL071123, HL07156001, and MH68545) by the Sam and Rose Stein Institute for Research on Aging, and by Scripps Clinic Academic Affairs. I think the paper is still relevant as he does appear to be a serious researcher.--Literaturegeek | T@1k? 13:31, 17 May 2008 (UTC)