Zolpidem in the treatment of adult and elderly primary insomnia patients

Abstract

The present section discusses the place of zolpidem in the treatment of primary insomnia including its new delivery formulations. The drug mechanism of action is first briefly reviewed. Then the pharmacokinetic, metabolic, and therapeutic properties of zolpidem are examined with a special focus on new delivery formulation such as extended-release and sublingual forms. The sleep-inducing effect of zolpidem has been convincingly demonstrated in various population and settings. Efficacy results coming from well-designed placebo-controlled clinical trials in chronic and/or primary insomnia show that the drug improves both subjective and objective sleep parameters such as sleep latency, wake after sleep onset, number of awakenings, total sleep time, sleep efficiency, sleep quality, and daytime functioning. Studies investigating intermittent and as needed administration of zolpidem as well as their combination with cognitive behavioral therapy indicate the usefulness of these approaches. Finally, zolpidem tolerability data are discussed and it is concluded that, when administered according to the manufacturer's prescribing information, zolpidem is well tolerated and associated with minimal rebound insomnia and a low propensity to cause next-day residual effects, drug abuse, or dependence.