Zolpidem chemical structure
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Ambien

Zolpidem is a prescription drug used for the short-term treatment of insomnia (sleeping pill). It works quickly (usually within 15 minutes) and has a short half-life (2-3 hours), but will last longer in patients with hepatic failure. Some trade names of zolpidem are Ambien®, Stilnox®, Stilnoct®, or Myslee®. more...

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Its sedative effects are similar to those of the benzodiazepines, but it is actually classified as an imidazopyridine, and the anticonvulsant and muscle relaxant effects only appear at 10 and 20 times the dose required for sedation, respectively. For that reason, it has never been approved for either muscle relaxation or seizure prevention. Such drastically increased doses are likely to induce one or more negative side effects, including hallucinations and/or amnesia.

The patent on zolpidem is held by the French pharmacutical corporation Sanofi-Aventis.

Uses

Zolpidem is approved for the short-term treatment of insomnia, but it has been studied for nightly use up to six months in a single-blind, open-label trial published in 1991, an open-label study lasting 180 days published in 1992 (with continued efficacy in patients who had kept taking it as of 180 days after the end of the trial), and in an open-label trial lasting 179 days published in 1993.

The United States Air Force uses zolpidem under trade name Ambien® as "no-go pills" to help the pilots sleep after the mission; another drug used for the same purpose is temazepam (Restoril®). (Cf. the "go-pills", amphetamine served under the name Dexedrine® as a stimulant for the pilots, or its recent modafinil (Provigil®) replacement).

It is also used off-label to treat restless leg syndrome.

As is the case with many prescription sedative/hypnotic drugs, zolpidem is sometimes used by stimulant users to "come down" after the use of stimulants such as methamphetamine, cocaine, methylenedioxymethamphetamine (MDMA), or pharmaceutical amphetamines.

Mechanism of action

In 1990, Pritchett and Seeburg noted that zolpidem binds with high affinity to the α1-, and with medium affinity to the α2- and α3-GABAA receptor subunits, and found that it had no affinity for the α5 subunit. Two years later, zolpidem was noted to have a high affinity for ω1-benzodiazepine receptors, a low affinity for ω2 and a very low affintity for ω3, respectively by Ruano et al in 1992. In other words, it has the highest affinity for ω1 binding sites on α-1GABAA receptor subunits, and it is this that mediates its sedative and weak anticonvulsant properties.

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Deadly combos: taking prescription drugs and herbs together can be risky for your health. Here's what not to mix
From Shape, 3/1/05 by Mary Jane Horton

If you use popular herbal supplements, such as Saint Johnswort, echinacea or even garlic, take note: Combining them with prescription medications may threaten your health, according to recent studies. Drug/herb interactions can interfere with the effectiveness of everything from birth-control pills to antibiotics, and can even cause uncontrolled bleeding, liver damage and death. "People think herbs are 'natural,' so they must be safe. But that isn't always true, especially when they are combined with other substances," says Brent A. Bauer, M.D., director of the Complementary and Integrative Medicine Program at the Mayo Clinic in Rochester, Minn.

"We are just starting to learn about these interactions," Bauer says. "However, much of the information is theoretical, based on what we know about the actions of the drugs and the actions of the herbs."

The chart below details what we do know. For more information on herb-drug interactions, visit mayoclinic.com, herbmed.org and nccam.nih.gov.

Mary Jane Horton is a health writer in Pasadena, Calif., who avoids all supplements to ensure she won't mix the wrong ones.

COPYRIGHT 2005 Weider Publications
COPYRIGHT 2005 Gale Group

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