Titre du document / Document title

Clinical pharmacokinetics and pharmacodynamics of zolpidem : therapeutic implications

Auteur(s) / Author(s)

SALVA P. ; COSTA J. ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

Univ. autònoma Barcelona, hosp. univ. Germans Trias i Pujol, clin. pharmacology dep., 08916 Badalona, ESPAGNE

Résumé / Abstract

Zolpidem is an imidazopyridine which differs in structure from the benzodiazepines and zopiclone. It is a strong sedative with only minor anxiolytic, myorelaxant and anticonvulsant properties, and has been shown to be effective in inducing and maintaining sleep in adults. The available evidence suggests that zolpidem produces no rebound or withdrawal effects, and patients have experienced good daytime alertness. Zolpidem 10 mg in non-elderly and a reduced dose of 5mg in elderly individuals are clinically effective. In humans, the major metabolic routes include oxidation and hydroxylation ; none of the metabolites appears to be pharmacologically active. The pharmacological activity of zolpidem results from selective binding to the central benzodiazepine receptors of the ω₁ subtype. Zolpidem is approximately 92% bound to plasma proteins ; absolute bioavailability of zolpidem is about 70%. After single 20 mg oral doses, typical values of pharmacokinetic variables for zolpidem in humans are : a peak plasma concentration of 192 to 324 μg/L occurring 0.75 to 2.6 hours postdose ; a terminal elimination half-life of 1.5 to 3.2 hours ; and total clearance of 0.24 to 0.27 ml/min/kg. Zolpidem pharmacokinetics are unchanged during multiple-dose treatment. Zolpidem pharmacokinetics are not significantly influenced by gender. Clearance of zolpidem in children is 3 times higher than in young adults, and is lower in very elderly people. There are no significant differences in the pharmacokinetic parameters between various racial groups. Dosage reduction appears to be prudent in patients with renal disease, and caution should be exercised when prescribing zolpidem to elderly patients with hepatic impairment. Coadministration of haloperidol, cimetidine, ranitidine, chlorpromazine, warfarin, digoxin or flumazenil do not alter the pharmacokinetics of zolpidem ; flumazenil predictably antagonises the hypnotic effects of zolpidem. Alertness tends to be reduced when cimetidine is combined with zolpidem. Volunteers treated with imipramine plus zolpidem developed anterograde amnesia.

Revue / Journal Title

Clinical pharmacokinetics   ISSN 0312-5963   CODEN CPKNDH 

Source / Source

1995, vol. 29, n^o3, pp. 142-153 (37 ref.)

Langue / Language

Anglais

Editeur / Publisher

Adis international, Auckland, NOUVELLE-ZELANDE  (1976) (Revue)

Mots-clés anglais / English Keywords

Hypnotic ; Psychotropic ; Drug abuse ; Biological activity ; Drug interaction ; Metabolism ; Pharmacokinetics ; Toxicity ; Review ; Single dose ; Multiple dose ; Sedative ;

Mots-clés français / French Keywords

Hypnotique ; Psychotrope ; Abus médicamenteux ; Activité biologique ; Interaction médicamenteuse ; Métabolisme ; Pharmacocinétique ; Toxicité ; Article synthèse ; Dose unique ; Dose répétée ; Zolpidem ; Sédatif ; Imidazo pyridine dérivé ;

Mots-clés espagnols / Spanish Keywords

Hipnótico ; Psicotropo ; Abuso de medicamentos ; Actividad biológica ; Interacción medicamentosa ; Metabolismo ; Farmacocinética ; Toxicidad ; Artículo síntesis ; Dosis única ; Dosis múltiple ; Sedante ;

Localisation / Location

INIST-CNRS, Cote INIST : 15599, 35400005435699.0010