Hypnogen

Hypnogen (zolpidem) is a medication used to treat insomnia. Zolpidem belongs to a class of medications known as hypnotics or sleep aids. It works by affecting chemicals in the brain that may be disrupted in people with insomnia, and helps improve sleep quality.

Zolpidem is usually taken before bedtime and helps reduce the time it takes to fall asleep. The drug may also help reduce awakenings during the night. The drug is usually used only for a short period of time to avoid dependence or decreased effectiveness over time.

Although zolpidem may be effective in treating insomnia, it should be taken under a doctor's supervision and dosage instructions should be followed strictly to avoid side effects or dependence.

Indications Hypnogen

1. Insomnia: Hypnogen is used to help people fall asleep or stay asleep. This can include taking more than 30 minutes to fall asleep, waking up in the middle of the night, and having trouble getting back to sleep.
2. Short-term sleep problems: Zolpidem may be useful for treating short-term sleep problems, such as stress, changes in routine, or travel that may temporarily disrupt sleep.
3. Sleep Disorders: Hypnogen may also be recommended for those who have diagnosed sleep disorders such as restless legs syndrome or obstructive sleep apnea.

Release form

Hypnogen, which contains zolpidem, is usually available as tablets for oral use.

Pharmacodynamics

Zolpidem belongs to a class of hypnotic drugs used to treat insomnia. It is a benzodiazepine-type receptor agonist that acts on one of the GABA-A receptor subtypes.

GABA-A receptors are receptors for gamma-aminobutyric acid (GABA), the main inhibitory neurotransmitter in the central nervous system. Activation of these receptors results in increased inhibitory activity of neurons and decreased excitation.

Zolpidem enhances the inhibitory effect of GABA, reduces the time it takes to fall asleep, increases the duration of sleep and improves its structure, reduces the time it takes to wake up at night and increases the total duration of sleep.

Pharmacokinetics

1. Absorption: Zolpidem is rapidly and completely absorbed from the gastrointestinal tract after oral administration. Peak plasma concentrations are usually reached within 1 hour after administration.
2. Metabolism: Zolpidem is metabolized in the liver to form active metabolites. The main metabolite is α-hydroxyzolpidem, which also has hypnotic properties.
3. Excretion: Zolpidem metabolites and zolpidem itself are excreted primarily via the kidneys. Elderly patients and patients with impaired renal function may experience slower elimination.
4. Elimination half-life: The elimination half-life of zolpidem in the body is approximately 2-3 hours, and for its metabolites it is approximately 2.5-4.5 hours.
5. Interactions: Zolpidem may interact with other centrally acting drugs, alcohol and CNS depressants, which may enhance its sedative effect. It is also important to consider possible interactions with drugs metabolized via the cytochrome P450 system.
6. Clinical aspects: The dosage of zolpidem is usually selected individually, taking into account age, gender, the presence of concomitant diseases and other factors. It is important to follow the doctor's recommendations and not to exceed the recommended dose.

Dosing and administration

1. Directions for use:

   • Hypnogen tablets are taken orally, whole, with a small amount of water.
   • The drug should be taken immediately before bedtime or a little before the planned bedtime.
   • The tablet should not be chewed, divided or broken, as this may affect the rate and extent of absorption of the drug.

2. Dosage:

   • The dosage of Hypnogen (zolpidem) may vary depending on the individual characteristics of the patient, the severity of insomnia and the doctor's recommendations.
   • It is generally recommended to start with the lowest effective dose to reduce the risk of side effects.
   • For adults, the usual starting dose is 5-10 mg at bedtime.

3. Duration of treatment:

   • The duration of treatment with Hypnogen is usually short, usually no more than 1-2 weeks.
   • The drug should be used only for medical reasons and under the supervision of a physician.

Use Hypnogen during pregnancy

Use of Hypnogen during pregnancy may increase the risk of some adverse pregnancy outcomes, but data are variable and caution is warranted when using this drug.

1. Placental transfer: Hypnogen is able to cross the placenta and reach the fetal circulation, which could potentially affect the fetus. A study noted that pregnant women with psychiatric illnesses taking zolpidem had less optimal obstetric outcomes, although the exact reason for this was not determined (Jurić et al., 2009).
2. Risk of birth defects: A study evaluating the association between zolpidem use in the first trimester of pregnancy and specific birth defects was conducted. No significant increase in risk was found, but small increases in risk for specific defects cannot be ruled out (Howley et al., 2023).
3. Increased risk of adverse pregnancy outcomes: Some studies show an increased risk of preterm birth, low birth weight babies, and other complications in women taking zolpidem during pregnancy (Wang et al., 2010).

Contraindications

1. Hypersensitivity: People with known hypersensitivity to zolpidem or other ingredients of the drug should avoid using it.
2. Allergic reactions: If you have previously had allergic reactions to zolpidem or similar drugs such as zolpidem tartrate, you should avoid using it.
3. Breathing problems: Using zolpidem may make breathing problems worse, especially in people with obstructive sleep apnea (stopping breathing during sleep) or obstructive sleep apnea syndrome.
4. Liver problems: Zolpidem is metabolized in the liver, so its use may be contraindicated in people with severe liver dysfunction.
5. Alcohol or other drug intoxication: Use of zolpidem in combination with alcohol or other centrally acting drugs may increase the risk of complications and increase central nervous system depression.
6. Pregnancy and breastfeeding: Zolpidem is not recommended for use during pregnancy or breastfeeding unless the benefit outweighs the potential risk to the baby.
7. Mental Health Problems: In people with a history of drug or alcohol addiction or mental illness, the use of zolpidem may be undesirable or require special caution.

Side effects Hypnogen

1. Daytime sleepiness: This is one of the most common side effects of zolpidem. After using the drug, some people may still feel sleepy during the day, which can make it difficult to perform daily tasks.
2. Dizziness or feeling light-headed: Some patients may experience dizziness after using zolpidem.
3. Difficulty with motor coordination: Zolpidem may cause problems with motor coordination and impairment of motor skills.
4. Restless dreams or nightmares: Some people may have unusual dreams, including restless dreams or nightmares, after taking zolpidem.
5. Memory and concentration problems: Some patients may experience memory and concentration problems after using zolpidem.
6. Increased appetite or changes in taste: In rare cases, some people may experience an increased appetite or changes in taste preferences.
7. Slowing down or depression of breathing: This side effect is rare but may occur, especially in people with breathing problems or in patients taking other drugs that can suppress breathing.

Overdose

Symptoms of a zolpidem overdose may include:

1. Severe drowsiness or fainting.
2. A deep and prolonged sleep from which it is difficult to awaken.
3. Slowing of breathing and heart rate.
4. Lethargy, depression of the central nervous system.
5. Loss of consciousness or coma.

Interactions with other drugs

1. Centrally acting drugs and alcohol: Concomitant use of zolpidem with other centrally acting drugs or alcohol may enhance its sedative and depressant effects on the central nervous system. This may lead to an increased risk of drowsiness, lethargy, respiratory depression, and other undesirable effects.
2. CNS depressant drugs: Drugs that also have a central nervous system depressant effect, such as opioids, benzodiazepines, antidepressants, and antihistamines, may enhance the sedative effects of zolpidem.
3. Drugs metabolized via the cytochrome P450 system: Zolpidem is metabolized in the liver via cytochrome P450 enzymes. Therefore, drugs that are also metabolized via this system (e.g., some antibiotics, antifungals, antiepileptics, and antifungals) may affect the blood concentration of zolpidem and its level of effectiveness.
4. Drugs that affect gastrointestinal pH: Drugs or substances that alter gastrointestinal pH (eg, antacids, antiulcer drugs, prokinetics) may alter the rate and extent of absorption of zolpidem, which may affect its effectiveness.
5. Drugs that increase urine production: Diuretics can speed up the elimination of zolpidem from the body, which may reduce its effectiveness.