Zaleplon

INTRODUCTION

Indications

Short-term management of insomnia in patients unable to get at least 4 hr of sleep; especially useful in sleep initiation disorders.

Action

Produces CNS depression by binding to gamma-aminobutyric acid (GABA) receptors in the CNS. Has no analgesic properties. Therapeutic Effects: Sedation and induction of sleep.

Adverse Reactions/Side Effects

CNS: abnormal thinking, amnesia, anxiety, behavior changes, depersonalization, dizziness, drowsiness, hallucinations, headache, impaired memory (briefly following dose), impaired psychomotor function (briefly following dose), malaise, sleep driving, vertigo, weakness. EENT: abnormal vision, ear pain, epistaxis, hearing sensitivity, ocular pain, altered sense of smell. CV: peripheral edema. GI: abdominal pain, anorexia, colitis, dyspepsia, nausea. GU: dysmenorrhea. Derm: photosensitivity. Neuro: hyperesthesia, paresthesia, tremor. Misc: fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor daytime drowsiness, anxiety, behavior changes, short-term memory deficits, hallucinations, and “drugged” feelings. Repeated or excessive symptoms may require change in dose or medication.

• Assess dizziness and vertigo that affects gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Assess signs of paresthesia (numbness, tingling), tremor, or abnormal sensitivity to touch or temperature (hyperesthesia). Perform objective tests, including electroneuromyography and sensory testing, to document any drug-related neuropathic changes.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth). Implement fall-prevention strategies, especially in older adults or if drowsiness and dizziness carry over into the daytime (See Appendix E).

• Help patient explore nonpharmacologic methods to improve sleep, such as relaxation techniques, regular exercise, avoid caffeine, and so forth.

• Causes photosensitivity; use care if administering UV treatments. Advise patient to avoid direct sunlight and use sunscreens and protective clothing.

Patient/Client-Related Instruction

• Instruct patients on prolonged treatment not to discontinue medication without consulting their physician. Long-term use can cause tolerance and physical/psychologic dependence, and abrupt withdrawal after 2 or more weeks of use may result in fatigue, nausea, flushing, light-headedness, uncontrolled crying, vomiting, GI upset, panic attack, or nervousness.

• Advise patient about the risk of daytime drowsiness and decreased attention and mental focus. Use care if driving or in other activities that require strong concentration.

• Caution patient and family/caregivers that “sleepwalking” and other complex activities, including driving a car (sleep driving), may occur while completely asleep. Care should be taken to monitor such activities and prevent access to motor ...