Ambien, Ambien CR
Produces CNS depression by binding to gamma-aminobutyric acid (GABA) receptors. Has no analgesic properties. Therapeutic Effects: Sedation and induction of sleep.
Adverse Reactions/Side Effects
CNS: abnormal thinking, amnesia, behavior changes, daytime drowsiness, dizziness, “drugged” feeling, hallucinations, sleep driving. GI: diarrhea, nausea, vomiting. Misc: ANAPHYLACTIC REACTIONS, hypersensitivity reactions, physical dependence, psychologic dependence, tolerance.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Monitor signs of hypersensitivity reactions and anaphylaxis, including pulmonary symptoms (laryngeal edema, wheezing, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.
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 that might affect 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.
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.
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 vehicles while under the influence of this drug.
Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.
Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged GI problems (nausea, vomiting, diarrhea), abnormal thoughts, or other bizarre behaviors.
Absorption: Rapidly absorbed following oral administration. Controlled-release formulation releases 10 mg immediately, then another 2.5 mg later.
Distribution: Minimal amounts enter breast milk; remainder of distribution not known.
Metabolism and Excretion: Converted to inactive metabolites, which are excreted by the kidneys.