Zolpidem, a Valuable Alternative to Benzodiazepine Hypnotics for Chronic Insomnia?

Abstract

Sleep quality and anxiety levels were examined using questionnaires and polysomnographic recordings in 22 chronic insomnia patients who regularly used benzodiazepines to treat their sleeping problems. After abruptly discontinuing their benzodiazepine medication, patients were randomly allocated to receive either a placebo or zolpidem 10 mg for 1 week, after which they entered an open extension phase, receiving zolpidem 10 mg for 3 weeks. Subjectively, sleep quality was considered mediocre during the use of a benzodiazepine hypnotic. One week after the discontinuation, an increase in sleep latency was observed in the placebo group, whereas zolpidem induced a significant decrease in sleep latency. Deterioration of other sleep variables (probably rebound) was not suppressed by zolpidem. An explanation for this could be the selective pharmacological profile of zolpidem. Polysomnographic differences between placebo and benzodiazepine and between placebo and zolpidem were not reflected by the subjective data on sleep and anxiety. Changes of sleep structure caused by hypnotics seem not always to be felt as such by patients. After 3 – 4 weeks of zolpidem treatment, the percentage of non-rapid eye movement-4 sleep increased significantly, corresponding with a significant subjective improvement of sleep quality. This indicates that zolpidem may restore physiological sleep.

Effects of Zolpidem CR on Sleep and Nocturnal Ventilation in Patients with Heart Failure

“…24 Zolpidem is as effective as benzodiazepines in decreasing sleep latency and prolonging TST in patients with insomnia. 25,26 In fact, our study showed that in patients with ischemic HF, zolpidem CR prolongs TST by an average of 16% compared to placebo. We also observed a trend toward an increase in sleep efficiency compared with placebo (P = 0.06).…”

Pharmacological class interventions for benzodiazepine withdrawal discontinuation: a meta-analysis

“…The GABAA -PAM included four trials. Alpidem (46,47), and zolpidem (48,49) clustered into their pharmacology class showed limited efficacy in alleviating withdrawal symptoms (e.g., withdrawal insomnia) during BZD discontinuation, but the effect size was small, and the result was not statistically significant (d= 0.108, p=0.479). Heterogeneity was small: I 2 = 8.261%.…”

Use of Imidazo[1,2‐a]pyridine as a Carbonyl Surrogate in a Mannich‐Like, Catalyst Free, One‐Pot Reaction

“…The imidazo [1,2-a]pyridine heterocycle is of particular interest for medicinal chemistry because of its therapeutic applications [11] including anti-cancer, [12][13][14][15] antiviral, [16][17][18] antibacterial, [19,20] anti-inflammatory [21] and sedation. [22,23] Having six positions for suitable derivatization and possible bioisosterism with indole and benzimidazole adds to the therapeutic utility of imidazo [1,2-a]pyridine. [14,24] The imidazo [1,2-a]pyridine heterocycle is also in several marketed drugs such as zolpidem, minodronic acid, and olprinone ( Figure 1).…”

“…The imidazo[1,2‐ a ]pyridine heterocycle is of particular interest for medicinal chemistry because of its therapeutic applications including anti‐cancer, antiviral, antibacterial,, anti‐inflammatory and sedation , . Having six positions for suitable derivatization and possible bioisosterism with indole and benzimidazole adds to the therapeutic utility of imidazo[1,2‐ a ]pyridine , .…”