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Ambien CR
Ambien CR is the extended-release formulation of zolpidem, a medication commonly prescribed for the treatment of insomnia, specifically difficulties with falling asleep and maintaining sleep. As a non-benzodiazepine sedative-hypnotic, Ambien CR works by enhancing the activity of gamma-aminobutyric acid (GABA), a neurotransmitter in the brain that promotes sleep. The extended-release nature of Ambien CR provides a two-layer system: the first layer helps you fall asleep quickly, and the second layer helps you stay asleep throughout the night.
Drug Availability and Controlled Substance Status
Ambien CR is available in oral tablet form, with strengths of 6.25 mg and 12.5 mg. It is classified as a Schedule IV controlled substance in the United States due to its potential for abuse, dependence, and addiction. As a result, Ambien CR is subject to strict prescribing regulations and monitoring.
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Frequently Asked Questions
Can Ambien CR be taken on an empty stomach?
Yes, Ambien CR can be taken on an empty stomach. However, taking it with food, especially a high-fat meal, can delay its onset of action, making it less effective at helping you fall asleep quickly.
How long does Ambien CR take to work?
Ambien CR typically begins to work within 30 minutes, helping you fall asleep more quickly.
Is Ambien CR habit-forming?
Yes, Ambien CR has the potential for dependence, especially with prolonged use. It should be used at the lowest effective dose and for the shortest duration possible under the guidance of a healthcare provider.
What should I do if I miss a dose of Ambien CR?
Ambien CR should only be taken when you are ready to go to bed. If you miss a dose and are still awake, take the dose as soon as possible, but only if you have enough time to sleep for 7-8 hours. If you do not have enough time for a full night's sleep, skip the missed dose.
Comprehensive Drug Guide
How Does Ambien CR Work?
Ambien CR works by binding to GABA-A receptors in the brain, which enhances the inhibitory effects of GABA, a neurotransmitter that slows down brain activity. This action induces sleep and helps maintain sleep throughout the night. The controlled-release formulation allows for a dual action: the initial release helps with falling asleep, while the delayed release helps prevent early awakenings.
What is Ambien CR Used For?
Common Dosages
Ambien CR is commonly available in the following dosages:
- 6.25 mg tablets (for women and elderly patients)
- 12.5 mg tablets (for men and non-elderly patients)
The typical dosing for Ambien CR is:
- Adults: 6.25 mg to 12.5 mg taken once nightly, immediately before bedtime. The lowest effective dose should be used, and the medication should not be taken unless the patient has at least 7-8 hours to devote to sleep.
- Elderly and Debilitated Patients: 6.25 mg taken once nightly before bedtime.
Typical Dosing
FDA Approved Indications
Ambien CR is FDA-approved for the treatment of:
- Insomnia characterized by difficulties with sleep initiation and/or sleep maintenance.
Off-Label Uses
There are no widely recognized off-label uses for Ambien CR.
Who Shouldn't Take Ambien CR?
Ambien CR should not be used in patients with:
- A history of complex sleep behaviors (e.g., sleepwalking, sleep-driving) while taking zolpidem or other sedative-hypnotics
- Severe respiratory impairment
- Known hypersensitivity to zolpidem or any of the components of the drug
Advice From The Pharmacist
Patients taking Ambien CR should:
- Take the medication exactly as prescribed, immediately before bedtime, and only when they can commit to a full night of sleep (7-8 hours).
- Avoid alcohol, as it can increase the sedative effects of Ambien CR and lead to dangerous side effects.
- Be aware of the risk of engaging in activities while not fully awake, such as sleepwalking or sleep-driving. If this occurs, discontinue the medication and contact a healthcare provider.
- Inform their healthcare provider of all other medications they are taking, as certain drugs can interact with Ambien CR and increase the risk of side effects.
Side Effects of Ambien CR
Common Side Effects
Common side effects of Ambien CR include:
- Drowsiness
- Dizziness
- Headache
- Dry mouth
Uncommon/Severe Side Effects
Serious side effects may include:
- Complex sleep behaviors (e.g., sleepwalking, sleep-driving)
- Severe allergic reactions (e.g., anaphylaxis, angioedema)
- Next-day drowsiness or impaired alertness
- Depression or worsening of depression symptoms
Risks and Warnings of Ambien CR
Major risks and warnings associated with Ambien CR include:
- Complex Sleep Behaviors: Ambien CR can cause activities such as sleepwalking, sleep-driving, or other behaviors while not fully awake. These events can lead to serious injury or death. If such behaviors occur, the medication should be discontinued immediately.
- Next-Day Impairment: Even at prescribed doses, Ambien CR can cause next-day drowsiness, impaired alertness, and reduced reaction times. Patients should avoid driving or operating heavy machinery the day after taking Ambien CR if they do not feel fully alert.
- Abuse and Dependence: Ambien CR has the potential for abuse, dependence, and withdrawal symptoms, particularly with prolonged use or use in higher-than-recommended doses.
Interactions with Ambien CR
Common Drug Interactions
Ambien CR may interact with:
- CNS Depressants (e.g., benzodiazepines, opioids): Increased risk of sedation, respiratory depression, and potentially fatal overdose.
- Alcohol: Enhances the sedative effects of Ambien CR, increasing the risk of side effects.
- CYP3A4 Inhibitors (e.g., ketoconazole): May increase the blood levels of zolpidem, leading to enhanced effects and increased risk of side effects.
Patients should inform their healthcare provider of all medications, supplements, and herbal products they are taking to avoid potential drug interactions.
Alternatives to Ambien CR
Alternative medications to Ambien CR include:
- Lunesta (eszopiclone): Another non-benzodiazepine sedative-hypnotic used for the treatment of insomnia.
- Sonata (zaleplon): A short-acting sedative-hypnotic used for difficulty falling asleep.
- Trazodone: An antidepressant with sedative properties, sometimes used off-label for insomnia.
