1. Aschenbrenner, Diane S. MS, RN


* A sublingual form of zolpidem tartrate (Intermezzo, known in oral form as Ambien) has been approved to treat a form of insomnia in which the person wakes up in the middle of the night and can't return to sleep. It can be taken once per night, as long as there's at least four more hours of sleeping time available.


* As with the oral form of zolpidem tartrate, the drug can cause the patient to get up and engage in complex behaviors, such as sleep driving, while not being fully awake and without any memory of the event in the morning.



Article Content

A sublingual form of zolpidem tartrate has been approved under the trade name Intermezzo for the treatment of a form of insomnia in which the patient wakes up in the middle of the night and can't get back to sleep. This is the first time a sedative has been approved for this specific indication.


Zolpidem has been available in oral form since 1992 under the trade name Ambien. This newer form contains a lower dose of the drug. Patients should take it only if there's at least four more hours before their planned awakening. Zolpidem is a hypnotic with a chemical structure unlike benzodiazepines or barbiturates. Although it interacts with the gamma amino butyric acid-benzodiazepine receptor complex and therefore has pharmacologic properties that are similar to those of benzodiazepines, it doesn't have all of the properties of a benzodiazepine; for instance, the drug causes sedation and promotes sleep, but doesn't produce muscle relaxation and can't treat seizures. A lower dose of zolpidem is used in women than in men because women clear the drug more slowly than men. A lower dose is also required in older adults, patients with hepatic impairment, and patients taking other central nervous system (CNS) depressants.


As with the original form of zolpidem tartrate, this formulation carries the risk of sleep driving and performing other complex behaviors while not being awake. Patients may eat, make phone calls, have sex, or engage in other behaviors after taking zolpidem tartrate but not remember having done so in the morning. Alcohol or concurrent use of other CNS depressants increases the risk of these behaviors.


Nurses should teach patients to place the medication under their tongue and allow the pill to dissolve completely before swallowing. The drug should be taken only once per night. Because food decreases the effectiveness of the drug, patients should be instructed not to take it with or immediately after a meal. Patients should also be instructed not to take zolpidem if they've had any alcohol to drink that day or before bedtime. To read the complete prescribing information for zolpidem, go to