Can We Identify Persons on Zolpidem at Risk for Driving Mishap?
November 1, 2013 less than 1 minute read
Benzodiazepines can impair consciousness. It has been recognized that the elderly — and anyone with renal impairment because they metabolize zolpidem (ZOL) more slowly — should receive a lower dose (ZOL 5 mg) than other adults (ZOL 10 mg). Soon after the advent of immediate-release ZOL, a controlled-release formulation became available. Prospective studies of ZOL indicated that plasma levels > 50 ng/mL were associated with impairment in driving skills. As formulations of ZOL evolved, pharmacokinetic studies found that the 10 mg approved dose of immediate-release ZOL was associated with ZOL levels > 50 ng/dL in as many as 15% of women (who metabolize ZOL more slowly).
Recognition of the potential for ZOL to produce impairment in driving has resulted in FDA recommendations for dose reductions in various ZOL formulations, especially in women.
Insomnia and other sleep disorders are, of course, associated with an increased risk of auto accidents due to excessive daytime sleepiness. Clinicians should maintain vigilance that appropriate dose limitations are observed — since patients often do not perceive the impairment induced by benzodiazepines — and that patients do not drive sooner than the recommended interval after taking their dose of medication.
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