Skip to main content
Erschienen in: Drugs & Aging 10/2014

01.10.2014 | Short Communication

Pharmacokinetics of Zolpidem from Sublingual Zolpidem Tartrate Tablets In Healthy Elderly Versus Non-Elderly Subjects

verfasst von: David J. Greenblatt, Jerold S. Harmatz, Nikhilesh N. Singh, Frank Steinberg, Thomas Roth, Stephen C. Harris, Ram P. Kapil

Erschienen in: Drugs & Aging | Ausgabe 10/2014

Einloggen, um Zugang zu erhalten

Abstract

Background

Pharmacokinetic parameters of sedative–hypnotic medications can be influenced by age and gender.

Objective

This study analyzed pharmacokinetic parameters of zolpidem, formulated as a sublingual zolpidem tartrate tablet (ZST; Intermezzo®), in healthy elderly males and females (mean age 72 years) and in non-elderly males and females (34 years).

Methods

This was a randomized, single-dose, open-label, two-way crossover study evaluating pharmacokinetic parameters of 1.75 and 3.5 mg dosages of ZST in elderly subjects (n = 22), and 3.5 mg dosages of ZST in non-elderly subjects (n = 24). Main outcome measures were pharmacokinetic parameters, including area under the plasma concentration–time curve (AUC), maximum observed concentration (C max), time to reach C max (T max), elimination half-life (T ½), and apparent oral clearance (CL/F).

Results

Dose proportionality in zolpidem exposure was maintained between 1.75 and 3.5 mg doses for both elderly females and males. With administration of the 3.5 mg dose of ZST to elderly and non-elderly subjects, significantly higher systemic exposure was seen in elderly females (C max +44.6 %, P < 0.01; AUC +40.4 %) compared with non-elderly females. However, systemic exposure was only modestly higher in elderly males compared with non-elderly males. Greater exposure was seen in elderly females compared to males (C max +46.8 %, P < 0.01; AUC +31.4 %). In this study, exposure between non-elderly females and males was equivalent. Changes in T ½ and T max values were not observed, with no significant age effect on oral clearance. There were no apparent differences in tolerability among age and gender groups.

Conclusion

Elderly individuals were found to have higher C max and AUC values compared with non-elderly subjects. C max and AUC were greater in elderly women compared with elderly men.
Literatur
2.
Zurück zum Zitat Bloom HG, Ahmed I, Alessi CA, Ancoli-Israel S, Buysse DJ, Kryger MH, Phillips BA, Thorpy MJ, Vitiello MV, Zee PC. Evidence-based recommendations for the assessment and management of sleep disorders in older persons. J Am Geriatr Soc. 2009;57:761–89.PubMedCrossRefPubMedCentral Bloom HG, Ahmed I, Alessi CA, Ancoli-Israel S, Buysse DJ, Kryger MH, Phillips BA, Thorpy MJ, Vitiello MV, Zee PC. Evidence-based recommendations for the assessment and management of sleep disorders in older persons. J Am Geriatr Soc. 2009;57:761–89.PubMedCrossRefPubMedCentral
3.
5.
Zurück zum Zitat Wilson SJ, Nutt DJ, Alford C, Argyropoulos SV, Baldwin DS, Bateson AN, Britton TC, Crowe C, Dijk DJ, Espie CA, Gringras P, Hajak G, Idzikowski C, Krystal AD, Nash JR, Selsick H, Sharpley AL, Wade AG. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. J Psychopharmacol. 2010;24:1577–601.PubMedCrossRef Wilson SJ, Nutt DJ, Alford C, Argyropoulos SV, Baldwin DS, Bateson AN, Britton TC, Crowe C, Dijk DJ, Espie CA, Gringras P, Hajak G, Idzikowski C, Krystal AD, Nash JR, Selsick H, Sharpley AL, Wade AG. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. J Psychopharmacol. 2010;24:1577–601.PubMedCrossRef
7.
Zurück zum Zitat Greenblatt DJ, Harmatz JS, Shader RI. Clinical pharmacokinetics of anxiolytics and hypnotics in the elderly: therapeutic considerations. Clin Pharmacokinet. 1991;21:165–77, 262–73. Greenblatt DJ, Harmatz JS, Shader RI. Clinical pharmacokinetics of anxiolytics and hypnotics in the elderly: therapeutic considerations. Clin Pharmacokinet. 1991;21:165–77, 262–73.
8.
Zurück zum Zitat Greenblatt DJ, Harmatz JS, von Moltke LL, Wright CE, Shader RI. Age and gender effects on the pharmacokinetics and pharmacodynamics of triazolam, a cytochrome P450 3A substrate. Clin Pharmacol Therapeutics. 2004;76:467–79.CrossRef Greenblatt DJ, Harmatz JS, von Moltke LL, Wright CE, Shader RI. Age and gender effects on the pharmacokinetics and pharmacodynamics of triazolam, a cytochrome P450 3A substrate. Clin Pharmacol Therapeutics. 2004;76:467–79.CrossRef
9.
Zurück zum Zitat Cotreau MM, von Moltke LL, Greenblatt DJ. The influence of age and sex on the clearance of cytochrome P450 3A substrates. Clinical Pharmacokinet. 2005;44:33–60.CrossRef Cotreau MM, von Moltke LL, Greenblatt DJ. The influence of age and sex on the clearance of cytochrome P450 3A substrates. Clinical Pharmacokinet. 2005;44:33–60.CrossRef
10.
Zurück zum Zitat Huedo-Medina TB, Kirsch I, Middlemass J, Klonizakis M, Siriwardena AN. Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration. BMJ. 2012;345:e8343.PubMedCrossRefPubMedCentral Huedo-Medina TB, Kirsch I, Middlemass J, Klonizakis M, Siriwardena AN. Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration. BMJ. 2012;345:e8343.PubMedCrossRefPubMedCentral
11.
12.
Zurück zum Zitat Greenblatt DJ, Harmatz JS, Shader RI. Psychotropic drug prescribing in the United States: extent, costs, and expenditures. J Clin Psychopharmacol. 2011;31:1–3.PubMedCrossRef Greenblatt DJ, Harmatz JS, Shader RI. Psychotropic drug prescribing in the United States: extent, costs, and expenditures. J Clin Psychopharmacol. 2011;31:1–3.PubMedCrossRef
13.
Zurück zum Zitat Bianchetti G, Dubruc C, Thiercelin JF, Bercoff E, Bouchet JL, Emeriau JP, Galperine I, Lambert D, Vandel B, Thebalt JJ. Clinical pharmacokinetics of zolpidem in various psychological and pathological conditions. In: Sauvanet JP, Langer SZ, Morselli PL, editors. Imidazopyridines in sleep disorders: a novel experimental and therapeutic approach. New York: Raven Press; 1988. p. 155–63. Bianchetti G, Dubruc C, Thiercelin JF, Bercoff E, Bouchet JL, Emeriau JP, Galperine I, Lambert D, Vandel B, Thebalt JJ. Clinical pharmacokinetics of zolpidem in various psychological and pathological conditions. In: Sauvanet JP, Langer SZ, Morselli PL, editors. Imidazopyridines in sleep disorders: a novel experimental and therapeutic approach. New York: Raven Press; 1988. p. 155–63.
14.
Zurück zum Zitat Olubodun JO, Ochs HR, von Moltke LL, Roubenoff R, Hesse LM, Harmatz JS, Shader RI, Greenblatt DJ. Pharmacokinetic properties of zolpidem in elderly and young adults: possible modulation by testosterone in men. Br J Clin Pharmacol. 2003;56:297–304.PubMedCrossRefPubMedCentral Olubodun JO, Ochs HR, von Moltke LL, Roubenoff R, Hesse LM, Harmatz JS, Shader RI, Greenblatt DJ. Pharmacokinetic properties of zolpidem in elderly and young adults: possible modulation by testosterone in men. Br J Clin Pharmacol. 2003;56:297–304.PubMedCrossRefPubMedCentral
15.
Zurück zum Zitat Greenblatt DJ, Harmatz JS, von Moltke LL, Wright CE, Durol ALB, Harrel-Joseph LM, Shader RI. Comparative kinetics and response to the benzodiazepine agonists triazolam and zolpidem: evaluation of sex-dependent differences. J Pharmacol Exp Therapeutics. 2000;293:435–43. Greenblatt DJ, Harmatz JS, von Moltke LL, Wright CE, Durol ALB, Harrel-Joseph LM, Shader RI. Comparative kinetics and response to the benzodiazepine agonists triazolam and zolpidem: evaluation of sex-dependent differences. J Pharmacol Exp Therapeutics. 2000;293:435–43.
16.
Zurück zum Zitat Greenblatt DJ, Harmatz JS, Roth T, Singh NN, Moline ML, Harris SC, Kapil RP. Pharmacokinetic profile of buffered sublingual zolpidem compared with oral immediate release zolpidem. Clin Therapeutics. 2013;35:604–11.CrossRef Greenblatt DJ, Harmatz JS, Roth T, Singh NN, Moline ML, Harris SC, Kapil RP. Pharmacokinetic profile of buffered sublingual zolpidem compared with oral immediate release zolpidem. Clin Therapeutics. 2013;35:604–11.CrossRef
17.
Zurück zum Zitat Greenblatt DJ, Harmatz JS, Singh NN, Steinberg F, Roth T, Moline ML, Harris SC, Kapil RP. Gender differences in pharmacokinetics and pharmacodynamics of zolpidem following sublingual administration. J Clin Pharmacol. 2014;54:282–90.PubMedCrossRef Greenblatt DJ, Harmatz JS, Singh NN, Steinberg F, Roth T, Moline ML, Harris SC, Kapil RP. Gender differences in pharmacokinetics and pharmacodynamics of zolpidem following sublingual administration. J Clin Pharmacol. 2014;54:282–90.PubMedCrossRef
18.
Zurück zum Zitat Roth T, Mayleben D, Corser BC, Singh NN. Daytime pharmacodynamic and pharmacokinetic evaluation of low-dose sublingual transmucosal zolpidem hemitartrate. Hum Psychopharmacol. 2008;23:13–20.PubMedCrossRefPubMedCentral Roth T, Mayleben D, Corser BC, Singh NN. Daytime pharmacodynamic and pharmacokinetic evaluation of low-dose sublingual transmucosal zolpidem hemitartrate. Hum Psychopharmacol. 2008;23:13–20.PubMedCrossRefPubMedCentral
19.
Zurück zum Zitat Roth T, Hull SG, Lankford DA, Rosenberg R, Scharf MB. Low-dose sublingual zolpidem tartrate is associated with dose-related improvement in sleep onset and duration in insomnia characterized by middle-of-the-night (MOTN) awakenings. Sleep. 2008;31:1277–84.PubMedPubMedCentral Roth T, Hull SG, Lankford DA, Rosenberg R, Scharf MB. Low-dose sublingual zolpidem tartrate is associated with dose-related improvement in sleep onset and duration in insomnia characterized by middle-of-the-night (MOTN) awakenings. Sleep. 2008;31:1277–84.PubMedPubMedCentral
20.
Zurück zum Zitat Lankford A. Sublingual zolpidem tartrate lozenge for the treatment of insomnia. Expert Rev Clin Pharmacol. 2009;2:333–7.PubMedCrossRef Lankford A. Sublingual zolpidem tartrate lozenge for the treatment of insomnia. Expert Rev Clin Pharmacol. 2009;2:333–7.PubMedCrossRef
21.
Zurück zum Zitat Roth T, Krystal A, Steinberg FJ, Singh NN, Moline M. Novel sublingual low-dose zolpidem tablet reduces latency to sleep onset following spontaneous middle-of-the-night awakening in insomnia in a randomized, double-blind, placebo-controlled, outpatient study. Sleep. 2013;36:189–96.PubMedPubMedCentral Roth T, Krystal A, Steinberg FJ, Singh NN, Moline M. Novel sublingual low-dose zolpidem tablet reduces latency to sleep onset following spontaneous middle-of-the-night awakening in insomnia in a randomized, double-blind, placebo-controlled, outpatient study. Sleep. 2013;36:189–96.PubMedPubMedCentral
22.
Zurück zum Zitat Ownby RL. New approaches in the treatment of short term and middle of the night insomnia: emerging evidence for a role for sublingual zolpidem tablets. Nat Sci Sleep. 2010;2:63–9.PubMedCrossRefPubMedCentral Ownby RL. New approaches in the treatment of short term and middle of the night insomnia: emerging evidence for a role for sublingual zolpidem tablets. Nat Sci Sleep. 2010;2:63–9.PubMedCrossRefPubMedCentral
23.
Zurück zum Zitat Ohayon MM. Nocturnal awakenings and comorbid disorders in the American general population. J Psychiatr Res. 2009;43:48–54.CrossRef Ohayon MM. Nocturnal awakenings and comorbid disorders in the American general population. J Psychiatr Res. 2009;43:48–54.CrossRef
24.
Zurück zum Zitat Ohayon MM. Nocturnal awakenings and difficulty resuming sleep: their burden in the European general population. J Psychosom Res. 2010;69:565–71.PubMedCrossRef Ohayon MM. Nocturnal awakenings and difficulty resuming sleep: their burden in the European general population. J Psychosom Res. 2010;69:565–71.PubMedCrossRef
25.
Zurück zum Zitat Roth T, Berglund P, Shahly V, Shillington AC, Stephenson JJ, Kessler RC. Middle-of-the-night hypnotic use in a large national health plan. J Clin Sleep Med. 2013;9:661–8.PubMedPubMedCentral Roth T, Berglund P, Shahly V, Shillington AC, Stephenson JJ, Kessler RC. Middle-of-the-night hypnotic use in a large national health plan. J Clin Sleep Med. 2013;9:661–8.PubMedPubMedCentral
26.
Zurück zum Zitat von Moltke LL, Greenblatt DJ, Granda BW, Duan SX, Grassi JM, Venkatakrishnan K, Harmatz JS, Shader RI. Zolpidem metabolism in vitro: responsible cytochromes, chemical inhibitors, and in vivo correlations. Br J Clin Pharmacol. 1999;48:89–97.CrossRef von Moltke LL, Greenblatt DJ, Granda BW, Duan SX, Grassi JM, Venkatakrishnan K, Harmatz JS, Shader RI. Zolpidem metabolism in vitro: responsible cytochromes, chemical inhibitors, and in vivo correlations. Br J Clin Pharmacol. 1999;48:89–97.CrossRef
27.
Zurück zum Zitat Greenblatt DJ, von Moltke LL. Gender has a small but statistically significant effect on clearance of CYP3A substrate drugs. J Clin Pharmacol. 2008;48:1350–5.PubMedCrossRef Greenblatt DJ, von Moltke LL. Gender has a small but statistically significant effect on clearance of CYP3A substrate drugs. J Clin Pharmacol. 2008;48:1350–5.PubMedCrossRef
28.
Zurück zum Zitat Verster JC, Roth T. Gender differences in highway driving performance after administration of sleep medication: a review of the literature. Traffic Inj Prev. 2012;13:286–92.PubMedCrossRef Verster JC, Roth T. Gender differences in highway driving performance after administration of sleep medication: a review of the literature. Traffic Inj Prev. 2012;13:286–92.PubMedCrossRef
29.
Zurück zum Zitat Farkas RH, Unger EF, Temple R. Zolpidem and driving impairment—identifying persons at risk. N Engl J Med. 2013;369:689–91.PubMedCrossRef Farkas RH, Unger EF, Temple R. Zolpidem and driving impairment—identifying persons at risk. N Engl J Med. 2013;369:689–91.PubMedCrossRef
30.
Zurück zum Zitat Greenblatt DJ. Sleep-promoting medications: weighing the hazards of use versus non-use. Clin Pharmacol Drug Dev. 2014;3:167–9.CrossRef Greenblatt DJ. Sleep-promoting medications: weighing the hazards of use versus non-use. Clin Pharmacol Drug Dev. 2014;3:167–9.CrossRef
Metadaten
Titel
Pharmacokinetics of Zolpidem from Sublingual Zolpidem Tartrate Tablets In Healthy Elderly Versus Non-Elderly Subjects
verfasst von
David J. Greenblatt
Jerold S. Harmatz
Nikhilesh N. Singh
Frank Steinberg
Thomas Roth
Stephen C. Harris
Ram P. Kapil
Publikationsdatum
01.10.2014
Verlag
Springer International Publishing
Erschienen in
Drugs & Aging / Ausgabe 10/2014
Print ISSN: 1170-229X
Elektronische ISSN: 1179-1969
DOI
https://doi.org/10.1007/s40266-014-0211-3

Weitere Artikel der Ausgabe 10/2014

Drugs & Aging 10/2014 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.