General

**BEERS Drug**

Pronunciation:
za-lep-lon

Trade Name(s)

• Sonata

Ther. Class.

sedative/hypnotics

Controlled Substance Schedule: IV

Indications

Short-term management of insomnia in patients unable to get ≥4 hr of sleep; especially useful in sleep initiation disorders.

Action

• Produces CNS depression by binding to GABA receptors in the CNS.
• Has no analgesic properties.

Therapeutic Effect(s):

Induction of sleep.

Pharmacokinetics

Absorption: Rapidly absorbed following oral administration.

Distribution: Well distributed to tissues.

Metabolism and Excretion: Extensively metabolized in the liver (mostly by aldehyde oxidase and some by the CYP3A4 isoenzyme).

Half-life: 1 hr.

TIME/ACTION PROFILE

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity;
• Black Box:  History of experiencing complex sleep behaviors with zaleplon;
• Severe hepatic impairment;
• OB:   Pregnancy;
• Lactation:  Lactation.

Use Cautiously in:

• Mild or moderate hepatic impairment or weight ≤50 kg (initiate therapy at lowest dose);
• Impaired respiratory function;
• History of suicide attempt;
• Pedi:  Safety and effectiveness not established in children;
• Geri:   Appears on Beers list. ↑ risk of cognitive impairment, delirium, falls, fractures, and motor vehicle accidents in older adults. Avoid use in older adults.

Adverse Reactions/Side Effects

CV: peripheral edema

Derm: photosensitivity

EENT: abnormal vision, altered sense of smell, ear pain, epistaxis, hearing sensitivity, ocular pain

GI: abdominal pain, anorexia, colitis, dyspepsia, nausea

GU: dysmenorrhea

Neuro: abnormal thinking, amnesia, anxiety, behavior changes, COMPLEX SLEEP BEHAVIORS (including sleep driving, sleep walking, or engaging in other activities while sleeping), depersonalization, dizziness, drowsiness, hallucinations, headache, hyperesthesia, impaired memory (briefly following dose), impaired psychomotor function (briefly following dose), malaise, nightmares, paresthesia, tremor, vertigo, weakness

Misc: fever

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

•  Cimetidine  may ↑ levels and risk of toxicity; initiate therapy at a lower dose.
• Additive CNS depression with other  CNS depressants, including  alcohol,  antihistamines,  opioid analgesics, other  sedative/hypnotics,  phenothiazines, and  tricyclic   antidepressants.
•  CYP3A4 inducers, including  rifampin,  phenytoin,  carbamazepine, and  phenobarbital, may ↓ levels and effectiveness.

Drug-Natural Products:

 Kava-kava,  valerian,  chamomile, or  hops  can ↑ risk of CNS depression.

Drug-Food:

Concurrent ingestion of a high-fat meal slows the rate of absorption.

Route/Dosage

PO (Adults  <65 yr): 10 mg (range 5–20 mg) at bedtime.

Hepatic Impairment 
PO (Adults): Initiate therapy at 5 mg at bedtime (not to exceed 10 mg at bedtime).

Availability (generic available)

Capsules: 5 mg, 10 mg

Assessment

• Assess mental status, sleep patterns, and potential for abuse prior to administering this medication. Zaleplon is used to treat short-term difficulty in falling asleep; ↓ time to sleep onset. May not ↑ total sleep time or ↓ number of wakenings after falling asleep. Prolonged use of >7–10 days may lead to physical and psychological dependence. Limit amount of drug available to the patient.
• Assess patient for pain and medicate as needed. Untreated pain ↓ sedative effect.
• Assess for complex sleep behaviors (sleep-walking, sleep-driving, or engaging in activities while not fully awake). May cause serious injuries and even death; if these behaviors occur, discontinue immediately if identified.

Implementation

• Do not confuse Sonata with Soriatane.

• Before administering, reduce external stimuli and provide comfort measures to ↑ effectiveness.

  • Protect patient from injury. Supervise ambulation and transfer of patient after administration. Remove any cigarettes. Side rails should be raised and call bell within reach at all times.
• PO  DNC: Tablets should be swallowed whole with full glass of water immediately before bedtime or after going to bed and experiencing difficulty falling asleep.  Do not administer with or immediately after a high-fat or heavy meal.

Patient/Family Teaching

• Explain purpose and side effects of medication. Advise patient to read  Patient Information  before starting therapy.
• Instruct patient not to take more than the amount prescribed because of the habit-forming potential. Not recommended for use longer than 7–10 days. Rebound insomnia (1–2 nights) may occur when stopped. If used for ≥2 wk, abrupt withdrawal may result in dysphoria, insomnia, abdominal or muscle cramps, vomiting, sweating, tremors, and seizures.
• Because of rapid onset, advise patient to go to bed immediately after taking zaleplon.
• May cause daytime drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to this medication is known.
• Inform patient that amnesia may occur, but can be avoided if only taken when they can get >4 hr sleep.
• Caution patient that complex sleep-related behaviors (sleep-driving, making phone calls, preparing and eating food, having sex, sleep walking) may occur while asleep. Inform patient to notify health care provider if sleep-related behaviors (may include sleep-driving: driving while not fully awake after ingestion of a sedative-hypnotic product, with no memory of the event) occur.
• Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other medications.
• Caution patient to avoid concurrent use of alcohol or other CNS depressants, including opioids.
• Rep:  May cause fetal harm. Use is not recommended during pregnancy or breastfeeding. Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

Improved ability to fall asleep; ↓ time to sleep onset.