Zolpidem is usually applied 6 months after brain injury or later. There are no reports of its efficacy in the early months after brain damage. The reason for this late efficacy is not known, but it is possibly due to late changes of the brain in response to localised neurotransmitter depletion.
The usual daily dose that has been applied for adults is 10 mg per day or 12.5 mg (Ambien), one hour after breakfast. If too sedating, the dose has been reduced to 5 mg daily or 6.25 mg (Ambien). In children, a 2.5 mg dose has been used. Zolpidem can be supplied by mouth either as a tablet or ground up in powder, applied in yogurt or in a liquid such as orange juice. It can be applied via an enteral feeding tube after a tablet has been ground, suspended in water or salt solution. The dose often has to be re adjusted to achieve optimal effect, especially in the first two months after the start of treatment.
Response to the drug is usually after first application within 30-40 minutes (often faster on enteral application) with a maximum response at 1 hour. The effect lasts for 3-4 hours after application of the medicine. If there is no response after the first dose, the daily application is usually continued for at least 2 weeks and longer if there is a response, even if minimal. There appears to be a clinical benefit following long term daily administration. Zolpidem is often applied on top of other routine medications, which do not have to be changed.
Please note that zolpidem use should occur under medical supervision. It needs to be considered and prescribed by a physician, for example a Neurologist or local Family Practitioner. Although zolpidem is relatively safe, there is a limited information on its long term daily use after brain damage. This is why its use should be monitored by regular clinical follow up, for example every 6 months.
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