Interacts with gamma-aminobutyric acid (GABA)–receptor complexes; not a benzodiazepine. Therapeutic Effects: Improved sleep with decreased latency and increased maintenance of sleep.
Adverse Reactions/Side Effects
CNS: abnormal thinking, behavior changes, depression, hallucinations, headache, sleep-driving. CV: chest pain, peripheral edema. GI: dry mouth, unpleasant taste. Derm: rash.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Monitor and report daytime drowsiness, depression, behavior changes, hallucinations, and “drugged” feelings. Repeated or excessive symptoms may require change in dose or medication.
Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.
Monitor any chest pain and attempt to determine if pain is drug induced or caused by cardiovascular dysfunction (e.g., angina that occurs during exercise).
Guard against falls and trauma (hip fractures, head injury, and so forth). Implement fall-prevention strategies, especially in older adults or if drowsiness and dizziness carry over into the daytime (See Appendix E).
Help patient explore non pharmacologic methods to improve sleep, including relaxation techniques, regular exercise, avoiding caffeine, and so forth.
Instruct patients on prolonged treatment not to discontinue medication without consulting a health care professional. Long-term use can cause tolerance and physical/psychologic dependence, and abrupt withdrawal after 2 or more weeks of use may cause increased sleep loss (rebound insomnia).
Advise patient about the risk of daytime drowsiness and decreased attention and mental focus. Use care if driving or in other activities that require strong concentration.
Caution patient and family/caregivers that “sleepwalking” and other complex activities including driving a car (sleep-driving) may occur while completely asleep. Care should be taken to monitor such activities and prevent access to motor vehicles while under the influence of this drug.
Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.
Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged skin rash, abnormal thoughts, dry mouth, or unpleasant taste.
Absorption: Rapidly absorbed after oral administration.
Metabolism and Excretion: Extensively metabolized by the liver (CYP3A4 and CYP2E1 enzyme systems); metabolites are renally excreted, <10% excreted unchanged in urine.