Short-term (up to 4 wk) management of insomnia.
Depresses the CNS, probably by potentiating gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter. Therapeutic Effects: Relief of insomnia.
Adverse Reactions/Side Effects
CNS: abnormal thinking, behavior changes, daytime drowsiness, confusion, dizziness, hallucinations, headache, insomnia, nervousness, sleep driving, slurred speech, weakness. EENT: blurred vision. CV: palpitations. GI: abdominal pain, constipation, diarrhea, dry mouth, nausea, vomiting. GU: urinary frequency, urinary hesitancy. Derm: itching, skin rash. MS: muscle spasm. Neuro: ataxia, trembling. Misc: allergic reactions, changes in libido, physical dependence, psychologic dependence, tolerance.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Monitor daytime drowsiness, short-term memory deficits, slurred speech, and “hangover” symptoms (headache, nausea, malaise, irritability, dysphoria). Repeated or excessive symptoms may require change in dose or medication.
Assess any muscle spasms to rule out musculoskeletal pathology; that is, try to determine if symptoms are drug induced rather than caused by anatomic or biomechanical problems.
Monitor signs of allergic reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.
Assess dizziness or ataxia that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.
Report any behavioral or personality changes such as confusion, nervousness, hallucinations, or expression of abnormal thoughts.
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 nonpharmacologic methods to improve sleep, such as relaxation techniques, regular exercise, avoid caffeine, and so forth.
Instruct patients on prolonged treatment not to discontinue medication without consulting their physician. Long-term use can cause tolerance and physical/psychologic dependence, and increased sleep problems (rebound insomnia) can occur when the drug is suddenly discontinued.
Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.
Caution patient and family/caregivers to guard against complex motor behaviors that can occur while asleep, including driving a car (sleep driving).
Instruct patient to report other bothersome side effects including severe or prolonged headache, blurred vision, palpitations, problems with urination, change in libido, skin reactions (rash, itching), or GI problems (nausea, vomiting, constipation, diarrhea, dry mouth, abdominal pain).
Absorption: Well absorbed after oral administration.
Metabolism and Excretion: Mostly metabolized ...