uses of order cheap stillnox 10mg near me
order cheap stillnox 10mg near me online, sold under the brand name Ambien, among others, is a medication primarily used for the short-term treatment of sleeping problems. Guidelines recommend that it be used only after cognitive behavioral therapy for insomnia and behavioral changes, such as sleep hygiene, have been tried. It decreases the time to sleep onset by about fifteen minutes and at larger doses helps people stay asleep longer. It is taken by mouth and is available in conventional tablets, sublingual tablets, or oral spray.
side effects of order cheap stillnox 10mg near me online
Common side effects of order cheap stillnox 10mg near me include daytime sleepiness, headache, nausea, and diarrhea.[7] More severe side effects include memory problems and hallucinations.[5] The previously recommended dose was decreased in 2013, by the US Food and Drug Administration (FDA), to the immediate-release 10 mg for men, and 5 mg for women, in an attempt to reduce next-day somnolence. Newer extended-release formulations include the 6.25 mg for women, and 12.5 mg or 6.25 mg for men, which also cause next-day somnolence when used in higher doses.[medical citation needed] Additionally, driving the next morning is not recommended with either higher doses or the long-acting formulation. While flumazenil, a GABAA–receptor antagonist, can reverse zolpidem’s effects, usually supportive care is all that is recommended in overdose.
visit website…https://lapharmacyonline.com/product/buy-affordable-stillnox-10mg-online/
order cheap stillnox 10mg near me online is a nonbenzodiazepine Z drug which acts as a sedative and hypnotic. buy affordable Stillnox 10mg onlinen is a GABAA receptor agonist of the imidazopyridine class.[7] It works by increasing GABA effects in the central nervous system by binding to GABAA receptors at the same location as benzodiazepines.[7] It generally has a half-life of two to three hours. This, however, is increased in those with liver problems.
order cheap stillnox 10mg near me online,
order cheap stillnox 10mg near me online was approved for medical use in the United States in 1992. It became available as a generic medication in 2007. Zolpidem is a Schedule IV controlled substance under the Controlled Substances Act of 1970 (CSA). More than ten million prescriptions are filled a year in the United States, making it one of the most commonly used treatments for sleeping problems. In 2019, it was the 47th most commonly prescribed medication in the United States, with more than 15 million prescriptions.
order cheap stillnox 10mg near me online (zolpidem tartrate) sublingual tablets are indicated for the short-term treatment of insomnia characterized by difficulties with sleep initiation.
The clinical trials performed with Zolpidem tartrate in support of efficacy were 4-5 weeks in duration with the final formal assessments of sleep latency performed at the end of treatment.
Short term treatment of insomnia in adults.
Benzodiazepines or benzodiazepine-like agents are only indicated when the disorder is severe, disabling or subjecting the individual to extreme distress.
The short-term treatment of insomnia in adults in situations where the insomnia is debilitating or is causing severe distress for the patient.
order cheap stillnox 10mg near me online (zolpidem tartrate extended-release tablets) is indicated for the treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance (as measured by wake time after sleep onset).
The clinical trials performed in support of efficacy were up to 3 weeks (using polysomnography measurement up to 2 weeks in both adult and elderly patients) and 24 weeks (using patient-reported assessment in adult patients only) in duration.
order cheap stillnox 10mg near me online (zolpidem tartrate) Oral Spray is indicated for the short-term treatment of insomnia characterized by difficulties with sleep initiation. Zolpidem tartrate has been shown to decrease sleep latency for up to 35 days in controlled clinical studies. The clinical trials performed in support of efficacy were 4-5 weeks in duration with the final formal assessments of sleep latency performed at the end of treatment.
order cheap stillnox 10mg near me online is one of the most popular sleep-inducing drugs. In the US it’s marketed as Ambien and in most parts of the world, it’s known as Zolpiderm—derived from its main active ingredient Zolpidem tartrate. It is the properties of this compound that allows Stillnox to bind and activate specific regions of the brain responsible for sleep.
order cheap stillnox 10mg near me online is used to help individuals with sleep deprivation and can only be prescribed by certified medical practitioners. It is very important to get enough information on how and when to take the drug since its abuse may come with undesirable ailments.
order cheap stillnox 10mg near me online Dosage In Adults
Use the lowest effective dose for the patient. The recommended initial dose is 5 mg for women and either 5 or 10 mg for men, taken only once per night immediately before bedtime with at least 7-8 hours remaining before the planned time of awakening. If the 5 mg dose is not effective, the dose can be increased to 10 mg. In some patients, the higher morning blood levels following use of the 10 mg dose increase the risk of next day impairment of driving and other activities that require full alertness. The total dose of order cheap stillnox 10mg near me should not exceed 10 mg once daily immediately before bedtime.
The recommended initial doses for women and men are different because zolpidem clearance is lower in women.
Special Populations
Elderly or debilitated patients may be especially sensitive to the effects of order cheap stillnox 10mg near me online tartrate. Patients with hepatic insufficiency do not clear the drug as rapidly as normal subjects. The recommended dose of order cheap stillnox 10mg near me in both of these patient populations is 5 mg once daily immediately before bedtime.
Use With CNS Depressants
Dosage adjustment may be necessary when order cheap stillnox 10mg near me online is combined with other CNS-depressant drugs because of the potentially additive effects.
Administration
The effect of order cheap stillnox 10mg near me online may be slowed by ingestion with or immediately after a meal.
order cheap stillnox 10mg near me online sublingual tablet should be placed under the tongue, where it will disintegrate. The tablet should not be swallowed and the tablet should not be taken with water.
For oral administration.
Treatment should be as short as possible. Generally the duration of treatment varies from a few days to two weeks with a maximum, including the tapering off process, of four weeks. The tapering off process should be tailored to the individual.
As with all hypnotics, long-term use is not recommended and a course of treatment should not exceed four weeks. In certain cases extension beyond the maximum treatment period may be necessary; if so, it should not take place without re-evaluation of the patient’s status.
The product acts rapidly and therefore should be taken with fluid just before going to bed, or in bed.
Adults
The treatment should be taken in a single intake and not be re-administered during the same night.
The recommended daily dose for adults is 10 mg to be taken immediately at bedtime. The lowest effective daily dose of order cheap stillnox 10mg near me should be used and must not exceed 10 mg.
Elderly (over 65 years) or debilitated patients
Elderly or debilitated patients may be especially sensitive to the effects of Stilnox therefore a 5 mg dose is recommended. These recommended doses should not be exceeded.
Hepatic impairment
Patients with hepatic insufficiency do not clear the drug as rapidly as normal individuals; therefore dosage should begin at 5 mg in these patients with particular caution being exercised in elderly patients. In adults (under 65 years) dosage may be increased to 10 mg only where the clinical response is inadequate and the drug is well tolerated.
The total dose of order cheap stillnox 10mg near me should not exceed 10mg in any patients.
Paediatric population
Safety and effectiveness of order cheap stillnox 10mg near me online in paediatric patients under the age of 18 years have not been established.
order cheap stillnox 10mg near me online,
Posology
The treatment should be taken in a single intake and not be re-administered during the same night.
The recommended daily dose for adults is 10 mg to be taken immediately at bedtime. The lowest effective daily dose of buy affordable Stillnox 10mg online should be used and must not exceed 10 mg.
As with all hypnotics, long-term use is not recommended and a course of treatment should not exceed four weeks. The duration of treatment should usually vary from a few days to two weeks with a maximum of four weeks including tapering off where clinically appropriate. In certain cases extension beyond the maximal treatment period may be necessary; if so, this should not take place without re-evaluation of the patient’s status.
Special populations
Paediatric population
order cheap stillnox 10mg near me is not recommended for use in children and adolescents below 18 years of age, due to a lack of data to support use in this age group.
Elderly
Elderly or debilitated patients may be especially sensitive to the effects of order cheap stillnox 10mg near me online therefore a 5 mg dose is recommended. These recommended doses should not be exceeded.
Hepatic impairment
As clearance and metabolism of zolpidem is reduced in hepatic impairment, dosage should begin at 5 mg in these patients with particular caution being exercised in elderly patients. In adults (under 65 years) dosage may be increased to 10 mg only where the clinical response is inadequate and the drug is well tolerated.
buy affordable Stillnox 10mg online must not be used in patients with severe hepatic impairment as it may contribute to encephalopathy.
Method of administration
Oral administration.
Dosage of order cheap stillnox 10mg near me In Adults
Use the lowest effective dose for the patient. The recommended initial dose is 6.25 mg for women and either 6.25 or 12.5 mg for men, taken only once per night immediately before bedtime with at least 7-8 hours remaining before the planned time of awakening. If the 6.25 mg dose is not effective, the dose can be increased to 12.5 mg. In some patients, the higher morning blood levels following use of the 12.5 mg dose increase the risk of next day impairment of driving and other activities that require full alertness. The total dose of order cheap stillnox 10mg near me online should not exceed 12.5 mg once daily immediately before bedtime. buy affordable Stillnox 10mg online should be taken as a single dose and should not be readministered during the same night.
The recommended initial doses for women and men are different because zolpidem clearance is lower in women.
Special Populations
Elderly or debilitated patients may be especially sensitive to the effects of zolpidem tartrate. The recommended dose of order cheap stillnox 10mg near me online in these patients is 6.25 mg once daily immediately before bedtime.
Patients with mild to moderate hepatic impairment do not clear the drug as rapidly as normal subjects. The recommended dose of buy affordable Stillnox 10mg online in these patients is 6.25 mg once daily immediately before bedtime. Avoid Stilnox use in patients with severe hepatic impairment as it may contribute to encephalopathy.
Use With CNS Depressants
Dosage adjustment may be necessary when order cheap stillnox 10mg near me online is combined with other CNS depressant drugs because of the potentially additive effects.
Administration
order cheap stillnox 10mg near me online extended-release tablets should be swallowed whole, and not be divided, crushed, or chewed. The effect of Stilnox may be slowed by ingestion with or immediately after a meal.
The dose of order cheap stillnox 10mg near me online (zolpidem tartrate oral spray) should be individualized.
Dosage in adults
The recommended dose for adults is 10 mg once daily immediately before bedtime. The total buy affordable Stillnox 10mg online (zolpidem tartrate oral spray) dose should not exceed 10 mg per day.
Special populations
Elderly or debilitated patients may be especially sensitive to the effects of order cheap stillnox 10mg near me tartrate. Patients with hepatic insufficiency do not clear the drug as rapidly as normal subjects. The recommended dose of Stilnox (zolpidem tartrate oral spray) in both of these patient populations is 5 mg once daily immediately before bedtime.
Use with CNS depressants
Dosage adjustment may be necessary when order cheap stillnox 10mg near me online (zolpidem tartrate oral spray) is combined with other CNS-depressant drugs because of the potentially additive effects.
Administration
order cheap stillnox 10mg near me online (zolpidem tartrate oral spray) is packaged in a child-resistant container. For detailed instructions on how to use Stilnox (zolpidem tartrate oral spray) , refer to the Patient Instructions for Use (following the Medication Guide). Stilnox (zolpidem tartrate oral spray) must be primed before it is used for the first time. To prime, patients should be told to point the black spray opening away from their face and other people and spray 5 times. For administration, the child-resistant container should be held upright with the black spray opening pointed directly into the mouth. The patient should fully press down on the pump to make sure a full dose (5 mg) of Stilnox (zolpidem tartrate oral spray) is sprayed directly into the mouth over the tongue. If a 10 mg dose is prescribed, a second spray should be administered.
If the patient does not use order cheap stillnox 10mg near me online (zolpidem tartrate oral spray) for at least 14 days, it must be primed again with 1 spray. The patient should be referred to the Patient Instructions for Use included at the end of the Medication Guide.
The effect of order cheap stillnox 10mg near me online (zolpidem tartrate oral spray) may be slowed by ingestion with or immediately after a meal.
Drug overdose
order cheap stillnox 10mg near me online medication must not be taken in excess as this has adverse health effects. Overdose may cause drowsiness of varying degrees leading to a coma. When getting treatment on other health issues, the patient should mention Stillnox prescription to the medical practitioners if taking any, especially if there are pending surgical procedures. Taking overdoses each time amplifies the possibility of side effects and could magnify the discomfort associated. In the event of a drug overdose, contact the doctor instantly or visit the nearest medical center. This should be done even when the victim is stable and not showing any pain or discomfort.
PRECAUTIONS
CNS Depressant Effects And Next-Day Impairment
order cheap stillnox 10mg near me online is a central nervous system (CNS) depressant and can impair daytime function in some patients even when used as prescribed. Prescribers should monitor for excess depressant effects, but impairment can occur in the absence of subjective symptoms, and may not be reliably detected by ordinary clinical exam (i.e. less than formal psychomotor testing). While pharmacodynamic tolerance or adaptation to some adverse depressant effects of Stilnox may develop, patients using Stilnox should be cautioned against driving or engaging in other hazardous activities or activities requiring complete mental alertness the day after use.
Additive effects occur with concomitant use of other CNS depressants (e.g. benzodiazepines, opioids, tricyclic antidepressants, alcohol), including daytime use. Downward dose adjustment of buy affordable Stillnox 10mg online and concomitant CNS depressants should be considered.
The use of order cheap stillnox 10mg near me online with other sedative-hypnotics (including other zolpidem products) at bedtime or the middle of the night is not recommended.
The risk of next-day psychomotor impairment is increased if order cheap stillnox 10mg near me online is taken with less than a full night of sleep remaining (7 to 8 hours); if higher than the recommended dose is taken; if co-administered with other CNS depressants or alcohol; or co-administered with other drugs that increase the blood levels of buy affordable Stillnox 10mg online. Patients should be warned against driving and other activities requiring complete mental alertness if Stilnox is taken in these circumstances.
Vehicle drivers and machine operators should be warned that, as with other hypnotics, there may be a possible risk of adverse reactions including drowsiness, prolonged reaction time, dizziness, sleepiness, blurred/double vision, reduced alertness and impaired driving the morning after therapy. In order to minimize this risk a full night of sleep (7-8 hours) is recommended.
Need To Evaluate For Co-morbid Diagnoses
Because sleep disturbances may be the presenting manifestation of a physical and/or psychiatric disorder, symptomatic treatment of insomnia should be initiated only after a careful evaluation of the patient. The failure of insomnia to remit after 7 to 10 days of treatment may indicate the presence of a primary psychiatric and/or medical illness that should be evaluated. Worsening of insomnia or the emergence of new thinking or behavior abnormalities may be the consequence of an unrecognized psychiatric or physical disorder. Such findings have emerged during the course of treatment with sedative/hypnotic drugs, including zolpidem.
Severe Anaphylactic And Anaphylactoid Reactions
Cases of angioedema involving the tongue, glottis or larynx have been reported in patients after taking the first or subsequent doses of sedative-hypnotics, including order cheap stillnox 10mg near me online. Some patients have had additional symptoms such as dyspnea, throat closing or nausea and vomiting that suggest anaphylaxis. Some patients have required medical therapy in the emergency department. If angioedema involves the throat, glottis or larynx, airway obstruction may occur and be fatal. Patients who develop angioedema after treatment with zolpidem should not be rechallenged with the drug.
Abnormal Thinking And Behavioral Changes
Abnormal thinking and behavior changes have been reported in patients treated with sedative/hypnotics, including order cheap stillnox 10mg near me 10mg online. Some of these changes included decreased inhibition (e.g. aggressiveness and extroversion that seemed out of character), bizarre behavior, agitation and depersonalization. Visual and auditory hallucinations have been reported.
In controlled trials, < 1% of adults with insomnia reported hallucinations. In a clinical trial, 7% of pediatric patients treated with AMBIEN 0.25 mg/kg taken at bedtime reported hallucinations versus 0% treated with placebo.
Complex behaviors such as “sleep-driving” (i.e., driving while not fully awake after ingestion of a sedative-hypnotic, with amnesia for the event) have been reported in sedative-hypnotic-naive as well as in sedative-hypnotic-experienced persons. Although behaviors such as “sleep-driving” have occurred with Stilnox alone at therapeutic doses, the co-administration of alcohol and other CNS depressants increases the risk of such behaviors, as does the use of Stilnox at doses exceeding the maximum recommended dose. Due to the risk to the patient and the community, discontinuation of buy affordable Stillnox 10mg online should be strongly considered for patients who report a “sleep-driving” episode.
Other complex behaviors (e.g., preparing and eating food, making phone calls, or having sex) have been reported in patients who are not fully awake after taking a sedative-hypnotic. As with “sleep-driving”, patients usually do not remember these events. Amnesia, anxiety and other neuro-psychiatric symptoms may also occur.
It can rarely be determined with certainty whether a particular instance of the abnormal behaviors listed above is drug induced, spontaneous in origin, or a result of an underlying psychiatric or physical disorder. Nonetheless, the emergence of any new behavioral sign or symptom of concern requires careful and immediate evaluation.
Use In Patients With Depression
In primarily depressed patients treated with sedative-hypnotics, worsening of depression, and suicidal thoughts and actions (including completed suicides), have been reported. Suicidal tendencies may be present in such patients and protective measures may be required. Intentional overdosage is more common in this group of patients; therefore, the lowest number of tablets that is feasible should be prescribed for the patient at any one time.
Respiratory Depression
Although studies with order cheap stillnox 10mg near me online tartrate did not reveal respiratory depressant effects at hypnotic doses in healthy subjects or in patients with mild-to-moderate chronic obstructive pulmonary disease (COPD), a reduction in the Total Arousal Index, together with a reduction in lowest oxygen saturation and increase in the times of oxygen desaturation below 80% and 90%, was observed in patients with mild-to-moderate sleep apnea when treated with order cheap stillnox 10mg near me online compared to placebo. Since sedative-hypnotics have the capacity to depress respiratory drive, precautions should be taken if Stilnox is prescribed to patients with compromised respiratory function. Post-marketing reports of respiratory insufficiency in patients receiving 10 mg of zolpidem tartrate, most of whom had pre-existing respiratory impairment, have been reported. The risk of respiratory depression should be considered prior to prescribing Stilnox in patients with respiratory impairment including sleep apnea and myasthenia gravis.
Precipitation Of Hepatic Encephalopathy
GABA agonists such as zolpidem tartrate have been associated with precipitation of hepatic encephalopathy in patients with hepatic insufficiency. In addition, patients with hepatic insufficiency do not clear zolpidem tartrate as rapidly as patients with normal hepatic function. Avoid buy affordable Stillnox 10mg online use in patients with severe hepatic impairment as it may contribute to encephalopathy.
Withdrawal Effects
There have been reports of withdrawal signs and symptoms following the rapid dose decrease or abrupt discontinuation of zolpidem. Monitor patients for tolerance, abuse, and dependence.
Severe Injuries
order cheap stillnox 10mg near me online can cause drowsiness and a decreased level of consciousness, which may lead to falls and consequently to severe injuries. Severe injuries such as hip fractures and intracranial hemorrhage have been reported.
Patient Counseling Information
Advise patients to read the FDA-approved patient labeling (Medication Guide). Inform patients and their families about the benefits and risks of treatment with Stilnox. Inform patients of the availability of a Medication Guide and instruct them to read the Medication Guide prior to initiating treatment with Stilnox and with each prescription refill. Review the Stilnox Medication Guide with every patient prior to initiation of treatment. Instruct patients or caregivers that AMBIEN CR should be taken only as prescribed.
CNS Depressant Effects And Next-Day Impairment
Tell patients that order cheap stillnox 10mg near me online can cause next-day impairment even when used as prescribed, and that this risk is increased if dosing instructions are not carefully followed. Caution patients against driving and other activities requiring complete mental alertness the day after use. Inform patients that impairment can be present despite feeling fully awake.
Severe Anaphylactic And Anaphylactoid Reactions
Inform patients that severe anaphylactic and anaphylactoid reactions have occurred with zolpidem. Describe the signs/symptoms of these reactions and advise patients to seek medical attention immediately if any of them occur.
Sleep-driving And Other Complex Behaviors
Instruct patients and their families that sedative hypnotics can cause abnormal thinking and behavior change, including “sleep driving” and other complex behaviors while not being fully awake (preparing and eating food, making phone calls, or having sex). Tell patients to call you immediately if they develop any of these symptoms.
Suicide
Tell patients to immediately report any suicidal thoughts.
Alcohol And Other Drugs
Ask patients about alcohol consumption, medicines they are taking, and drugs they may be taking without a prescription. Advise patients not to use buy affordable Stillnox 10mg online if they drank alcohol that evening or before bed.
Tolerance, Abuse, And Dependence
Tell patients not to increase the dose of order cheap stillnox 10mg near me on their own, and to inform you if they believe the drug “does not work”.
Administration Instructions
Patients should be counseled to take order cheap stillnox 10mg near me right before they get into bed and only when they are able to stay in bed a full night (7-8 hours) before being active again. Stilnox tablets should not be taken with or immediately after a meal. Advise patients NOT to take buy affordable Stillnox 10mg online if they drank alcohol that evening.
Nonclinical Toxicology
Carcinogenesis, Mutagenesis, Impairment Of Fertility
Carcinogenesis
order cheap stillnox 10mg near me online was administered to mice and rats for 2 years at oral doses of 4, 18, and 80 mg base/kg. In mice, these doses are approximately 2, 9, and 40 times the maximum recommended human dose (MRHD) of 12.5 mg/day (10 mg zolpidem base) on mg/m² basis. In rats, these doses are approximately 4, 18, and 80 times the MRHD on a mg/m² basis. No evidence of carcinogenic potential was observed in mice. In rats, renal tumors (lipoma, liposarcoma) were seen at the mid-and high doses.
Mutagenesis
order cheap stillnox 10mg near me was negative in in vitro (bacterial reverse mutation, mouse lymphoma, and chromosomal aberration) and in vivo (mouse micronucleus) genetic toxicology assays.
Impairment Of fertility
Oral administration of order cheap stillnox 10mg near me online(doses of 4, 20, and 100 mg base/kg/day) to rats prior to and during mating, and continuing in females through postpartum day 25, resulted in irregular estrus cycles and prolonged precoital intervals at the highest dose tested. The no-effect dose for these findings is approximately 20 times the MRHD on a mg/m² basis. There was no impairment of fertility at any dose tested.
Use In Specific Populations
Pregnancy
Pregnancy Category C
There are no adequate and well-controlled studies of Stilnox in pregnant women. Studies in children to assess the effects of prenatal exposure to zolpidem have not been conducted; however, cases of severe neonatal respiratory depression have been reported when zolpidem was used at the end of pregnancy, especially when taken with other CNS depressants. Children born to mothers taking sedative-hypnotic drugs may be at risk for withdrawal symptoms during the postnatal period. Neonatal flaccidity has also been reported in infants born to mothers who received sedative-hypnotic drugs during pregnancy. buy affordable Stillnox 10mg online should be used during pregnancy only if the potential benefit outweighs the potential risk to the fetus.
Administration of zolpidem to pregnant rats and rabbits resulted in adverse effects on offspring development at doses greater than the order cheap stillnox 10mg near me maximum recommended human dose (MRHD) of 12.5 mg/day (approximately 10 mg/day zolpidem base); however, teratogenicity was not observed.
When order cheap stillnox 10mg near me online was administered at oral doses of 4, 20, and 100 mg base/kg/day to pregnant rats during the period of organogenesis, dose-related decreases in fetal skull ossification occurred at all but the lowest dose, which is approximately 4 times the MRHD on a mg/m² basis. In rabbits treated during organogenesis with zolpidem at oral doses of 1, 4, and 16 mg base/kg/day, increased embryo-fetal death and incomplete fetal skeletal ossification occurred at the highest dose. The no-effect dose for embryo-fetal toxicity in rabbits is approximately 8 times the MRHD on a mg/m² basis. Administration of zolpidem to rats at oral doses of 4, 20, and 100 mg base/kg/day during the latter part of pregnancy and throughout lactation produced decreased offspring growth and survival at all but the lowest dose, which is approximately 4 times the MRHD on a mg/m² basis.
Labor And Delivery of order cheap stillnox 10mg near me
buy affordable Stillnox 10mg online has no established use in labor and delivery.
Nursing Mothers
order cheap stillnox 10mg online is excreted in human milk. Caution should be exercised when Stilnox is administered to a nursing woman.
Pediatric Use
order stillnox 10mg near me online is not recommended for use in children. Safety and effectiveness of zolpidem in pediatric patients below the age of 18 years have not been established.
In an 8-week study in pediatric patients (aged 6-17 years) with insomnia associated with attention-deficit/hyperactivity disorder (ADHD) an oral solution of zolpidem tartrate dosed at 0.25 mg/kg at bedtime did not decrease sleep latency compared to placebo. Psychiatric and nervous system disorders comprised the most frequent ( > 5%) treatment emergent adverse reactions observed with zolpidem versus placebo and included dizziness (23.5% vs. 1.5%), headache (12.5% vs. 9.2%), and hallucinations were reported in 7% of the pediatric patients who received zolpidem; none of the pediatric patients who received placebo reported hallucinations. Ten patients on zolpidem (7.4%) discontinued treatment due to an adverse reaction.
FDA has not required pediatric studies of buy affordable Stillnox 10mg online in the pediatric population based on these efficacy and safety findings.
Geriatric Use
A total of 99 elderly ( ≥ 65 years of age) received daily doses of 6.25 mg Stilnox in a 3week placebo-controlled study. The adverse reaction profile of Stilnox 6.25 mg in this population was similar to that of Stilnox 12.5 mg in younger adults ( ≤ 64 years of age). Dizziness was reported in 8% of buy affordable Stillnox 10mg online-treated patients compared with 3% of those treated with placebo.
The dose of buy affordable Stillnox 10mg online in elderly patients is 6.25 mg to minimize adverse effects related to impaired motor and/or cognitive performance and unusual sensitivity to sedative/hypnotic drugs.
order cheap stillnox 10mg near meonline,
Gender Difference In Pharmacokinetics
Women clear zolpidem tartrate from the body at a lower rate than men. Cmax and AUC parameters of zolpidem from buy affordable Stillnox 10mg online were, respectively, approximately 50% and 75% higher at the same dose in adult female subjects compared to adult male subjects. Between 6 and 12 hours after dosing, zolpidem concentrations were 2-to 3 fold higher in adult female compared to adult male subjects. Given the higher blood levels of zolpidem tartrate in women compared to men at a given dose, the recommended initial dose of AMBIEN CR for adult women is 6.25 mg, and the recommended dose for adult men is 6.25 or 12.5 mg.
In geriatric patients, clearance of zolpidem is similar in men and women. The recommended dose of buy affordable Stillnox 10mg online in geriatric patients is 6.25 mg regardless of gender.
Hepatic Impairment
The recommended dose of Stilnox in patients with mild to moderate hepatic impairment is 6.25 mg once daily immediately before bedtime. Avoid buy affordable Stillnox 10mg online use in patients with severe hepatic impairment as it may contribute to encephalopathy.
WARNINGS
Included as part of the PRECAUTIONS section.
PRECAUTIONS
Need to evaluate for co-morbid diagnoses
Because sleep disturbances may be the presenting manifestation of a physical and/or psychiatric disorder, symptomatic treatment of insomnia should be initiated only after a careful evaluation of the patient. The failure of insomnia to remit after 7 to 10 days of treatment may indicate the presence of a primary psychiatric and/or medical illness that should be evaluated. Worsening of insomnia or the emergence of new thinking or behavioral abnormalities may be the consequence of an unrecognized psychiatric or physical disorder. Such findings have emerged during the course of treatment with sedative-hypnotic drugs, including zolpidem.
Severe anaphylactic and anaphylactoid reactions
Rare cases of angioedema involving the tongue, glottis, or larynx have been reported in patients after taking the first or subsequent doses of sedative-hypnotics, including zolpidem. Some patients have had additional symptoms such as dyspnea, throat closing, or nausea and vomiting that suggest anaphylaxis. Some patients have required medical therapy in the emergency department. If angioedema involves the throat, glottis, or larynx, airway obstruction may occur and be fatal. Patients who develop angioedema after treatment with zolpidem should not be rechallenged with the drug.
Abnormal thinking and behavioral changes
A variety of abnormal thinking and behavioral changes have been reported to occur in association with the use of sedative-hypnotics. Some of these changes may be characterized by decreased inhibition (e.g., aggressiveness and extroversion that seemed out of character), similar to effects produced by alcohol and other CNS depressants. Visual and auditory hallucinations have been reported as well as behavioral changes such as bizarre behavior, agitation, and depersonalization. In controlled trials, < 1% of adults with insomnia who received zolpidem reported hallucinations. In a clinical trial, 7.4% of pediatric patients with insomnia associated with attention-deficit/hyperactivity disorder (ADHD), who received zolpidem, reported hallucinations.
Complex behaviors such as “sleep-driving” (i.e., driving while not fully awake after ingestion of a sedative-hypnotic, with amnesia for the event) have been reported with sedative-hypnotics, including zolpidem. These events can occur in sedative-hypnotic-naive as well as in sedativeÂhypnotic-experienced persons. Although behaviors such as “sleep-driving” may occur with buy affordable Stillnox 10mg online(zolpidem tartrate oral spray) alone at therapeutic doses, the use of alcohol and other CNS depressants with zolpidem tartrate appears to increase the risk of such behaviors, as does the use of zolpidem at doses exceeding the maximum recommended dose. Due to the risk to the patient and the community, discontinuation of Stilnox (zolpidem tartrate oral spray) should be strongly considered for patients who report a “sleep-driving” episode. Other complex behaviors (e.g., preparing and eating food, making phone calls, or having sex) have been reported in patients who are not fully awake after taking a sedative-hypnotic. As with “sleep-driving”, patients usually do not remember these events. Amnesia, anxiety, and other neuropsychiatric symptoms may occur unpredictably.
In primarily depressed patients, worsening of depression, including suicidal thoughts and actions (including completed suicides), has been reported in association with the use of sedative-hypnotics.
It can rarely be determined with certainty whether a particular instance of the abnormal behaviors listed above is drug induced, spontaneous in origin, or a result of an underlying psychiatric or physical disorder. Nonetheless, the emergence of any new behavioral sign or symptom of concern requires careful and immediate evaluation.
Withdrawal effects
Following the rapid dose decrease or abrupt discontinuation of sedative-hypnotics, there have been reports of signs and symptoms similar to those associated with withdrawal from other CNS-depressant drugs.
CNS-depressant effects
buy affordable Stillnox 10mg online tartrate, like other sedative-hypnotic drugs, has CNS-depressant effects. Due to the rapid onset of action, Stilnox (zolpidem tartrate oral spray) should only be administered immediately prior to going to bed. Patients should be cautioned against engaging in hazardous occupations requiring complete mental alertness or motor coordination such as operating machinery or driving a motor vehicle after ingesting the drug, including potential impairment of the performance of such activities that may occur the day following administration of Stilnox. Zolpidem tartrate showed additive effects when combined with alcohol and should not be taken with alcohol. Patients should also be cautioned about possible combined effects with other CNS-depressant drugs. Dosage adjustments may be necessary when Stilnox (zolpidem tartrate oral spray) is administered with such agents because of the potentially additive effects.
Special populations
Use in the elderly and/or debilitated patients
Impaired motor and/or cognitive performance after repeated exposure or unusual sensitivity to sedative-hypnotic drugs is a concern in the treatment of elderly and/or debilitated patients. Therefore, the recommended Stilnox (zolpidem tartrate oral spray) dosage is 5 mg in such patients to decrease the possibility of side effects. These patients should be closely monitored.
Use in patients with concomitant illness
Clinical experience with zolpidem tartrate in patients with concomitant systemic illness is limited. Caution is advisable in using Stilnox (zolpidem tartrate oral spray) in patients with diseases or conditions that could affect metabolism or hemodynamic responses.
Although studies did not reveal respiratory depressant effects at hypnotic doses of zolpidem in normal subjects or in patients with mild to moderate chronic obstructive pulmonary disease (COPD), a reduction in the Total Arousal Index together with a reduction in lowest oxygen saturation and increase in the times of oxygen desaturation below 80% and 90% was observed in patients with mild-to-moderate sleep apnea when treated with zolpidem tartrate (10 mg) when compared to placebo. Since sedative-hypnotics have the capacity to depress respiratory drive, precautions should be taken if Stilnox (zolpidem tartrate oral spray) is prescribed to patients with compromised respiratory function. Post-marketing reports of respiratory insufficiency, most of which involved patients with pre-existing respiratory impairment, have been received. Stilnox (zolpidem tartrate oral spray) should be used with caution in patients with sleep apnea syndrome or myasthenia gravis.
Data in end-stage renal failure patients repeatedly treated with buy affordable Stillnox 10mg online tartrate did not demonstrate drug accumulation or alterations in pharmacokinetic parameters. No dosage adjustment in renally impaired patients is required; however, these patients should be closely monitored.
A study in subjects with hepatic impairment did reveal prolonged elimination in this group; therefore, treatment should be initiated with 5 mg in patients with hepatic compromise, and they should be closely monitored.
Use in patients with depression
As with other sedative-hypnotic drugs, Stilnox (zolpidem tartrate oral spray) should be administered with caution to patients exhibiting signs or symptoms of depression. Suicidal tendencies may be present in such patients and protective measures may be required. Intentional over-dosage is more common in this group of patients; therefore, the least amount of drug that is feasible should be prescribed for the patient at any one time.
Use in pediatric patients
Safety and effectiveness of zolpidem have not been established in pediatric patients. In an 8-week study in pediatric patients (6-17 years of age) with insomnia associated with ADHD, zolpidem did not decrease sleep latency compared to placebo. Hallucinations were reported in 7.4% of the pediatric patients who received zolpidem tartrate; none of the pediatric patients who received placebo reported hallucinations.
Patient Counseling Information
Prescribers or other healthcare professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with sedative-hypnotics, should counsel them in its appropriate use, and should instruct them to read the accompanying Medication Guide and Patient Instructions for Use.
Severe anaphylactic and anaphylactoid reactions
Inform patients that severe anaphylactic and anaphylactoid reactions have occurred with zolpidem. Describe the signs/symptoms of these reactions and advise patients to seek medical attention immediately if any of them occur.
Sleep-driving and other complex behaviors
There have been reports of people getting out of bed after taking a sedative-hypnotic and driving their cars while not fully awake, often with no memory of the event. If a patient experiences such an episode, it should be reported to his or her doctor immediately, since “sleep-driving” can be dangerous. This behavior is more likely to occur when buy affordable Stillnox 10mg online(zolpidem tartrate oral spray) is taken with alcohol or other central nervous system depressants. Other complex behaviors (e.g., preparing and eating food, making phone calls, or having sex) have been reported in patients who are not fully awake after taking a sedative-hypnotic. As with “sleepdriving”, patients usually do not remember these events.
In addition patients should be advised to report all concomitant medications to the prescriber. Patients should be instructed to report events such as “sleep-driving” and other complex behaviors immediately to the prescriber.
Administration instructions
See the DOSAGE AND ADMINISTRATION section. buy affordable Stillnox 10mg online(zolpidem tartrate oral spray) is packaged in a child-resistant container. Patients should be referred to the Patient Instructions for Use (following the Medication Guide) for detailed instructions on how to use Stilnox (zolpidem tartrate oral spray). Patients should be counseled to take Stilnox (zolpidem tartrate oral spray) right before they get into bed and only when they are able to stay in bed a full night (7-8 hours) before being active again. buy affordable Stillnox 10mg online (zolpidem tartrate oral spray) should not be taken with or immediately after a meal. Advise patients NOT to take Stilnox (zolpidem tartrate oral spray) when drinking alcohol.
Nonclinical Toxicology
Carcinogenesis, mutagenesis, impairment of fertility
Carcinogenesis
buy affordable Stillnox 10mg online was administered to mice and rats for 2 years at dietary dosages of 4, 18, and 80 mg base/kg. In mice, these doses are ≈ 2.5, 10, and 50 times the maximum recommended human dose (MRHD) of 10 mg/day (8 mg zolpidem base) on mg/m² basis. In rats, these doses are ≈ 5, 20, and 100 times the MRHD on a mg/m² basis. No evidence of carcinogenic potential was observed in mice. In rats, renal tumors (lipoma, liposarcoma) were seen at the mid- and high doses.
Mutagenesis
Zolpidem was negative in in vitro (bacterial reverse mutation, mouse lymphoma, and chromosomal aberration) and in vivo (mouse micronucleus) genetic toxicology assays.
Impairment of fertility
Oral administration of buy affordable Stillnox 10mg online(doses of 4, 20, and 100 mg base/kg or ≈5, 24, and 120 times the MRHD on a mg/m² basis) to rats prior to and during mating, and continuing in females through postpartum day 25, resulted in irregular estrus cycles and prolonged precoital intervals. The no-effect dose for these findings is ≈24 times the MRHD on a mg/m² basis. There was no impairment of fertility at any dose tested.
Use In Specific Populations
Pregnancy
Pregnancy Category C
There are no adequate and well-controlled studies of Stilnox (zolpidem tartrate oral spray) in pregnant women. Stilnox (zolpidem tartrate oral spray) should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Studies to assess the effects on children whose mothers took zolpidem during pregnancy have not been conducted. There is a published case report documenting the presence of zolpidem in human umbilical cord blood. Children born to mothers taking sedative-hypnotic drugs may be at some risk for withdrawal symptoms from the drug during the postnatal period. In addition, neonatal flaccidity has been reported in infants born of mothers who received sedative-hypnotic drugs during pregnancy.
Administration of zolpidem to pregnant rats and rabbits resulted in adverse effects on offspring development at doses greater than the maximum recommended human dose (MRHD) of 10 mg/day (8 mg/day zolpidem base); however, teratogenicity was not observed.
When buy affordable Stillnox 10mg online was administered at oral doses of 4, 20, and 100 mg base/kg ( 5, 24, and 120 times the MRHD on a mg/m² basis) to pregnant rats during the period of organogenesis, dose-related decreases in fetal skull ossification were observed at all but the low dose, which is 5 times the MRHD on a mg/m² basis. In rabbits treated during organogenesis with zolpidem at oral doses of 1, 4, and 16 mg base/kg (≈ 2.5, 10, and 40 times the MRHD on a mg/m² basis), increased embryo-fetal death and incomplete fetal skeletal ossification were seen at the highest dose tested. The no-effect dose for embryo-fetal toxicity in rabbits is ≈ 10 times the MRHD on a mg/m² basis. Administration of zolpidem to rats at oral doses of 4, 20, and 100 mg base/kg (≈ 5, 24, and 120 times the MRHD on a mg/m² basis) during the latter part of pregnancy and throughout lactation produced decreased offspring growth and survival at all but the low dose, which is ≈ 5 times the MRHD on a mg/m² basis.
Labor and delivery
Stilnox (zolpidem tartrate oral spray) has no established use in labor and delivery.
Nursing mothers
buy affordable Stillnox 10mg online is excreted into human milk. Studies in lactating mothers indicate that the t½ of zolpidem is similar to that in non-lactating women (2.6 ± 0.3hours). Between 0.004% and 0.019% of the total administered dose is excreted into milk. The effect of zolpidem on the nursing infant is not known.
Pediatric use
Safety and effectiveness of zolpidem have not been established in pediatric patients.
In an 8-week controlled study, 201 pediatric patients (6-17 years of age) with insomnia associated with ADHD (90% of the patients were using psychoanaleptics) were treated with an oral solution of buy affordable Stillnox 10mg online (n=136) or placebo (n=65). Zolpidem did not significantly decrease latency to persistent sleep, compared to placebo, as measured by polysomnography after 4 weeks of treatment. Psychiatric and nervous system disorders comprised the most frequent ( > 5%) treatment emergent adverse reactions observed with zolpidem tartrate versus placebo and included dizziness (23.5% vs 1.5%), headache (12.5% vs 9.2%), and hallucinations (7.4% vs 0%). Ten patients on zolpidem (7.4%) discontinued treatment due to an adverse reaction.
Geriatric use
A total of 154 patients in U.S. controlled clinical trials and 897 patients in non-U.S. clinical trials who received zolpidem were ≥ 60 years of age. In a pool of U.S. patients receiving zolpidem at doses of ≥ 10 mg or placebo, there were three adverse reactions occurring at an incidence of at least 3% for buy affordable Stillnox 10mg online tartrate and for which the zolpidem incidence was at least twice the placebo incidence (i.e., they could be considered drug related).
| Adverse Reaction | Zolpidem | Placebo |
| Dizziness | 3% | 0% |
| Drowsiness | 5% | 2% |
| Diarrhea | 3% | 1% |
A total of 30/1,959 (1.5%) non-U.S. patients receiving zolpidem reported falls, including 28/30 (93%) who were ≥ 70 years of age. Of these 28 patients, 23 (82%) were receiving zolpidem doses > 10 mg. A total of 24/1,959 (1.2%) non-U.S. patients receiving zolpidem reported confusion, including 18/24 (75%) who were ≥ 70 years of age. Of these 18 patients, 14 (78%) were receiving zolpidem doses > 10 mg.
The dose of Stilnox (zolpidem tartrate oral spray) in elderly patients is 5 mg to minimize the adverse effects related to impaired motor and/or cognitive performance and unusual sensitivity to sedative-hypnotic drugs.
