Zolpidem: a review of its use in the management of insomnia

Use of Zolpidem and Risk of Acute Pyelonephritis in Women: A Population-Based Case-Control Study in Taiwan

The aim of this study was to assess a possible correlation between zolpidem use and acute pyelonephritis (APN) in women in Taiwan. Therefore, we performed a case-control study involving the Taiwan's National Health Insurance Research Database between 2000 and 2011. This study included 3151 female participants aged 20 to 84 years who experienced the first bout of APN (case group) and 6015 randomly selected female participants without APN (control group). Zolpidem use was defined as "current," "early," or "late," if the last remaining 1 tablet for zolpidem was detected within 7 days, between 8 and 14 days, or ≥15 days before the date of APN diagnosis, respectively. The multivariable unconditional logistic regression model was used to calculate the odds ratios (ORs) with 95% confidence intervals (CIs) to assess the correlation between zolpidem use and APN. After adjusting for confounders, the multivariable analysis yielded an adjusted APN OR of 2.2 for participants with current zolpidem use (95%CI 1.7-2.8) compared with participants who never used zolpidem. The adjusted ORs gradually decreased to 1.4 for participants with early zolpidem use (95%CI 0.8-2.5) and 1.1 for participants with late zolpidem use (95%CI 0.9-1.2), but without statistical significance. Only patients with current zolpidem use had a significantly increased relative risk of APN. Additional large confirmatory studies are needed to illustrate a causal relationship. Meanwhile, physicians and pharmacists should be more cautious about the risk of APN when prescribing and dispensing zolpidem in women.

Synthesis and biological evaluation of imidazopyridinyl-1,3,4-oxadiazole conjugates as apoptosis inducers and topoisomerase IIα inhibitors

A series of imidazopyridinyl-1,3,4-oxadiazole conjugates were synthesized and investigated for their cytotoxic activity and some compounds showed promising cytotoxic activity. Compound 8q (NSC: 763639) exhibited notable growth inhibition that satisfies threshold criteria at single dose (10μM) on all human cancer cell lines. This compound was further evaluated at five dose levels (0.01, 0.1, 1, 10 and 100μM) to obtain GI₅₀ values ranging from 1.30 to 5.64μM. Flow cytometric analysis revealed that compound 8q arrests the A549 cells in sub G1 phase followed by induction of apoptosis which was further confirmed by Annexin-V-FITC, Hoechst nuclear staining, caspase 3 activation, measurement of mitochondrial membrane potential and ROS generation. Topo II mediated DNA relaxation assay results showed that conjugate 8q could significantly inhibit the activity of topo II. Moreover, molecular docking studies also indicated binding to the topoisomerase enzyme (PDBID 1ZXN).

High-dose zolpidem dependence - Psychostimulant effects? A case report and literature review

Zolpidem, an imidazoline nonbenzodiazepine sedative drug, is used widely. Initial reports showed minimal abuse potential. However, multiple reports have appeared of dose escalation and abuse. Subjective effects of high-dose zolpidem are not known. In light of accumulating evidence of abuse potential, we hereby report a case of high-dose dependence and a review of relevant literature. A 33-year-old male presented with 5 years of daily use of 600-1700 mg of zolpidem tartrate. He reported subjective effects of euphoria, intense craving, and inability to stop use. Loss of receptor specificity, pharmacokinetic factors, and different receptor distributions can explain paradoxical stimulatory effects of high-dose zolpidem. Further studies are required to characterize subjective effects of high-dose zolpidem.

Zolpidem Mucoadhesive Formulations for Intranasal Delivery: Characterization, In Vitro Permeability, Pharmacokinetics, and Nasal Ciliotoxicity in Rats

Zolpidem is a non-benzodiazepine hypnotic for the treatment of insomnia characterized by difficulties with sleep initiation. Our study aimed at developing a zolpidem mucoadhesive formulation with minimal local toxicity, prolonged nasal residence time, and enhanced absorption after intranasal delivery. In vitro permeability studies using artificial membrane and Calu-3 cell culture model indicated efficient permeability of zolpidem. Aqueous solubility of zolpidem was found to be significantly improved by hydroxypropyl-β-cyclodextrin. Various mucoadhesive formulations were then prepared comprising zolpidem, hydroxypropyl-β-cyclodextrin, and mucoadhesive polymers such as hydroxypropyl methylcellulose, sodium carboxymethylcellulose, and sodium alginate. Pharmacokinetic studies in rats demonstrated that intranasally administered zolpidem could achieve significantly faster absorption rate and higher plasma concentration than that from oral route. In comparison with solution formulation (ZLP-S03), the optimized mucoadhesive formulation (ZLP-B01) containing 0.25% hydroxypropyl methylcellulose was found to improve Cmax from 352.6 ± 86.0 to 555.7 ± 175.8 ng/mL, and AUC0-inf from 32,890 ± 7547 to 65,447 ± 36,996 ng·min/mL with mild nasal ciliotoxicity in rats.

Mechanism of the gold(i)-catalyzed synthesis of imidazo-pyrimidines and imidazo-pyrazines via [3 + 2] dipolar cycloaddition: a DFT study

The mechanisms of gold(i)-catalyzed [3 + 2] cycloaddition reactions of pyridinium N-(heteroaryl)-aminides with alkynes have been investigated using DFT calculations.

Copper catalyzed aerobic oxidative cyclization and ketonization: one pot synthesis of benzoimidazo[1,2-a]imidazolones

A highly efficient synthesis of benzoimidazo[1,2-a]imidazolone through a novel oxidative 5-exo-dig cyclization-ketonization cascade of 2-aminobenzimidazole, aldehyde and terminal alkyne has been explored under aerobic conditions.

R, Sajith AM, K. V. D, C. S, Anwar S. Functionalised dihydroazo pyrimidine derivatives from Morita–Baylis–Hillman acetates: synthesis and studies against acetylcholinesterase as its inhibitors

Dihydroazo pyrimidine derivatives were synthesized at room temperature using MBH acetates and aminoazole derivatives. The in vitro studies carried on a couple of derivatives exhibited much higher potency for Alzheimer's disease (AD).

Sulfonic acid functionalized silica-coated CuFe2O4 core–shell nanoparticles: an efficient and magnetically separable heterogeneous catalyst for the synthesis of 2-pyrazole-3-amino-imidazo-fused polyheterocycles

Synthesis of easily separable magnetic core–shell nanoparticles and their efficient use as catalyst in a multicomponent reaction.

A novel approach for the synthesis of imidazo and triazolopyridines from dithioesters

Various imidazo- and triazolo-pyridines were synthesised by the intramolecular cyclization of pyridine 2-methylamine and dithioesters under mild conditions.

Copper-catalyzed domino synthesis of benzo[b]thiophene/imidazo[1,2-a]pyridines by sequential Ullmann-type coupling and intramolecular C(sp2)–H thiolation

An efficient method for the synthesis of benzo[b]thiophene/imidazo[1,2-a]pyridines has been developed via copper-catalyzed double C–S bond formation using K₂S as a sulfur source.

Relationship Between Acute Benzodiazepine Poisoning and Acute Pancreatitis Risk: A Population-Based Cohort Study

We designed a population-based retrospective cohort study to investigate the association between the event of benzodiazepine (BZD) poisoning and the risk of acute pancreatitis.In the present study, 12,893 patients with BZD poisoning during 2000 to 2011 were enrolled and matched with 4 comparison patients according to mean age and sex. We determined the cumulative incidences and adjusted hazard ratios of acute pancreatitis.A significant association was observed between BZD poisoning and acute pancreatitis. After adjustment for potential risk factors, the patients with BZD poisoning had a 5.33-fold increased risk of acute pancreatitis compared with the controls without BZD poisoning (HR = 5.33, 95% CI = 2.26-12.60). The results revealed that acute pancreatitis in patients with BZD poisoning occurred in a follow-up time of ≤1 month (HR = 50.0, P < .001), and the risk of acute pancreatitis was no different between the patients with and without BZD poisoning when the follow-up time was >1 month (HR = 1.07, P > .05).This population-based study revealed the positive correlation between the event of BZD poisoning and an increased risk of acute pancreatitis. The findings warrant further large-scale and in-depth investigation.

Zolpidem Use Associated With Increased Risk of Pyogenic Liver Abscess: A Case-Control Study in Taiwan

The purpose of this study was to explore the association between zolpidem use and pyogenic liver abscess in Taiwan.This was a population-based case-control study using the database of the Taiwan National Health Insurance Program since 2000 to 2011. We identified 1325 patients aged 20 to 84 years with the first-attack of pyogenic liver abscess as the cases, and 5082 patients without pyogenic liver abscess matched with sex, age, comorbidities, and index year of hospitalization for pyogenic liver abscess as the controls. Patients whose last remaining 1 tablet for zolpidem was noted ≤7 days before the date of admission for pyogenic liver abscess were defined as current use of zolpidem. Patients whose last remaining 1 tablet for zolpidem was noted >7 days before the date of admission for pyogenic liver abscess were defined as late use of zolpidem. Patients who never received 1 prescription for zolpidem were defined as never use of zolpidem. A multivariable unconditional logistic regression model was used to measure the odds ratio (OR) and 95% confidence interval (CI) to explore the association between zolpidem use and pyogenic liver abscess.After adjustment for possible confounding variables, the adjusted OR of pyogenic liver abscess was 3.89 for patients with current use of zolpidem (95% CI 2.89, 5.23), when compared with those with never use of zolpidem. The adjusted OR decreased to 0.85 for those with late use of zolpidem (95% CI 0.70, 1.03), but without statistical significance.Current use of zolpidem is associated with the increased risk of pyogenic liver abscess. Physicians should take the risk of pyogenic liver abscess into account when prescribing zolpidem.

CuBr catalyzed aerobic oxidative coupling of 2-aminopyridines with cinnamaldehydes: direct access to 3-formyl-2-phenyl-imidazo[1,2-a]pyridines

Copper bromide catalyzed aerobic oxidative coupling of 2-aminopyridines with cinnamaldehydes directly led to the formation of 3-formyl-2-phenyl-imidazo[1,2-a]pyridines. The quantum chemical calculations were performed to trace the reaction mechanism and get insights into the possible reaction pathway. 2-Aminopyridines on coupling with cinnamaldehyde generate (E)-3-phenyl-3-(pyridin-2-ylamino)acrylaldehyde IV as a key intermediate, which undergoes C-N bond formation reaction to produce 3-formyl-2-phenyl-imidazo[1,2-a]pyridines.

Effect of Inhaled Lavender and Sleep Hygiene on Self-Reported Sleep Issues: A Randomized Controlled Trial

OBJECTIVES

To compare the effectiveness of lavender (Lavandula angustifolia) and sleep hygiene versus sleep hygiene alone on sleep quantity and sleep quality and to determine sustained effect at two-week follow-up.

DESIGN

A randomized controlled trial with investigator blinding and steps taken to blind the participants.

SETTING

Participants' usual sleep setting.

SUBJECTS

Seventy-nine college students with self-reported sleep issues.

INTERVENTIONS

The intervention took place over five nights with baseline, postintervention, and two-week follow-up assessments. Both groups practiced good sleep hygiene and wore an inhalation patch on their chest at night. One group wore a patch with 55 μl of lavender essential oil and the other group wore a blank patch.

OUTCOME MEASURES

Sleep quantity was measured using a Fitbit(®) tracker and a sleep diary, and sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) and the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance short form.

RESULTS

The lavender and sleep hygiene group demonstrated better sleep quality at postintervention and two-week follow-up (PSQI p=0 .01, <0.001 and PROMIS p=0.04, 0.007, respectively). The sleep-hygiene-only group also demonstrated better sleep quality but to a lesser extent (PSQI p=0.02, 0.06 and PROMIS p=0.03, 0.03, respectively). Additionally, a clinical effect was found for the lavender group at postintervention, along with a significant finding for waking feeling refreshed (p=0.01). Sleep quantity did not differ between groups.

CONCLUSIONS

Lavender and sleep hygiene together, and sleep hygiene alone to a lesser degree, improved sleep quality for college students with self-reported sleep issues, with an effect remaining at follow-up.

Increased relative risk of acute pancreatitis in zolpidem users

OBJECTIVES

The aim of this study was to investigate the relationship between zolpidem use and the risk of acute pancreatitis in Taiwan.

METHODS

In this population-based case-control study using the database from the Taiwan National Health Insurance Program from 2000 to 2011, we selected 4535 subjects aged 20-84 years with the first episode of acute pancreatitis as cases and 18,140 subjects without acute pancreatitis matched for sex, age, and index year as controls. Immediate use of zolpidem was defined as subjects who received at least one prescription for zolpidem within 7 days before the date of diagnosing acute pancreatitis. The absence of zolpidem prescription was defined as never use. The odds ratio (OR) and 95 % confidence interval (CI) were used to evaluate the risk of acute pancreatitis associated with zolpidem use and other comorbidities.

RESULTS

After adjustment for confounding factors, the multivariable logistic regression model demonstrated that the adjusted OR of acute pancreatitis was 7.20 for immediate use of zolpidem (95 % CI 5.81, 8.92), when compared to those with never use of zolpidem. In further analysis, as a reference of subjects with never use of zolpidem and without any of these comorbidities including alcoholism, biliary stone, diabetes mellitus, hepatitis B, hepatitis C, and hypertriglyceridemia, the adjusted OR was 18.04 in those with immediate use of zolpidem and without any comorbidity (95 % CI 12.71, 25.60). The OR increased to 30.32 in subjects with immediate use of zolpidem and with any comorbidity (95 % CI 23.71, 38.79).

CONCLUSIONS

Patients actively using zolpidem are at 7-fold increased odds of acute pancreatitis. Clinicians should be more cautious of acute pancreatitis risk among patients with any comorbidity studied when prescribing zolpidem.

Polycyclic imidazo[1,2-a]pyridine analogs – synthesis via oxidative intramolecular C–H amination and optical properties

Oxidative C–H amination has proved to be an efficient strategy to construct pyrido[2′,1′:2,3]imidazo[4,5-b]indoles and their π-expanded analogs.

Metal-free synthesis of imidazopyridine from nitroalkene and 2-aminopyridine in the presence of a catalytic amount of iodine and aqueous hydrogen peroxide

We have developed a metal-free synthetic method for 3-nitroimidazo[1,2-a]pyridines from nitroalkenes and 2-aminopyridines using catalytic amounts of iodine and aqueous hydrogen peroxide as a terminal oxidant.

Synthesis of 2-triazolyl-imidazo[1,2-a]pyridine through a one-pot three-component reaction using a nano copper oxide assisted click-catalyst

The syntheses of 2-triazolyl imidazo[1,2-a]pyridine were accomplished through 5-exo dig cyclisation using 5 mol% nanocopper oxide together with 10 mol% sodium ascorbate as a click-catalyst in ethanol at 70 °C.

Graphene oxide (GO)-catalyzed multi-component reactions: green synthesis of library of pharmacophore 3-sulfenylimidazo[1,2-a]pyridines

Graphene oxide (GO)-catalyzed multi-component reactions: green synthesis of library of pharmacophore 3-sulfenylimidazo[1,2-a]pyridines

Regioselective copper-catalyzed thiolation of imidazo[1,2-a]pyridines: an efficient C–H functionalization strategy for C–S bond formation

Regioselective copper-catalyzed thiolation of imidazo[1,2-a]pyridines.

A copper-catalyzed multi-component reaction accessing fused imidazo-heterocycles via C–H functionalization

An efficient synthesis of fused imidazo-heterocycles is described using Cu(OTf)₂ in [bmim]BF₄ by the multi-component reaction of pyridin-2(1H)-one or thiazol/benzo[d]thiazol-2(3H)-ones with O-tosylhydroxyl amine and acetophenones under microwave irradiation.

I2–DMSO–PTSA: a simple and metal free oxidative cross coupling of imidazo[1,2-a]pyridines and methylketones

A simple, metal free and selective oxidative cross-coupling promoted by I₂–DMSO in presence of PTSA has been developed with the use of imidazo[1,2-a]pyridines (1) and methyl ketones (2) to access 3 in a one pot reaction.

Sulfamic acid-functionalized hydroxyapatite-encapsulated γ-Fe2O3 nanoparticles as a magnetically recoverable catalyst for synthesis of N-fused imidazole-quinoline conjugates under solvent-free conditions

γ-Fe₂O₃-HAp-(CH₂)₃-NHSO₃H was shown to be a powerful and reusable catalyst for the synthesis of N-fused imidazole-quinoline conjugates under solvent-free conditions.

Organopromoted direct synthesis of 6-iodo-3-methylthioimidazo[1,2-a]pyridines via convergent integration of three self-sorting domino sequences

An NH₂CN-promoted convergent integration of three self-sorting domino sequences is described for the construction of 6-iodo-3-methylthioimidazo[1,2-a]pyridines from aryl methyl ketones and 2-aminopyridines.

Copper-catalyzed intramolecular dehydrogenative cyclization: direct access to sensitive formyl-substituted imidazo[1,2-a]pyridines

A direct method for the synthesis of formyl-substituted imidazo[1,2-a]pyridines was achieved easily from cyclization of aminopyridines and cinnamaldehydes via copper catalysis.

Non-Benzodiazepine Receptor Agonists for Insomnia

Because of proven efficacy, reduced side effects, and less concern about addiction, non-benzodiazepine receptor agonists (non-BzRA) have become the most commonly prescribed hypnotic agents to treat onset and maintenance insomnia. First-line treatment is cognitive-behavioral therapy. When pharmacologic treatment is indicated, non-BzRA are first-line agents for the short-term and long-term management of transient and chronic insomnia related to adjustment, psychophysiologic, primary, and secondary causation. In this article, the benefits and risks of non-BzRA are reviewed, and the selection of a hypnotic agent is defined, based on efficacy, pharmacologic profile, and adverse events.

N-Bridged 5,6-bicyclic pyridines: Recent applications in central nervous system disorders

The search for novel heterobicyclic compounds within the drug-like chemical space continues to be an area of interest in medicinal chemistry. Unsaturated N-bridgehead heterocycles are well represented in marketed drugs for a variety of therapeutic areas, and continue to play an important role in central nervous system (CNS) drug discovery programs. Examples of medicinal chemistry strategies that make use of N-bridged 5,6-bicyclic pyridines are discussed here in this Minireview, which covers the literature from 2010 up to 2014. B1-class imidazopyridines and B3-class pyrazolopyridines have proven to be at the forefront of molecular prototypes that are capable of interacting with disease relevant targets in neurodegeneration and neuropsychiatry.

Three-component reaction of a 2-aminoazine, a 2-oxoaldehyde, and a cyclic 1,3-dicarbonyl compound for the synthesis of imidazo[1,2-a]azine derivatives

A three-component reaction of a 2-aminoazine, a 2-oxoaldehyde, and a cyclic 1,3-dicarbonyl compound providing access toward a novel class of imidazo[1,2-a]azine derivatives was developed and studied. The scope of the process was thoroughly explored under three different reaction conditions resulting in the generation of a small library of title compounds and highlighting the possibility of case-specific approach.