Temazepam AND Zolpidem?

[pharmdinfl]

Have any of you read any studies recently regarding the usage of both temazepam and zolpidem?

We have a psychiatrist at the facility I work at who has a patient taking both and I'm trying to find some articles or research that may support this? I haven't been able to come across anything so far - which is okay, but I just thought I'd check and see if anyone else has happened across something.

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[Pianopooh]

Neither agent significantly reduced objective sleep latency relative to placebo. Zolpidem reduced awakenings and wake after sleep onset (WASO); temazepam did not. Both agents improved sleep efficiency and most subjective sleep measures relative to placebo, with zolpidem superior for five of six subjective outcome measures compared to temazepam. SCT, morning sleepiness and morning concentration were not altered by any treatment. Zolpidem significantly reduced morning DSST performance; temazepam did not. Zolpidem 10 mg provided greater subjective hypnotic efficacy than temazepam 15 mg in this model of transient insomnia, with reduced polysomnographic awakenings and WASO.

Source: http://www.ncbi.nlm.nih.gov/pubmed/12404587

 

[Vitamin K]

Is the person taking them at the same time or alternating?

 

[aboveliquidice]

Is the person taking them at the same time or alternating?

I have seen both alternating and and inconjunction... In most cases I have seen - the patient is maxed out on ambien therapy - taking it QHS (no longer PRN) and still not getting to sleep. They have tried alternate therapies etc. They just end up doubling up as a method of last resort.

 

[pharmdinfl]

I've found plenty of studies comparing the two agents separately - I'm trying to find if there is any documentation on the benefit of using them together on the same night.

I've seen them used together myself as well, but I'm just trying to find any research (if any exists) or journals that discuss the advantage/disadvantage of using them concominately.

 

[BMBiology]

Ambien (fast onset, short half life) is for difficult falling asleep while temazepam (slow onset, long half life) is being used to help the patient maintain sleep with its long half life.

 

[Old Timer]

Halcion is great for very short term use when you have to fall asleep. Great for sleep latency. Temazepam as pointed has just about no effect on sleep latency. Everybody is afraid of Halcion.......

 

[Pharmavixen]

Everybody is afraid of Halcion.......

For good reasons................................

Where I work, we use quetiapine as a sedative. But now we're running into people who abuse quetiapine.

 

[StaviZFingerZ]

why bother if its helping the patient. forget the study..go talk to the patients, monitor them for adr and see what its doing. the studies you find may not apply to these patients. psychiatry is a very subjective field.

 

[Praziquantel86]

For good reasons................................

Where I work, we use quetiapine as a sedative. But now we're running into people who abuse quetiapine.

I've heard that quietiapine and efavirenz are getting pretty popular among the prison population.

 

[VCU2011]

Ambien (fast onset, short half life) is for difficult falling asleep while temazepam (slow onset, long half life) is being used to help the patient maintain sleep with its long half life.

Had an interesting case come into the pharmacy a few days ago that I wanted to get some input on. We told her to never come back, but have any of you heard of the need to take ambien 30 mg at bedtime? The whole thing made very little sense- we called the physicians office and the receptionist said he couldn't come to the phone but to just give it to the patient as written.

When we told the patient, she said "the doc wrote it like that so i could get it for a 30 day price."

We mentioned to both the receptionist and patient that it was insurance fraud since there is no indication for it to be taken 3 times a day. Neither one of them could care less.

After screaming at the entire pharmacy for 30 mins she finally left for good (thank god)...

 

[Praziquantel86]

Had an interesting case come into the pharmacy a few days ago that I wanted to get some input on. We told her to never come back, but have any of you heard of the need to take ambien 30 mg at bedtime? The whole thing made very little sense- we called the physicians office and the receptionist said he couldn't come to the phone but to just give it to the patient as written.

When we told the patient, she said "the doc wrote it like that so i could get it for a 30 day price."

We mentioned to both the receptionist and patient that it was insurance fraud since there is no indication for it to be taken 3 times a day. Neither one of them could care less.

After screaming at the entire pharmacy for 30 mins she finally left for good (thank god)...

Not to mention illegal prescribing practices. Controls are limited to a one month supply...defrauding the pharmacist is not a way around this.

 

[Pharmavixen]

I've heard that quietiapine and efavirenz are getting pretty popular among the prison population.

For "efavirenz," you meant Effexor, right?

Seroquel, Effexor, Welbutrin, gabapentin ... all are what I call "provisional" drugs of abuse taken by drug-seekers who can't get stronger stuff.

 

[metrarx]

....http://abcnews.go.com/Health/MindMoodNews/story?id=7227982&page=1

 

[VCU2011]

Not to mention illegal prescribing practices. Controls are limited to a one month supply...defrauding the pharmacist is not a way around this.

it was a one month supply as written

 

[Old Timer]

For good reasons................................

Where I work, we use quetiapine as a sedative. But now we're running into people who abuse quetiapine.

Not really... If you you need to put someone to sleep Halcion 0.125mg will do the trick. It's for short term use. If you give 0.5mg hs on a nightly basis you will get problems. I'll take a benzo over an atypical antipshychotic any day of the week.

 

[Praziquantel86]

it was a one month supply as written

However, the prescription was not written as the physician intended the patient to take it. If the physician writes down one set of directions and tells the patient another, it is defrauding the pharmacist (and insurance).

Regardless, I can't imagine a script for 30mg qhs. They would have switched to the stronger stuff long before it got to that.

 

[WVUPharm2007]

Had an interesting case come into the pharmacy a few days ago that I wanted to get some input on. We told her to never come back, but have any of you heard of the need to take ambien 30 mg at bedtime? The whole thing made very little sense- we called the physicians office and the receptionist said he couldn't come to the phone but to just give it to the patient as written.

When we told the patient, she said "the doc wrote it like that so i could get it for a 30 day price."

We mentioned to both the receptionist and patient that it was insurance fraud since there is no indication for it to be taken 3 times a day. Neither one of them could care less.

After screaming at the entire pharmacy for 30 mins she finally left for good (thank god)...

Wow...if they acted like that I'd have called the DEA to inform them of illegal prescribing practices and the insurance company to inform them that a patient is trying to defraud them. Then I'd call the board of medicine and inform them that a receptionist is prescribing.

It's the only way this **** is going to stop. I know many in retail have no ambition and don't give a **** thanks to the complacency begotten from a 6-fig salary (hence POWER is taking off and corporate pharmacy has taken over)...but y'all got to stand up for your legal obligations...Jesus...

 

[VCU2011]

Wow...if they acted like that I'd have called the DEA to inform them of illegal prescribing practices and the insurance company to inform them that a patient is trying to defraud them. Then I'd call the board of medicine and inform them that a receptionist is prescribing.

It's the only way this **** is going to stop. I know many in retail have no ambition and don't give a **** thanks to the complacency begotten from a 6-fig salary (hence POWER is taking off and corporate pharmacy has taken over)...but y'all got to stand up for your legal obligations...Jesus...

hey man im with you I offered to go through all the steps on my own- but like you said, its all corporate pharmacy now and if they dont HAVE to deal with it, they dont want to deal with it. All they see is that they now have an "unsatisfied customer" because we wouldn't give them 90 ambien for a 30 day cost. We actually had to get the regional managers approval just to tell them not to come back to the pharmacy anymore. It's sick!

 

[pharmacology888]

Not to mention illegal prescribing practices. Controls are limited to a one month supply...defrauding the pharmacist is not a way around this.

I thought Ambien, a schedule IV drug, was limited to a 180 days supply. The 30 day supply is a limit per insurance company. Help~

 

[Old Timer]

I thought Ambien, a schedule IV drug, was limited to a 180 days supply. The 30 day supply is a limit per insurance company. Help~

depends on the state.....

 

[Pharmavixen]

Nope, he means efavirenz.

Have you not heard how it's quickly becoming a drug of abuse in Africa? People smoke the tablets.

http://abcnews.go.com/Health/MindMoodNews/story?id=7227982&page=1

I totally had never heard of this one. I can see how it's a provisional drug of abuse in Africa, though, if it's cheap there. And it is psychoactive.

 

[Praziquantel86]

I thought Ambien, a schedule IV drug, was limited to a 180 days supply. The 30 day supply is a limit per insurance company. Help~

You're right, I confused my federal limits with the state limits. My mistake!

 

[eventualeventer]

I've heard that quietiapine and efavirenz are getting pretty popular among the prison population.

Stupid ? from non-pharmacist -- don't atypical (and typical) antipsychotics antagonize dopamine and decrease activity in reward centers? Why would that lead to repeated self-administration? It's been too long since I took behavioral pharmacology . . .

 

[Praziquantel86]

Stupid ? from non-pharmacist -- don't atypical (and typical) antipsychotics antagonize dopamine and decrease activity in reward centers? Why would that lead to repeated self-administration? It's been too long since I took behavioral pharmacology . . .

That's how the dopamine theory goes, in general. The typical antipsychotics have a pretty strong affinity for the D2 receptor in particular. Atypicals have a much weaker affinity for that receptor, and their effects are mediated elsewhere.

Quietapine has about equal affinity for the 5HT-2 receptor as for the D2, as well as mild affinity for other serotonergic and some histaminic receptors. The serotonin release is most likely the source of the euphoric feeling when abused.

Neuropharm is confusing as all hell, so I hope I got the above information right. Interesting stuff though.

 

[eventualeventer]

Thanks for the response. It's crazy what people will abuse...