Pharmacokinetics of zolpidem from sublingual zolpidem tartrate tablets in healthy elderly versus non-elderly subjects.

David J Greenblatt, Jerold S Harmatz, Nikhilesh N Singh, Frank Steinberg, Thomas Roth, Stephen C Harris, Ram P Kapil
Author Information
  1. David J Greenblatt: Department of Integrative Physiology and Pathobiology, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA, dj.greenblatt@tufts.edu.

Abstract

BACKGROUND: Pharmacokinetic parameters of sedative-hypnotic medications can be influenced by age and gender.
OBJECTIVE: This study analyzed pharmacokinetic parameters of zolpidem, formulated as a sublingual zolpidem tartrate tablet (ZST; Intermezzo®), in healthy elderly males and females (mean age 72 years) and in non-elderly males and females (34 years).
METHODS: This was a randomized, single-dose, open-label, two-way crossover study evaluating pharmacokinetic parameters of 1.75 and 3.5 mg dosages of ZST in elderly subjects (n = 22), and 3.5 mg dosages of ZST in non-elderly subjects (n = 24). Main outcome measures were pharmacokinetic parameters, including area under the plasma concentration-time curve (AUC), maximum observed concentration (C(max)), time to reach C(max) (T(max)), elimination half-life (T(½)), and apparent oral clearance (CL/F).
RESULTS: Dose proportionality in zolpidem exposure was maintained between 1.75 and 3.5 mg doses for both elderly females and males. With administration of the 3.5 mg dose of ZST to elderly and non-elderly subjects, significantly higher systemic exposure was seen in elderly females (C(max) +44.6 %, P < 0.01; AUC +40.4 %) compared with non-elderly females. However, systemic exposure was only modestly higher in elderly males compared with non-elderly males. Greater exposure was seen in elderly females compared to males (C(max) +46.8 %, P < 0.01; AUC +31.4 %). In this study, exposure between non-elderly females and males was equivalent. Changes in T(½) and T(max) values were not observed, with no significant age effect on oral clearance. There were no apparent differences in tolerability among age and gender groups.
CONCLUSION: Elderly individuals were found to have higher C(max) and AUC values compared with non-elderly subjects. C(max) and AUC were greater in elderly women compared with elderly men.

References

N Engl J Med. 2013 Aug 22;369(8):689-91 [PMID: 23923991]
J Clin Psychopharmacol. 2011 Feb;31(1):1-3 [PMID: 21192134]
Hum Psychopharmacol. 2008 Jan;23(1):13-20 [PMID: 17907263]
J Clin Sleep Med. 2013 Jul 15;9(7):661-8 [PMID: 23853559]
J Psychiatr Res. 2008 Nov;43(1):48-54 [PMID: 18374943]
Clin Pharmacol Drug Dev. 2014 May;3(3):167-9 [PMID: 27128605]
J Am Geriatr Soc. 2009 May;57(5):761-89 [PMID: 19484833]
BMJ. 2012 Dec 17;345:e8343 [PMID: 23248080]
Sleep. 2008 Sep;31(9):1277-84 [PMID: 18788653]
Gerontology. 2010;56(2):181-9 [PMID: 19738366]
Sleep. 2013 Feb 01;36(2):189-96 [PMID: 23372266]
Br J Clin Pharmacol. 2003 Sep;56(3):297-304 [PMID: 12919178]
Clin Ther. 2013 May;35(5):604-11 [PMID: 23541711]
Expert Rev Clin Pharmacol. 2009 Jul;2(4):333-7 [PMID: 22112177]
Traffic Inj Prev. 2012;13(3):286-92 [PMID: 22607251]
Expert Opin Pharmacother. 2012 Apr;13(6):879-93 [PMID: 22424586]
J Pharmacol Exp Ther. 2000 May;293(2):435-43 [PMID: 10773013]
Clin Pharmacokinet. 2005;44(1):33-60 [PMID: 15634031]
Clin Pharmacol Ther. 2004 Nov;76(5):467-79 [PMID: 15536461]
Clin Pharmacokinet. 1991 Sep;21(3):165-77 [PMID: 1684924]
JAMA. 2013 Feb 20;309(7):706-16 [PMID: 23423416]
Neurotherapeutics. 2012 Oct;9(4):728-38 [PMID: 22976558]
Neuropsychol Rev. 2011 Mar;21(1):41-53 [PMID: 21225347]
Br J Clin Pharmacol. 1999 Jul;48(1):89-97 [PMID: 10383565]
J Psychopharmacol. 2010 Nov;24(11):1577-601 [PMID: 20813762]
J Clin Pharmacol. 2008 Nov;48(11):1350-5 [PMID: 18757784]
J Clin Pharmacol. 2014 Mar;54(3):282-90 [PMID: 24203450]
Nat Sci Sleep. 2010 Apr 14;2:63-9 [PMID: 23616698]
J Psychosom Res. 2010 Dec;69(6):565-71 [PMID: 21109044]

MeSH Term

Administration, Sublingual
Adult
Aged
Aging
Area Under Curve
Cross-Over Studies
Female
Health Services for the Aged
Humans
Hypnotics and Sedatives
Male
Pyridines
Zolpidem

Chemicals

Hypnotics and Sedatives
Pyridines
Zolpidem