The Hospice Clinician Blog

Intermezzo® is a recently approved sleep medication, indicated for middle-of-the-night awakening with difficulty returning to sleep. Intermezzo contains low-dose zolpidem (1.75 mg or 3.5 mg sublingual tablets) and has a duration of action of about 4 hours. While it is marketed as the only sleep medication to be specifically indicated for middle-of-the-night awakening, zaleplon (Sonata®) is already used this way (it is also short-acting with a duration of action of about 4 hours) and is less than half the cost of Intermezzo®.

Intermezzo® should not be used if another hypnotic was used earlier in the night for difficulty falling asleep. Patients who have trouble both falling asleep and maintaining sleep should use regular strength zolpidem (Ambien®, Ambien CR®) or eszopiclone (Lunesta®), which have a longer duration of action. Patients should not take Intermezzo® unless they will be able to sleep for at least 4 hours.

Dosing of Intermezzo® is gender-specific. Men should take the 3.5 mg strength and women should take the 1.75 mg strength (women metabolize zolpidem more slowly). The 1.75 mg strength is also recommended for elderly patients, patients with hepatic impairment, and patients who are also taking CNS depressants (e.g., opioids, benzodiazepines) – in other words, the vast majority of hospice patients.

Zolpidem is also available as a 5 and 10 mg sublingual tablet (Edluar®) and a 5 mg oral spray (Zolpimist®), for patients who have difficulty swallowing.

Posted on April 27. 2012