What is a tablet with ZZ on it?
When you discover a pill with the imprint 'ZZ', you are likely looking at a specific dosage of Intermezzo, a sublingual form of the medication zolpidem. Zolpidem is a sedative-hypnotic medication prescribed for the treatment of insomnia. The letters 'ZZ' are the imprint codes that pharmaceutical companies are required to use to help identify medications. The specific appearance of the tablet, including its color and shape, indicates the dosage strength.
- 1.75 mg strength: Typically appears as a yellow, round tablet with 'ZZ' imprinted on one side.
- 3.5 mg strength: Appears as a tan, round tablet with 'ZZ' imprinted on one side.
Intermezzo is different from other forms of zolpidem, like Ambien, because it is specifically formulated to be taken in the middle of the night for people who wake up and have trouble returning to sleep. It is placed under the tongue to dissolve and should only be taken if there are at least four hours remaining before the planned time of awakening.
The role of zolpidem in insomnia treatment
Zolpidem is part of a class of drugs known as "Z-drugs" (which also includes zaleplon and eszopiclone), named for their initial letter. These medications work by slowing activity in the brain to help people fall asleep. Unlike older benzodiazepines, zolpidem is a non-benzodiazepine sedative-hypnotic, which means it has a different chemical structure but produces similar effects. It acts on GABA (gamma-aminobutyric acid) receptors in the brain, increasing the inhibitory effects of GABA, thereby inducing a state of calm and promoting sleep.
Zolpidem is recommended for short-term use, typically for a few weeks, to minimize the risk of dependence and misuse. The immediate-release version, sold under brand names like Ambien, helps with sleep onset, while extended-release versions (Ambien CR) and sublingual formulations (Intermezzo) address both falling asleep and staying asleep.
Important safety considerations and side effects
As a controlled substance, zolpidem carries important risks and warnings. The U.S. Food and Drug Administration (FDA) has issued warnings about complex sleep behaviors associated with Z-drugs, which can be dangerous and even fatal. Patients have reported engaging in activities like sleep-driving, sleep-walking, and sleep-eating while not fully awake and having no memory of the events.
Common side effects of zolpidem may include:
- Daytime drowsiness or feeling "drugged"
- Dizziness or lightheadedness
- Headache
- Nausea, diarrhea, or stomach pain
- Memory problems or amnesia
- Unsteady walking or loss of balance
More serious risks include:
- Worsening of depression or suicidal thoughts
- Hallucinations and bizarre behavior
- Severe allergic reactions (anaphylaxis and angioedema)
- Dependence and withdrawal symptoms upon abrupt discontinuation
Zolpidem (Intermezzo) vs. Other Sleep Aids
| Feature | Zolpidem (Intermezzo) | Zolpidem (Ambien CR) | OTC Sleep Aids (Diphenhydramine) |
|---|---|---|---|
| Primary Use | Middle-of-the-night awakening | Falling and staying asleep | Occasional sleeplessness |
| Formulation | Sublingual tablet, dissolves under tongue | Extended-release oral tablet | Oral tablet or capsule |
| Onset of Action | Rapid, for prompt effect during the night | Dual-layer tablet for immediate and extended release | Varies, can take longer to feel effects |
| Full Night Sleep Required | At least 4 hours remaining | At least 7-8 hours remaining | Varies, generally requires full night |
| Dependence Risk | Moderate to high; classified as Schedule IV controlled substance | Moderate to high; classified as Schedule IV controlled substance | Lower, but tolerance can build; not recommended for long-term use |
| Complex Sleep Behaviors | Yes, boxed warning issued by FDA | Yes, boxed warning issued by FDA | Not typically associated, but possible side effects |
The proper way to take zolpidem sublingual tablets
For your safety, it is essential to follow the administration guidelines for Intermezzo exactly as prescribed by a healthcare provider.
- Read the Medication Guide: Every prescription for zolpidem comes with a Medication Guide explaining the risks and proper usage. Read it thoroughly.
- Take only when needed: The sublingual tablet is for occasional, as-needed use during the night, not for every night.
- Ensure enough sleep time: You must have at least four hours of sleep time remaining before you need to be awake. Taking it with less time can lead to next-day drowsiness and impaired alertness.
- Place under tongue: Let the tablet dissolve completely under your tongue. Do not swallow it whole or take it with water.
- Avoid food and alcohol: Do not take Intermezzo with or immediately after a meal, as this can affect how quickly it works. Avoid alcohol entirely, as it can dangerously increase the sedative effects.
What to do if you encounter a ZZ tablet
If you find an unprescribed tablet with ZZ on it, or if it is a forgotten prescription, do not take it. The best course of action is to:
- Do not assume it is for you: Unless it was explicitly prescribed for you and you know the dosage, do not assume it is safe.
- Use a pill identifier: Use online pill identification tools, like those from Drugs.com or WebMD, to verify the medication based on its imprint, shape, and color.
- Consult a professional: The safest step is to consult a pharmacist or doctor. They can verify the medication and advise on the proper disposal of controlled substances.
- Understand the context: Remember that Intermezzo has specific uses. Taking it outside of a situation where you can guarantee four hours of uninterrupted sleep is unsafe.
Conclusion
In summary, a tablet with 'ZZ' on it is Intermezzo, a specific sublingual formulation of the powerful sedative zolpidem, used for middle-of-the-night insomnia. As a Schedule IV controlled substance, it carries a risk of dependence, and its use is associated with serious potential side effects, including dangerous complex sleep behaviors. While it can be an effective treatment for specific types of insomnia, it must be used strictly as prescribed and with full awareness of the associated risks. The imprint serves as a critical identifier for pharmacists, doctors, and patients, emphasizing the importance of never taking an unidentified pill. Consulting a healthcare professional is the only way to ensure safe and appropriate use of this or any other prescription medication.
