Intermezzo is the brand name of a new formulation of the familiar drug zolpidem, better known as Ambien. Unfortunately the most interesting thing about Intermezzo may be its name. Intermezzo is also a term for in an opera or play for a composition of music or drama that fits between two other pieces. As a drug Intermezzo is indicated for patients who awaken earlier than desired and want to get back to sleep, i.e. between two “pieces” of the night’s sleep. I like the name but question paying a premium for the generic product. Intermezzo was brought to market buy Transcept Pharmaceuticals as a sublingual product, designed to be placed under the tongue and to dissolve there. The recommended dose is different for men than for women, with a dose of 1.75 mg. for women and 3.5 mg for men recommended. The explanation for this by the manufacturer is that men clear zolpidem from the blood stream faster than women.
Zolpidem has been available as a generic for the branded sleeping medication Ambien since the patent expired last year. Zolpidem is among the shortest acting of the sleep aides available, and has been marketed as an extended release product, Ambien CR to try to extend the duration of sleep for patients who find zolpidem effective at inducing sleep but who reawaken earlier than they desire. Now solpidem has been repackaged as a low dose sublingual product that is approved for use if in patients who tend to reawaken far too early after getting to sleep. You can take Intermezzo to get back to sleep with the anticipation that as long as you have at least 4 hours until you need to wake up you can take the Intermezzo and not be overly sedated in the morning.
Patients have been taking a half dose of a 5 or 10 mg zolpidem for this purpose for some time, although it is not an FDA approved indication. The effect of zolpidem taken orally in most people is only about 3-4 hours anyway, although in some people the effect can be longer. Does the sublingual route of administration make much difference? It is possible that if the drug is absorbed directly into the bloodstream through the oral mucosa that the serum levels are achieved more quickly than with oral ingestion, and if so in theory the medication may be more quickly cleared from the bloodstream and the hypnotic effect may last slightly less time.
Zolpidem as a generic product is relatively inexpensive at $17.99/ 30 tablets for both the 5 mg and 10 mg doses on drugstore.com. In cannot find a price online for Intermezzo but undoubtedly as a branded product it will be much higher than generic zolpidem. I’ll be interested to hear if patients find Intermezzo more effective than low dose generic zolpidem for getting back to sleep after early awakening, but I suspect that a 2.5 mg or 5 mg dose orally will be pretty similar in efficacy, and much easier on the pocketbook.
Please leave a comment if you have tried Intermezzo, especially if you have also used oral zolpidem for the same symptoms. Comparative experience will be interesting.