Zolpidem
AMBIEN
What it isAlpha-1-preferring GABA-A positive allosteric modulator; short-term treatment of insomnia.
Why this oneIt targets sleep onset with less broad muscle-relaxant and anxiolytic action than benzodiazepines, but is not dependence-free.
What limits itStop after any complex sleep behavior. Next-day impairment is worse in slower clearers; repeated use brings tolerance and rebound insomnia.
FDA-approved for
- insomnia (1992)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Insomnia (sleep-onset) | Women | 5 mg QHS | 10 mg QHS | |
| Insomnia (sleep-onset) | Men | 5 or 10 mg QHS | 10 mg QHS | |
| Insomnia (sleep-onset) | Elderly/debilitated | 5 mg QHS | 5 mg QHS |
Renal Undefined
Hepatic Mild-moderate: 5 mg QHS; avoid in severe impairment (may precipitate encephalopathy)
Do not exceed 10 mg once daily; single dose per night, do not redose
Instructions
- Take as a single dose immediately before bedtime with ≥7-8 h remaining before awakening; do not readminister the same night
- Onset may be slowed if taken with or immediately after a meal
- Lower dose may be needed with other CNS depressants
- May cause next-day impairment; caution with driving and activities requiring alertness
Contraindications
- Prior complex sleep behaviors after taking zolpidem
Cautions
- CNS depression and next-day impairment; additive with other CNS depressants and alcohol
- Severe anaphylactic/anaphylactoid reactions, angioedema
- Abnormal thinking and behavioral changes
- Worsening depression and suicidal ideation
- Respiratory depression in compromised respiratory function
- Hepatic encephalopathy in hepatic insufficiency
- Withdrawal effects with rapid dose reduction or discontinuation
- Falls, especially in the elderly
Adverse reactions
- Drowsiness
- Dizziness
- Diarrhea
- Drugged feeling
- Headache
Pregnancy Late third-trimester use may cause neonatal respiratory depression and sedation; no clear association with major birth defects.
Lactation Present in human milk; monitor infant for excess sedation; may pump and discard milk for 23 h after a dose.
⚠ BOXED WARNING
- Complex sleep behaviors including sleepwalking and sleep-driving
Cost, est. cash$4–$80/month
Generic entry2007
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityComplex sleep behaviors, next-day impairment, falls and additive CNS depression.
Mechanism of action: Zolpidem ballicule
Open Zolpidem in the interactive console ↗
Memory aids: mascots and interaction avatars
