Zolpidem should not be taken by people with obstructive sleep apnea, myasthenia gravis, severe liver disease, respiratory depression or by children, or people with psychotic illnesses. It can be taken if there are at least 4 hours between the time of administration and when the person must be awake. Ī lower-dose version (3.5 mg for men and 1.75 mg for women) is given as a tablet under the tongue and used for middle-of-the-night awakenings. This is based in part on a 2012 review which found that zolpidem's effectiveness is nearly as much due to psychological effects as to the medication itself. cognitive behavioral therapy for insomnia). Guidelines from NICE, the European Sleep Research Society, and the American College of Physicians recommend medication for insomnia (including possibly zolpidem) only as a second line treatment after non-pharmacological treatment options have been tried (e.g. It may be used for both improving sleep onset, sleep onset latency, and staying asleep. Zolpidem is labelled for short-term (usually about two to six weeks) treatment of insomnia at the lowest possible dose. In 2020, it was the 47th most commonly prescribed medication in the United States, with more than 14 million prescriptions. More than ten million prescriptions are filled each year in the United States, making it one of the most commonly used treatments for sleeping problems. Zolpidem is a Schedule IV controlled substance under the Controlled Substances Act of 1970 (CSA). It became available as a generic medication in 2007. Zolpidem was approved for medical use in the United States in 1992. This, however, is increased in those with liver problems. It generally has a half-life of two to three hours. It works by increasing GABA effects in the central nervous system by binding to GABA A receptors at the same location as benzodiazepines. Zolpidem is a GABA A receptor agonist of the imidazopyridine class. Zolpidem is a nonbenzodiazepine or Z-drug which acts as a sedative and hypnotic. While flumazenil, a GABA A–receptor antagonist, can reverse zolpidem's effects, usually supportive care is all that is recommended in overdose. Additionally, driving the next morning is not recommended with either higher doses or the long-acting formulation. Newer extended-release formulations include the 6.25 mg for women, and 12.5 mg or 6.25 mg for men, which also cause next-day somnolence when used in higher doses. The previously recommended dose was decreased in 2013, by the US Food and Drug Administration (FDA), to the immediate-release 10 mg for men, and 5 mg for women, in an attempt to reduce next-day somnolence. More severe side effects include memory problems and hallucinations. Ĭommon side effects include daytime sleepiness, headache, nausea, and diarrhea. It is taken by mouth and is available in conventional tablets, sublingual tablets, or oral spray. It decreases the time to sleep onset by about fifteen minutes and at larger doses helps people stay asleep longer. Guidelines recommend that it be used only after cognitive behavioral therapy for insomnia and behavioral changes, such as sleep hygiene, have been tried. Zolpidem, sold under the brand name Ambien, among others, is a medication primarily used for the short-term treatment of sleeping problems.
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