Zolpidem: 6 things you should know
Medically reviewed by C. Fookes, BPharm. Last updated on Nov 2, 2018.
1. How it works
- Zolpidem helps induce sleep by enhancing the effects of GABA, a chemical transmitter in the brain. However, zolpidem's chemical structure is different from the benzodiazepines.
- Zolpidem belongs to the class of medicines known as sedative-hypnotics.
- May be used to help you get to sleep and stay asleep.
- Different forms of zolpidem are used for sleep initiation, sleep maintenance, or returning to sleep when "middle-of-the-night" awakening is followed by difficulty getting back to sleep.
- Available as tablets, extended-release tablets, sublingual (under the tongue) tablets, and an oral spray.
- Generic zolpidem is available.
If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:
- Drowsiness and unsteadiness on standing, feeling like you have been "drugged", lightheadedness or dizziness; all of which may increase your risk of having a fall. Do not drive or operate machinery after taking zolpidem. Avoid alcohol.
- A headache is also a common side effect.
- The brands of zolpidem called Ambien, Ambien CR, Edluar, Zolpimist should only be taken if you are able to stay in bed a full night (7 to 8 hours). The shorter-acting zolpidem called Intermezzo may be taken if you wake in the middle of the night and need to get back to sleep and there are at least 4 hours left until waking.
- Zolpidem is potentially addictive and may cause emotional and physical dependence. The lowest dose should be used for the shortest possible time.
- Withdrawal symptoms (including tiredness, nausea, flushing, stomach cramps, and panic attacks) may occur if you stop zolpidem abruptly after you have been taken it for extended periods of time. Zolpidem should be tapered off slowly under a doctor's supervision.
- May interact with a number of other medications including opioids, other medications that cause sedation (such as alcohol, antipsychotics, antidepressants, or sedative antihistamines), ketoconazole, fluvoxamine, or St. John's Wort.
- May not be suitable for some people including those with an unrecognized psychiatric disorder or pre-existing respiratory disease (such as COPD or sleep apnea). The elderly or frail may be especially sensitive to zolpidem's effects
Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.
- Food delays the onset of effect so zolpidem will work faster if not taken with food. Take tablets immediately before going to bed, not sooner.
- Sublingual tablets should be placed under the tongue and allowed to disintegrate. Do not swallow whole. Protect from light and moisture. Edluar is a dissolvable tablet that is placed on the tongue and allowed to dissolve in the mouth without water.
- Zolpimist should be sprayed directly into the mouth over the tongue. Prime the pump prior to initial use or if you haven't used the spray for at least 14 days.
- The extended-release form of zolpidem may help with staying asleep, as well as sleep initiation. Do not cut, crush, or chew extended-release forms.
- Higher dosages and extended-release forms may impair next-day alertness and ability to drive.
- One dosage form of zolpidem (Intermezzo) should only be taken by people who awaken in the middle of the night with more than four hours of sleep remaining; do not take if less than four hours sleep remaining. Other forms of zolpidem (Ambien, Edluar, Zolpimist, Ambien CR) should only be taken if there are 7 to 8 hours that can be devoted to sleep before awakening.
- Be cautious about driving or operating machinery the next day if you are still feeling sleepy after taking zolpidem the night before.
- If your mood changes or you experience depression or a worsening of depression, talk with your doctor.
- Zolpidem may make you feel dizzy, increasing your risk of falls. Be careful when sitting or standing up after lying down.
- The safety and effectiveness of zolpidem in children has not been demonstrated.
6. Response and Effectiveness
- Time to peak effect varies depending on formulation but ranges from just over half an hour to 1.5 hours. Food delays time to peak.
- Duration of effect also varies depending on formulation but immediate-release tablets last 6-8 hours.
- Immediate-release forms of zolpidem are Ambien, Intermezzo, Edluar, and Zolpimist. These help a person to fall asleep. Intermezzo may also be used if a person awakens in the middle of the night and has trouble falling back to sleep (although at least four hours of potential sleep time should still remain).
- Ambien CR is an extended-release form of zolpidem. It consists of an outer layer that dissolves quickly to help a person fall asleep and a second layer that dissolves slowly to help a person stay asleep.
Zolpidem [Package Insert]. Revised 12/2017. Wockhardt USA LLC https://www.drugs.com/pro/zolpidem.html
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use zolpidem only for the indication prescribed.
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