Zolpidem: 7 things you should know
Medically reviewed by Carmen Fookes, BPharm. Last updated on Feb 27, 2023.
1. How it works
- Zolpidem may be used to help people sleep.
- Zolpidem induces sleep by enhancing the effects of GABA, a chemical transmitter in the brain. However, zolpidem's chemical structure is different from 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 a "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, and Zolpimist should only be taken if you can 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 taking it for extended periods. Zolpidem should be tapered off slowly under a doctor's supervision.
- Reports of "sleep-driving” (driving while not fully awake), and other behaviors (such as eating, making phone calls, or having sex) after zolpidem have been documented. The risk may be exacerbated by large doses of alcohol. Seek medical advice if this occurs.
- May interact with several 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
Note: 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. View complete list of side effects
4. Bottom Line
- Zolpidem induces sleep; however, longer-acting formulations may impair physical and mental capabilities the next day. May induce complex or dangerous sleep-related behaviors like "sleep-driving" which is worse with high doses or when zolpidem is combined with alcohol or other drugs that cause sleepiness.
- Food delays the onset of the 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 before 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 the 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 it if you have 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
- The time to peak effect varies depending on the formulation but ranges from just over half an hour to 1.5 hours. Food delays the time to peak.
- Duration of effect also varies depending on the 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 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.
Medicines that interact with zolpidem may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with zolpidem. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.
Common medications that may interact with zolpidem include:
- anti-anxiety medications, including benzodiazepines, such as diazepam and oxazepam
- anticonvulsants such as valproate
- antidepressants, such as amitriptyline, imipramine, nortriptyline
- antifungal medications, such as itraconazole, or ketoconazole
- antihistamines that cause sedation, such as diphenhydramine
- monoamine oxidase inhibitors, such as selegiline, isocarboxazid, or phenelzine
- opioid analgesics such as codeine, oxycodone and morphine
- muscle relaxants such as cyclobenzaprine
- sleeping pills, such as eszopiclone
- some medications used to treat mental illness, such as clozapine and thioridazine
- St. John's Wort
Alcohol may worsen the side effects of zolpidem such as drowsiness and dizziness.
Note that this list is not all-inclusive and includes only common medications that may interact with zolpidem. You should refer to the prescribing information for zolpidem for a complete list of interactions.
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- Drug class: miscellaneous anxiolytics, sedatives and hypnotics
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Related treatment guides
- Zolpidem. Revised 12/2022. ACI Healthcare USA, Inc. 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.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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