II. Indication
- Insomnia
-
Sleep maintenance
- Standard Ambien and Ambien CR have similar effect on sleep maintenance
- Early awakening (Intermezzo)
- Contraindicated if other Sedative-Hypnotic used earlier in evening
- Similar to Sonata (generic in 2012), but Intermezzo costs significantly more
III. Medications
- Standard dose Zolpidem (Ambien)
- Younger Adult
- Men: 5-10 mg (or 6.25 to 12.5 mg for CR) orally at bedtime
- Women: 5 mg (or 6.25 mg for CR) orally at bedtime
- May increase to 10 mg (12.5 mg CR) if ineffective at lower dose
- Dose decreased by FDA in 2013 due to next-morning Impairment
- See below under precautions
- http://www.fda.gov/Drugs/DrugSafety/ucm334033.htm
- Elderly: 2.5 to 5 mg orally at bedtime
- Younger Adult
- Controlled release (CR)
- Adult: 12.5 mg orally at bedtime
- Intermezzo (low dose Zolpidem)
- Regular dose: 3.5 mg orally on early awakening
- Indicated in men
- Low dose: 1.75 mg orally on early awakening
- Indicated in women, elderly, liver disease, use of other CNS Depressants
- References
- (2012) Presc Lett 19(5): 26
- Regular dose: 3.5 mg orally on early awakening
IV. Precautions
- FDA decreased recommended Zolpidem dose in 2013 from 10 mg (12.5 mg CR) to 5 mg (or 6.25 mg CR)
- Reduced dose in women due to next-morning Impairment (also occurs in 25% of men)
- Women metabolize Zolpidem more slowly resulting in blood levels twice as high as men
- Levels are even higher and prolonged with the controlled release preparations
- References
V. Pharmacokinetics
VI. Mechanism
- Nonbenzodiazepine Hypnotic Agent (Benzodiazepine Receptor Agonist)
- Acts at omega 1 subtype Benzodiazepine receptor
- No anticonvulsant or myorelaxant effects
VII. Lactation
- Compatible with Breast Feeding per AAP
- Lack of longterm data - other medications are preferred
VIII. Pregnancy
- Pregnancy Class B (not CR version)
- Lack of longterm data - other medications are preferred
IX. Drug Interactions
- Avoid taking with food or immediately after a meal
- Delays onset of action
- Decreases maximal concentration
- Avoid taking with Alcohol
- May increase CNS depression
X. Adverse effects
- See Nonbenzodiazepine Hypnotic Agent for common effects
- Abdominal Pain or gastrointestinal upset
- Rebound Insomnia
- Nightmares
- Sleep-eating is more common
XI. Resources
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Related Studies
| zolpidem (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| ZOLPIDEM TART 1.75 MG TAB SL | Generic | $4.72 each |
| ZOLPIDEM TART 3.5 MG TABLET SL | Generic | $4.83 each |
| ZOLPIDEM TART ER 12.5 MG TAB | Generic | $0.15 each |
| ZOLPIDEM TART ER 6.25 MG TAB | Generic | $0.19 each |
| ZOLPIDEM TARTRATE 10 MG TABLET | Generic | $0.03 each |
| ZOLPIDEM TARTRATE 5 MG TABLET | Generic | $0.03 each |
| ambien (on 1/3/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| AMBIEN 10 MG TABLET | Generic | $0.03 each |
| AMBIEN 5 MG TABLET | Generic | $0.03 each |
| AMBIEN CR 12.5 MG TABLET | Generic | $0.15 each |