zolpidem
Zolpidem is a sleeping pill used to treat insomnia, a condition where you have trouble falling or staying asleep. The dose is typically taken at bedtime to help you sleep. Since it's a controlled substance, it has a risk of misuse and dependency. Zolpidem should only be taken for a short period of time, especially since the medication can cause side effects like dizziness, daytime sleepiness, sleepwalking, or sleep driving. It comes as an oral tablet or capsule that you swallow and a sublingual tablet that you place under your tongue.
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What is Zolpidem?
What is Zolpidem used for?
Insomnia (trouble sleeping)
Waking up in the middle of the night - certain sublingual tablets only
How Zolpidem works
Zolpidem is a gamma-aminobutyric acid (GABA) A receptor positive modulator. It works on GABA receptors in the brain to slow down brain activity. This helps you relax and fall asleep faster.
Drug Facts
More on Zolpidem essentials
What are the risks and warnings for Zolpidem?
Zolpidem can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Abnormal sleep behaviors
Risk factors: Taking zolpidem with alcohol or other medications that also cause sleepiness
Zolpidem can sometimes cause abnormal sleep behaviors, such as sleepwalking, sleep driving, or sleep eating. It can also cause you to make phone calls or engage in sexual activities while not being fully alert. Taking zolpidem with alcohol or other sleep medications might raise your risk for these types of behaviors, but it can also happen when taken alone at the recommended dose. These behaviors can sometimes lead to serious injuries or even death. You also might not remember doing these activities when you wake up the next morning. If you or your loved ones see you performing any activity while sleeping, stop taking zolpidem and let your healthcare provider know right away because you might have to switch to a different medication.
Daytime sleepiness and lowered alertness
Risk factors: Drinking alcohol | Using zolpidem with other medications that cause sleepiness | Taking zolpidem with less than 7 to 8 hours of sleep
Zolpidem can cause daytime sleepiness, dizziness, confusion, and slowed brain activity, especially when combined with alcohol, benzodiazepines, opioids, or tricyclic antidepressants. If you take any of these medications, let your healthcare provider know because you might need a lower dose of either zolpidem or your other medication.
Taking zolpidem on less than a full night of sleep (7 to 8 hours) can raise your risk of daytime sleepiness, longer reaction times, dizziness, blurred vision, and lowered alertness. Don't drive or perform any activity that requires your full concentration if you take zolpidem too close to waking up. Older adults are at a greater risk of falling due to sleepiness and lowered alertness. If you feel sleepy during the day while taking zolpidem, let your healthcare provider know.
Severe allergic reaction
Zolpidem can sometimes cause a serious allergic reaction known as angioedema, or swelling of your tongue, lips, throat, or mouth. Other symptoms of an allergic reaction include trouble breathing, nausea, or vomiting. This can happen at any time during your treatment with zolpidem. Allergic reactions can be life-threatening, so you should call for emergency medical help right away.
Abnormal thoughts, behavior changes, and depression
Risk factors: Worsening insomnia | History of suicidal thoughts | History of depression
Zolpidem can cause you to have abnormal thoughts and changes in behavior. If you notice any changes in your behavior, such as aggression, feeling agitated, or having hallucinations, tell your provider so you can be properly evaluated and diagnosed.
Zolpidem can worsen depression and suicidal thoughts. If you have a history of depression or suicidal thoughts or behaviors, let your provider know before starting zolpidem. For your safety, your provider might prescribe the lowest amount of pills for the shortest amount of time.
Slowed breathing
Risk factors: Sleep apnea | Myasthenia gravis | Using opioids or other medications that can cause slowed breathing
Zolpidem can sometimes cause slowed breathing, especially if you have a history of sleep apnea. Let your healthcare provider know if you notice changes in your breathing while using zolpidem because you might need to be switched to another medication.
Liver damage in people with liver problems
Risk factors: History of liver problems
If you have a history of liver problems, your body might not clear zolpidem as quickly as someone without these problems, leading to a higher risk of side effects. The medication should be avoided in people who have severe liver problems because it can lead to brain damage (encephalopathy). For your safety, let your healthcare provider know if you have a liver condition before starting zolpidem.
Withdrawal symptoms
Risk factors: Suddenly stopping zolpidem | Lowered dose of zolpidem
If you've been taking zolpidem for a long period of time, you can become tolerant and eventually dependent on it. If your dose is lowered or you suddenly stop taking the medication, you might have withdrawal symptoms. Symptoms include nausea, vomiting, sweating, tremor, uncontrolled crying, panic attacks, stomach cramps, muscle cramps, nervousness, tiredness, or lightheadedness. Let your healthcare provider know if you experience any withdrawal symptoms.
What are the side effects of Zolpidem?
Common Side Effects
- Headache (7%)
- Sleepiness (2%)
- Dizziness (1%)
- Diarrhea (1%)
Other Side Effects
- Nausea
- Dry mouth
- Back pain
- Flu-like symptoms
- Chest pain
- Feeling tired or loss of energy
- Lightheadedness
- Depression
- Abnormal dreams
- Memory loss
- Stomach pain
- Constipation
- Sinus infection
- Sore throat
- Rash
Serious Side Effects
- Dangerous sleep behaviors: sleepwalking, sleep driving, or doing any activity while not being fully alert
- Slowed brain activity (CNS depression): excessive sleepiness, confusion, coma
- Trouble breathing (respiratory depression): shallow breaths, tiredness, slow breaths
- Serious allergic reaction: itchy, red rash (hives), shortness of breath, chest tightness, throat closing, nausea, vomiting, swelling of lips, tongue, face, or eyes
- Suicidal thoughts and behavior
Source: DailyMed
More on Zolpidem side effects
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Less common
confusion about identity, place, and time
discouragement
false or unusual sense of well-being
fast, irregular, pounding, or racing heartbeat or pulse
feeling sad or empty
general feeling of discomfort or illness
irritability
lack of appetite
lightheadedness
loss of interest or pleasure
shakiness and unsteady walk
tiredness
trouble concentrating
trouble sleeping
unsteadiness, trembling, or other problems with muscle control or coordination
unusual tiredness or weakness
Rare
attack, assault, or force
black, tarry stools
bladder pain
bloody or cloudy urine
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
change in walking and balance
chills
cold sweats
crying
decreased awareness or responsiveness
deep or fast breathing with dizziness
delusions of persecution, mistrust, suspiciousness, or combativeness
difficult, burning, or painful urination
difficulty with swallowing
dizziness
dizziness, faintness, or lightheadedness when getting up from lying or sitting position
fainting
false beliefs that cannot be changed by facts
feeling of unreality
frequent urge to urinate
irregular heartbeat
irritability
lack of feeling or emotion
light-colored stools
lower back or side pain
numbness of the feet, hands, and around the mouth
pale skin
poor insight and judgment
problems with memory or speech
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
quick to react or overreact emotionally
rapidly changing moods
restlessness
seeing, hearing, or feeling things that are not there
sense of detachment from self or body
severe sleepiness
sores, ulcers, or white spots on the lips or in the mouth
stomach pain
swollen glands
thoughts of killing oneself or changes in behavior
tightness in the chest
trouble recognizing objects
trouble thinking and planning
trouble walking
troubled breathing with exertion
uncaring
unusual bleeding or bruising
vomiting
yellow eyes or skin
unease or dissatisfaction with life
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Change or loss of consciousness
difficult or troubled breathing
irregular, fast or slow, or shallow breathing
pale or blue lips, fingernails, or skin
sleepiness or unusual drowsiness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Back pain
being forgetful
belching
body aches or pain
congestion
difficulty having a bowel movement
difficulty with moving
double vision
feeling of constant movement of self or surroundings
hoarseness
indigestion
longer or heavier menstrual periods
loss of memory
muscle pain or stiffness
pain or tenderness around the eyes and cheekbones
seeing double
sensation of spinning
stomach discomfort
tender, swollen glands in the neck
unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
voice changes
Rare
Bad, unusual, or unpleasant (after) taste
blemishes on the skin
blindness
blurred vision
breast pain
change in near or distance vision
change in taste
changes in patterns and rhythms of speech
decreased interest in sexual intercourse
difficulty in focusing the eyes
feeling of warmth
frequent urge to defecate
inability to have or keep an erection
increased appetite
increased sensitivity of the skin to sunlight
increased sweating
itching of the vagina or genital area
lack or loss of strength
loss in sexual ability, desire, drive, or performance
pain during sexual intercourse
paleness of the skin
redness of the face, neck, arms, and occasionally, upper chest
redness or other discoloration of the skin
severe sunburn
slurred speech
stomach upset
straining while passing stool
tearing
thick, white vaginal discharge with no odor or with a mild odor
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Zolpidem
Pros
Works quickly within 15 to 30 minutes to help you feel sleepy
Available as a lower-cost generic medication
Comes in multiple strengths which can be helpful to determine the right dose for you
Available as a tablet that dissolves under your tongue if you have trouble swallowing pills
Cons
Can only be used for short-term treatment of insomnia
Has a serious risk of nighttime sleep behaviors, such as sleepwalking, sleep driving, or sleep eating
Can cause unpleasant withdrawal symptoms, such as stomach cramps, sweating, or vomiting, when stopped suddenly
Is a controlled substance with a risk of misuse and dependence
Pharmacist tips for Zolpidem
Zolpidem is a controlled substance, meaning it's highly regulated by the FDA because of its risk of misuse, dependence, addiction, and overdose. For these reasons, you should only use this medication as prescribed by your healthcare provider.
Taking too much zolpidem can lead to an overdose. Symptoms of an overdose include lowered alertness, excessive sleepiness, and coma. You might also have some heart-related problems and trouble breathing. Overdoses need to be treated right away so make sure you and your loved ones know the symptoms above.
For your safety, only take zolpidem if you'll be able to get a full night of sleep, or at least 7 to 8 hours.
If you're using the zolpidem sublingual tablet for middle-of-the-night awakening, only take it if you have at least 4 hours remaining before having to wake up. Taking the medication too close to waking up can cause you to wake up feeling sleepy, dizzy, or sluggish. Doing any activity while feeling sleepy can lead to serious injury or death.
Avoid taking zolpidem with food or right after eating a meal because food affects how well the medication is absorbed into your body. The medication works better to help you fall asleep faster if you take it on an empty stomach.
Zolpidem can cause daytime sleepiness the following day. Wait for at least 8 hours after taking the medication before driving or doing activities that require you to be alert.
If you're using the zolpidem extended-release tablet (Ambien CR), don't chew, crush, break, or dissolve your tablet because this can affect how well the medication gets absorbed into your body. Always swallow the tablet whole on an empty stomach.
If you're using the zolpidem sublingual tablet, place the entire tablet under your tongue. The tablet will slowly break down and dissolve under your tongue. Don't swallow the tablet or drink water with it as this can affect how well the medication gets absorbed and works in your body.
Avoid taking zolpidem if you drank alcohol that evening or before bedtime. If you already drank alcohol that night or before bed, skip your dose of the medication. Drinking alcohol with the medication can raise your risk of serious side effects, such as excessive sleepiness, dizziness, slowed brain activity, and confusion.
Frequently asked questions about Zolpidem
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Zolpidem dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 7.5mg | 30 capsules | $209.65 | $6.99 |
Typical dosing for Zolpidem
Insomnia
Immediate-release tablet: The typical dose is 5 mg to 10 mg by mouth nightly at bedtime.
Immediate-release capsule: The typical dose is 7.5 mg by mouth nightly at bedtime.
Extended-release tablet (Ambien CR): The typical dose is 6.25 mg to 12.5 mg by mouth nightly at bedtime.
Sublingual tablet (Edluar): The typical dose is 5 mg to 10 mg tablet placed under the tongue nightly at bedtime.
Middle-of-the-night awakening
Sublingual tablet (generic): The typical dose is 1.75 mg to 3.5 mg tablet placed under the tongue once as needed.
More on Zolpidem dosage forms
Interactions between Zolpidem and other drugs
More on Zolpidem interactions
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Calcium Oxybate
- Magnesium Oxybate
- Potassium Oxybate
- Sodium Oxybate
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abametapir
- Alfentanil
- Alprazolam
- Amobarbital
- Anileridine
- Baclofen
- Benzhydrocodone
- Boceprevir
- Bromazepam
- Bromopride
- Buprenorphine
- Buspirone
- Butabarbital
- Butorphanol
- Cannabidiol
- Carbinoxamine
- Carisoprodol
- Ceritinib
- Cetirizine
- Chloral Hydrate
- Chlordiazepoxide
- Chlorpromazine
- Chlorzoxazone
- Ciprofloxacin
- Clarithromycin
- Clobazam
- Clonazepam
- Clorazepate
- Cobicistat
- Codeine
- Conivaptan
- Cyclobenzaprine
- Dexmedetomidine
- Diacetylmorphine
- Diazepam
- Difenoxin
- Dihydrocodeine
- Diphenhydramine
- Diphenoxylate
- Doxylamine
- Esketamine
- Estazolam
- Eszopiclone
- Ethchlorvynol
- Ethylmorphine
- Fentanyl
- Flibanserin
- Flumazenil
- Flunitrazepam
- Flurazepam
- Fosnetupitant
- Fospropofol
- Gabapentin
- Gabapentin Enacarbil
- Halazepam
- Hydrocodone
- Hydromorphone
- Hydroxyzine
- Idelalisib
- Indinavir
- Itraconazole
- Ketamine
- Ketazolam
- Ketobemidone
- Ketoconazole
- Lemborexant
- Levocetirizine
- Levorphanol
- Lofexidine
- Lopinavir
- Lorazepam
- Loxapine
- Meclizine
- Meperidine
- Mephobarbital
- Meprobamate
- Meptazinol
- Metaxalone
- Methadone
- Methocarbamol
- Methohexital
- Methotrimeprazine
- Metoclopramide
- Midazolam
- Morphine
- Morphine Sulfate Liposome
- Nalbuphine
- Nefazodone
- Nelfinavir
- Netupitant
- Nicomorphine
- Nitrazepam
- Opium
- Opium Alkaloids
- Orphenadrine
- Oxazepam
- Oxycodone
- Oxymorphone
- Papaveretum
- Paregoric
- Pentazocine
- Pentobarbital
- Perampanel
- Periciazine
- Phenobarbital
- Piritramide
- Posaconazole
- Prazepam
- Pregabalin
- Primidone
- Promethazine
- Propofol
- Quazepam
- Ramelteon
- Remifentanil
- Remimazolam
- Ritonavir
- Saquinavir
- Scopolamine
- Secobarbital
- Sufentanil
- Tapentadol
- Telaprevir
- Telithromycin
- Temazepam
- Thiopental
- Thioridazine
- Tilidine
- Tizanidine
- Topiramate
- Tramadol
- Trazodone
- Triazolam
- Voriconazole
- Zaleplon
- Zopiclone
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Zolpidem cost?
Zolpidem contraindications
Abnormal sleep behaviors after taking zolpidem (such as sleepwalking, sleep driving, or sleep eating)
What are alternatives to Zolpidem?
Insomnia (trouble sleeping)
Waking up in the middle of the night - certain sublingual tablets only
Insomnia (difficulty falling asleep)
Trouble falling asleep (insomnia)
What is the latest news about Zolpidem?
Zolpidem images
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References
Best studies we foundAlmatica Pharma LLC. (2023). Zolpidem tartrate capsule [package insert]. DailyMed.
Bouchette, D., et al. (2022). Zolpidem. StatPearls.
Breckenridge Pharmaceutical, Inc. (2023). Zolpidem tartrate tablet, extended release [package insert]. DailyMed.
Meda Pharmaceuticals Inc. (2022). Edluar- zolpidem tartrate tablet [package insert] . DailyMed.
Hoque, R., et al. (2009). Zolpidem-Induced Sleepwalking, Sleep Related Eating Disorder, and Sleep-Driving: Fluorine-18-Flourodeoxyglucose Positron Emission Tomography Analysis, and a Literature Review of Other Unexpected Clinical Effects of Zolpidem. Journal of Clinical Sleep Medicine.
Memon, R. J., et al. (2023). Angioedema. StatPearls.
MGH Center for Women’s Mental Health. (n.d.). National Pregnancy Registry for Psychatic Medications©.
Par Pharmaceutical, Inc. (2019) Zolpidem tartrate sublingual tablet [package insert]. DailyMed.
Par Pharmaceutical, Inc. (2019). Zolpidem tartrate sublingual tablet [package insert]. DailyMed.
sanofi-aventis U.S. LLC. (2019). Ambien CR- zolpidem tartrate tablet, coated [package insert]. DailyMed.
Shih, H. I., et al. (2015). An increased risk of reversible dementia may occur after zolpidem derivative use in the elderly population: A population-based case-control study. Medicine.
Torrent Pharmaceuticals Limited. (2022). Zolpidem tartrate- zolpidem tartrate tablet [package insert]. DailyMed.
U.S. Food and Drug Administration. (2018). Questions and answers: Risk of next-morning impairment after use of insomnia drugs; FDA requires lower recommended doses for certain drugs containing zolpidem (Ambien, Ambien CR, Edluar, and Zolpimist).
U.S. Food and Drug Administration. (2022). FDA adds Boxed Warning for risk of serious injuries caused by sleepwalking with certain prescription insomnia medicines.
United States Drug Enforcement Administration. (n.d.). Drug scheduling.
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