Zolpidem

Zolpidem treats insomnia. Standard formulations help with sleep onset; extended-release treatment also helps sleep maintenance. Certain low-dose sublingual formulations have separate middle-of-the-night instructions.

It enhances GABA activity at a benzodiazepine-receptor site. It can help sleep while impairing memory, coordination, and alertness, including the next day.

Sleep may improve from the first few nights. Review persistent insomnia rather than increasing doses yourself. Keep a brief record of bedtime, awakenings, wake time, and next-day alertness.

• For standard bedtime formulations, take only when ready for bed with seven to eight hours available for sleep.
• Only a specifically prescribed low-dose middle-of-the-night formulation uses the separate four-hour remaining-sleep rule. Do not apply that rule to Ambien or Ambien CR.
• Swallow ER tablets whole and follow exact sublingual or spray instructions. Food can delay onset.
• Do not take a second dose that night, combine formulations, or use alcohol.

• Sleepiness, headache, or dizziness
• Vivid dreams or nightmares
• Next-day impairment or falls

Some side effects resolve with time; others may require a change of medication. Discuss persistent or bothersome side effects with your provider.

Watch for next-day impairment, memory gaps, falls, and unusual nighttime behavior. Serious complex sleep behaviors can occur even with a first dose and without alcohol.

Tolerance, dependence, and misuse are possible. After regular use, consult with your provider before stopping; rebound insomnia and withdrawal may occur.

After extended-release zolpidem, labeling cautions against driving or activities requiring full alertness the following day. Follow the specific formulation’s restrictions.

For a suspected overdose, call Poison Control at 1-800-222-1222 immediately, even if you feel well. Call 911 for a seizure, collapse, trouble breathing, or inability to wake.

Do not use if you have had complex sleep behaviors with zolpidem, zaleplon, or eszopiclone. Discuss breathing problems, sleep apnea, liver disease, falls, depression, and substance use.

Discuss pregnancy, pregnancy plans, and breastfeeding with your provider. Treatment decisions should consider both the medication and the condition being treated.

Review all your medications with your provider, including over-the-counter medicines and supplements. Have new medications checked before taking them.

Avoid alcohol and do not combine with another insomnia medicine unless your provider has specifically reviewed the plan. Opioids and other sedatives increase impairment.

Some antibiotics, antifungals, antivirals, and seizure medicines change drug levels. Review grapefruit and all new medicines.

Keep a consistent wake-up time and allow adequate sleep.

Avoid driving or dangerous work when drowsy, even if you think you slept enough.

Keep medication in its labeled container, away from excess heat and moisture and out of reach of children and pets. Do not share it. Ask a pharmacy about disposal of unused medication.