II. Indication

  1. Insomnia
  2. Sleep maintenance
    1. Standard Ambien and Ambien CR have similar effect on sleep maintenance
  3. Early awakening (Intermezzo)
    1. Contraindicated if other Sedative-Hypnotic used earlier in evening
    2. Similar to Sonata (generic in 2012), but Intermezzo costs significantly more

III. Preparations

  1. Standard dose Zolpidem (Ambien)
    1. Younger Adult
      1. Men: 5-10 mg (or 6.25 to 12.5 mg for CR) orally at bedtime
      2. Women: 5 mg (or 6.25 mg for CR) orally at bedtime
        1. May increase to 10 mg (12.5 mg CR) if ineffective at lower dose
        2. Dose decreased by FDA in 2013 due to next-morning Impairment
          1. See below under precautions
          2. http://www.fda.gov/Drugs/DrugSafety/ucm334033.htm
    2. Elderly: 2.5 to 5 mg orally at bedtime
  2. Controlled release (CR)
    1. Adult: 12.5 mg orally at bedtime
  3. Intermezzo (low dose Zolpidem)
    1. Regular dose: 3.5 mg orally on early awakening
      1. Indicated in men
    2. Low dose: 1.75 mg orally on early awakening
      1. Indicated in women, elderly, liver disease, use of other CNS depressants
    3. References
      1. (2012) Presc Lett 19(5): 26

IV. Precautions

  1. FDA decreased recommended Zolpidem dose in 2013 from 10 mg (12.5 mg CR) to 5 mg (or 6.25 mg CR)
    1. Reduced dose in women due to next-morning Impairment (also occurs in 25% of men)
    2. Women metabolize Zolpidem more slowly resulting in blood levels twice as high as men
    3. Levels are even higher and prolonged with the controlled release preparations
  2. References
    1. FDA website
      1. http://www.fda.gov/Drugs/DrugSafety/ucm334033.htm

V. Pharmacokinetics

  1. Peak onset: <30 minutes (may be as quick onset as 7 minutes for standard Ambien)
  2. Duration: 4-8 hours (6 to 8 hours with CR version)
  3. Half-Life: 2-3 hours (3 to 4.5 hours with CR version)
  4. Metabolized by CYP450 3A4

VI. Mechanism

  1. Nonbenzodiazepine Hypnotic Agent (Benzodiazepine Receptor Agonist)
  2. Acts at omega 1 subtype Benzodiazepine receptor
  3. No anticonvulsant or myorelaxant effects

VII. Lactation

  1. Compatible with Breast Feeding per AAP
  2. Lack of longterm data - other medications are preferred

VIII. Pregnancy

  1. Pregnancy Class B (not CR version)
  2. Lack of longterm data - other medications are preferred

IX. Drug Interactions

  1. Avoid taking with food or immediately after a meal
    1. Delays onset of action
    2. Decreases maximal concentration
  2. Avoid taking with Alcohol
    1. May increase CNS depression

X. Adverse effects

  1. See Nonbenzodiazepine Hypnotic Agent for common effects
  2. Abdominal Pain or gastrointestinal upset
  3. Rebound Insomnia
  4. Nightmares
  5. Sleep-eating is more common

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Cost: Medications

zolpidem (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
ZOLPIDEM TART ER 12.5 MG TAB Generic $1.09 each
ZOLPIDEM TART ER 6.25 MG TAB Generic $1.40 each
ZOLPIDEM TARTRATE 10 MG TABLET Generic $0.03 each
ZOLPIDEM TARTRATE 5 MG TABLET Generic $0.03 each
ambien (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
AMBIEN 10 MG TABLET Generic $0.03 each
AMBIEN CR 12.5 MG TABLET Generic $1.09 each
intermezzo (on 1/3/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
INTERMEZZO 1.75 MG TAB SUBLING $10.94 each
INTERMEZZO 3.5 MG TAB SUBLING $11.17 each

Ontology: zolpidem (C0078839)

Definition (NCI_NCI-GLOSS) A drug used to treat insomnia (inability to sleep), and anxiety. It is a type of imidazopyridine (sedative hypnotic).
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C049109
SnomedCT 387569009, 96231005
LNC LP17255-8, MTHU012369
English N,N,6-trimethyl-2-(4-methylphenyl)imidazo(1,2a)pyridine-3-acetamide hemitartrate, zolpidem, zolpidem [Chemical/Ingredient], ZOLPIDEM, zolpidem (medication), hypnotics zolpidem, Zolpidem, Zolpidem (product), Zolpidem (substance), ZPD
Spanish zolpidem (producto), zolpidem (sustancia), zolpidem

Ontology: Ambien (C0487782)

Definition (CHV) brand name of zolpidem, a drug used to treat insomnia
Definition (CHV) brand name of zolpidem, a drug used to treat insomnia
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C049109
English Ambien, ambien, ambien [brand name], Sanofi brand of zolpidem tartrate