Class: Nonbarbiturate Hypnotic. C-IV
Dosage Forms. Tablet: 5 mg, 10 mg; Tablet, Extended Release: 6.25 mg, 12.5 mg; Sublingual Tablet: 1.75 mg, 3.5 mg, 5 mg, 10 mg; Oromucosal Spray: 5 mg/actuation
Common FDA Label Indication, Dosing, and Titration.
1. Insomnia, short-term treatment: Immediate release, 10 mg po daily hs
2. Insomnia, short-term treatment: Extended release, 12.5 mg po daily hs
Off-Label Uses. None
MOA. Zolpidem binds the benzodiazepine receptor, preferentially with a high affinity ratio of the α1/α5 subunits.
Drug Characteristics: Zolpidem
Medication Safety Issues: Zolpidem
Drug Interactions: Zolpidem
Adverse Reactions: Zolpidem
Efficacy Monitoring Parameters. Improved ability to fall asleep and sleep through the night.
Toxicity Monitoring Parameters. Seek medical attention if severe drowsiness, thoughts of suicide, allergic reaction, fast or irregular heartbeat.
Key Patient Counseling Points. Take on an empty stomach. May cause drowsiness; avoid driving or other tasks requiring motor coordination. Avoid alcohol. Take immediately prior to bedtime. May cause complex behaviors (driving, talking on phone, etc, while not fully awake); bed partner should monitor and zolpidem should be discontinued. Place sublingual tablet under the tongue. Do not swallow or take with water.
Clinical Pearls. Not for long-term use (usually 7-10 d only). Use caution in elderly, appear more sensitive to the effects; dose reductions of 50% have been recommended. Use of CNS depressants with caution, may have additive effects. The FDA is recommending that the doses for immediate-release products be lowered from 10 to 5 mg and from 12.5 to 6.25 mg for extended-release products in women to reduce risk of morning somnolence. Dispense with medication safety guide.