Zolpidem: Side Effects, Dosage, Uses, and More - Healthline

1. Zolpidem oral tablets are available as both generic and brand-name drugs. Brand names: Ambien (immediate-release tablet), Ambien CR (extended-release tablet), Edluar (sublingual tablet), Intermezzo (sublingual tablet).
2. Zolpidem also comes as an oral spray.
3. Zolpidem oral tablets are used to treat insomnia (trouble sleeping). They can help you fall asleep or stay asleep.

Zolpidem is a prescription drug that comes as an oral tablet and an oral spray.

The oral tablet comes in three forms: immediate-release, extended-release, and sublingual. The immediate-release form releases the drug into your body right away. The extended-release form releases the drug into your body slowly. The sublingual tablet dissolves under your tongue.

These forms are available as the following brand-name drugs:

• Ambien (immediate-release tablet)
• Ambien CR (extended-release tablet)
• Edluar (sublingual tablet)

All forms of zolpidem oral tablets are also available as generic drugs. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in all strengths or forms as the brand-name drug.

Why it's used

Zolpidem oral tablets are used to treat insomnia. Insomnia causes trouble falling asleep or staying asleep.

The immediate-release tablets and Edluar sublingual tablets are used if you have trouble falling asleep. The extended-release tablets are used if you have trouble falling asleep or staying asleep.

The low-dose (1.75-mg and 3.5-mg) sublingual tablets are used when you wake up in the middle of the night and have trouble falling back to sleep.

How it works

Zolpidem belongs to a class of drugs called hypnotics. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Zolpidem increases the activity of GABA. GABA is a chemical in your body that causes sleepiness. Increasing its activity helps you fall asleep.

Zolpidem can cause mild or serious side effects. The following list contains some of the key side effects that may occur while taking zolpidem. This list does not include all possible side effects.

For more information on the possible side effects of zolpidem, or tips on how to deal with a troubling side effect, talk with your doctor or pharmacist.

More common side effects

The more common side effects of zolpidem can include:

• headache
• drowsiness
• dizziness
• diarrhea
• dry mouth
• chest pain
• palpitations (fast, strong, or irregular heart rate, or feeling like your heart is skipping a beat)
• grogginess
• lightheadedness
• muscle pain

If these effects are mild, they may go away within a few days or a couple of weeks. If they're more severe or don't go away, talk with your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you're having a medical emergency. Serious side effects and their symptoms can include the following:

• Allergic reactions. Symptoms can include:
  • swelling of your tongue or face
  • trouble breathing
• New or worse symptoms of depression. Symptoms can include:
  • thoughts of suicide or of harming yourself
  • loss of interest in activities you normally enjoy
  • feelings of guilt or worthlessness
  • lack of energy
  • trouble thinking or concentrating
  • weight loss or weight gain
• Abnormal thoughts or behaviors. Symptoms can include:
  • agitation
  • being more outgoing than normal
  • thinking things aren't real or that you're watching yourself from outside of your body
  • hallucinations (seeing or hearing things that aren't there)
• Doing activities while you're asleep and having no memory of the event. These can include:
  • driving
  • preparing and eating food
  • talking on the phone
  • having sex
• Trouble breathing. Symptoms can include:
  • slowed breathing
  • shallow breathing
  • tiredness
  • decreased oxygen in your blood
• Amnesia (memory loss)
• Hallucinations (seeing or hearing something that isn't there)

Zolpidem oral tablet can interact with several other medications. Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.

Below is a list of medications that can interact with zolpidem. This list does not contain all drugs that may interact with zolpidem.

Before taking zolpidem, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Increased side effects from both zolpidem and other drugs

Taking zolpidem with certain medications raises your risk for side effects. This is because zolpidem and these other medications can cause the same side effects. As a result, these side effects can be increased. Examples of these drugs include:

• Drugs that decrease your alertness such as imipramine and chlorpromazine. If you take any of these medications with zolpidem, you may have more sedation and drowsiness.

Increased side effects from zolpidem

Taking zolpidem with certain medications raises your risk for side effects from zolpidem. This is because the amount of zolpidem in your body may be increased. Examples of these drugs include:

• Antibiotics such as clarithromycin and erythromycin
• Drugs used to treat fungal infections, such as ketoconazole, itraconazole, and voriconazole
• Ritonavir and atazanavir

Interactions that can make your drugs less effective

When zolpidem is used with certain drugs, it may not work as well to treat your condition. This is because the amount of zolpidem in your body may be decreased. Examples of these drugs include:

• Antibiotics such as rifampin, rifabutin, and rifapentine
• Anticonvulsant drugs such as carbamazepine, phenobarbital, and phenytoin
• St. John's wort

The zolpidem dosage your doctor prescribes will depend on several factors. These include:

• the type of insomnia you're using zolpidem to treat
• your age or sex
• the form of zolpidem you take
• other medical conditions you may have, such as liver damage

Typically, your doctor will start you on a low dosage and adjust it over time to reach the dosage that's right for you. They'll ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.

Forms and strengths

Generic: Zolpidem

• Form: immediate-release oral tablet
• Strengths: 5 mg, 10 mg
• Form: extended-release oral tablet
• Strengths: 6.25 mg, 12.5 mg
• Form: sublingual tablet
• Strengths: 1.75 mg, 3.5 mg, 5 mg, 10 mg

Brand: Ambien

• Form: immediate-release oral tablet
• Strengths: 5 mg, 10 mg

Brand: Ambien CR

• Form: extended-release oral tablet
• Strengths: 6.25 mg, 12.5 mg

Brand: Edluar

• Form: sublingual tablet
• Strengths: 5 mg, 10 mg

Dosage for insomnia with trouble falling asleep

Adult dosage (ages 18–64 years)

Ambien, Edluar, and generic formulations:

• Starting dosage: 5 mg for women and 5 mg or 10 mg for men, taken right before bedtime. You should only take a dose if you have at least 7–8 hours before you need to wake up.
• Dosage increases: Your doctor may increase your dosage to 10 mg per day if the 5 mg dose is not effective.
• Maximum dosage: 10 mg once per day taken right before bedtime.

Child dosage (ages 0–17 years)

This medication hasn't been studied in children. It shouldn't be used in people younger than 18 years.

Senior dosage (ages 65 years and older)

The liver of an older adult may not work as well as it used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk for side effects. Your doctor may start you on a lowered dosage or a different treatment schedule. This can help keep levels of this drug from building up too much in your body.

• Ambien, Edluar, and generic formulations: 5 mg once per day taken right before bedtime.

Special dosage considerations for people with liver disease

• Ambien, Edluar, and generic formulations: 5 mg once per day taken right before bedtime for people with mild to moderate liver disease. Avoid this drug if you have severe liver disease.

Dosage for trouble falling or staying asleep

Adult dosage (ages 18–64 years)

Ambien CR and generic extended-release oral tablets only:

• Starting dosage: 6.25 mg for women and 6.25 mg or 12.5 mg for men, taken right before bedtime. Take it only when you have at least 7–8 hours before you need to wake up.
• Dosage increases: Your doctor may increase your dosage to 12.5 mg per day if the 6.25 mg dose is not effective.
• Maximum dosage: 12.5 mg once per day taken right before bedtime.

Child dosage (ages 0–17 years)

This medication hasn't been studied in children. It shouldn't be used in people younger than 18 years.

Senior dosage (ages 65 years and older)

The liver of an older adult may not work as well as it used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk for side effects. Your doctor may start you on a lowered dosage or a different treatment schedule. This can help keep levels of this drug from building up too much in your body.

• Ambien CR and generic extended-release oral tablets only: 6.25 mg once per day taken right before bedtime.

Special dosage considerations for people with liver disease

• Ambien CR and generic extended-release oral tablets only: 6.25 mg once per day taken right before bedtime for people with mild to moderate liver disease. Avoid this drug if you have severe liver disease.

Dosage for trouble falling asleep after waking

Adult dosage (ages 18–64 years)

Generic low-dose sublingual tablets:

• Starting dosage: 1.75 mg for women and 3.5 mg for men, taken once per night as needed. Take this drug only when you have trouble falling back to sleep after waking in the middle of the night. Also, take this drug only when you have at least 4 hours before you need to wake up.
• Dosage increases: If you're a man and were started on the 1.75-mg dosage, your doctor may increase your dosage to 3.5 mg per day.
• Maximum dosage: 1.75 mg per day for women and 3.5 mg per day for men.

Child dosage (ages 0–17 years)

This medication hasn't been studied in children. It shouldn't be used in people younger than 18 years.

Senior dosage (ages 65 years and older)

The liver of an older adult may not work as well as it used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk for side effects. Your doctor may start you on a lowered dosage or a different treatment schedule. This can help keep levels of this drug from building up too much in your body.

• Generic low-dose sublingual tablet: 1.75 mg taken once per night only as needed. Take it when you have trouble falling back to sleep after waking in the middle of the night. Also, only take this drug when you have at least 4 hours left before you need to wake up.

Special dosage considerations for people with liver disease

• Generic low-dose sublingual tablet: 1.75 mg taken once per night as needed. Only take it when you have trouble falling back to sleep after waking in the middle of the night. Also, only take this drug when you have at least 4 hours left before you need to wake up.

Zolpidem oral tablet comes with several warnings.

Decreased awareness and reaction time warning

If you take zolpidem and don't get a full night's sleep, you may have decreased awareness and slower reaction times the next day. This may cause trouble driving. You shouldn't drive or do other activities that require alertness if you take this drug and don't get a full night's sleep.

If you're taking generic low-dose sublingual tablets, you shouldn't drive or do activities that require alertness without getting at least 4 more hours of sleep after taking it.

Abnormal behaviors warning

This drug may cause changes in behavior, such as increased agitation. You may act differently. You may act more outgoing, hallucinate (see or hear things that aren't real), or feel like you're watching yourself from outside of your body. You also may sleep-drive or do other activities in your sleep that you can't remember later.

Tell your doctor if any of this happens to you.

Withdrawal effects warning

Don't stop taking this drug without talking with your doctor. If you've been taking this medication for a while and stop taking it suddenly, you may have withdrawal.

Symptoms can include muscle cramps, vomiting, sweating, flushing (reddening and warming of your skin), and emotional changes. These can include feelings of nervousness, panic attacks, and uncontrollable crying.

Allergy warning

Zolpidem can cause a severe allergic reaction. Symptoms can include:

• trouble breathing
• swelling of your throat or tongue

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 911 or go to the nearest emergency room.

Don't take this drug again if you've ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Food interaction warning

Eating food with zolpidem may make the drug take longer to work. You should take this drug on an empty stomach.

Alcohol interaction warning

Drinking alcohol can increase your risk for sedation and drowsiness from zolpidem. You shouldn't take this drug on nights when you drink alcohol. If you drink alcohol, talk with your doctor. You may need to be monitored more closely for side effects.

Warnings for people with certain health conditions

For people with depression: This drug may make your symptoms of depression worse. Ask your doctor if this drug is safe for you.

For people with myasthenia gravis: This drug may slow your breathing or make it shallow. This can decrease the amount of oxygen in your blood. If you have myasthenia gravis, you may already have lower oxygen levels. Ask your doctor if this drug is safe for you.

For people with sleep apnea: This drug may slow your breathing or make it shallow. This can decrease the amount of oxygen in your blood. If you have sleep apnea, you may already have lower oxygen levels. Ask your doctor if this drug is safe for you.

For people with liver disease: If you have liver problems or a history of liver disease, you may not be able to process this drug well. This may increase the levels of the drug in your body and cause more side effects. It may also cause a serious condition called hepatic encephalopathy. With this condition, the poor function of your liver causes problems with the way your brain works. Symptoms can include being confused, forgetting things, and slurring your speech. If you have severe liver damage, you should not use zolpidem.

Warnings for other groups

For pregnant women: There haven't been enough studies done in humans to be certain how the drug might affect the fetus. Research in animals has shown negative effects to the fetus when the mother takes zolpidem. But animal studies don't always predict how humans would respond.

Studies have shown that when mothers take this drug late in their third trimester, their newborns can have slowed breathing and excessive sleepiness. Your doctor will monitor your newborn closely if exposure to zolpidem occurred during your pregnancy.

This drug should only be used if the potential benefit justifies the potential risk. Talk with your doctor if you're pregnant or plan to become pregnant. And call your doctor right away if you become pregnant while taking this drug.

For women who are breastfeeding: Zolpidem may pass into breast milk and cause side effects in a child who is breastfed. Talk with your doctor about breastfeeding your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

For seniors: The liver of an older adult may not work as well as it used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk for side effects, such as sedation and decreased alertness. You may also be more sensitive to these effects. If you're over the age of 65 years, your doctor may give you a lower dosage of this drug.

For children: This drug hasn't been studied in children. It shouldn't be used in people younger than 18 years.

Zolpidem oral tablet is used for short-term treatment. It comes with serious risks if you don't take it as prescribed.

If you stop taking the drug suddenly or don't take it at all: If you don't take this drug, you'll still have trouble falling or staying asleep. If you've been taking this medication for a while and stop taking it suddenly, you may have signs of withdrawal.

Withdrawal symptoms can include muscle cramps, vomiting, sweating, flushing (reddening and warming of your skin), and emotional changes. These can include nervousness, panic attacks, or uncontrollable crying. Never stop taking this drug without talking to your doctor.

If you miss doses or don't take the drug on schedule: Your medication may not work as well or may stop working completely.

If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

• extreme drowsiness
• loss of consciousness
• coma
• trouble breathing

If you think you've taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose:

• For immediate-release tablets, extended-release tablets, and Edluar: Take your dose as soon as you remember, but only if you have 7–8 hours left before you need to wake up.
• For generic low-dose sublingual tablets: Don't take your dose if you have less than 4 hours left before you need to wake up.

How to tell if the drug is working: You should have an easier time falling asleep and staying asleep.

Keep these considerations in mind if your doctor prescribes zolpidem oral tablet for you.

General

• You should not take this drug with food. Taking this drug with food may make it take longer to work.
• Take the immediate-release tablets, extended-release tablets, and Edluar right before bedtime. Only take these forms when you have 7–8 hours to sleep before you need to wake up.
• Only take Ambien as a single dose each night. Do not take it a second time during the same night.
• Take generic low-dose sublingual tablets when you wake up in the night. Take it only if you have 4 hours of sleep left before you need to wake up.
• You can cut or crush the immediate-release tablets. Do not cut or crush the extended-release tablets.
• Store the immediate-release tablets (Ambien) and sublingual tablets (Edluar) at room temperature. Keep them between 68°F and 77°F (20°C and 25°C).

Storage

• Store the extended-release tablets (Ambien CR) between 59°F and 77°F (15°C and 25°C). Keep them away from light.
• Don't store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. Since zolpidem is a Schedule IV controlled substance, your doctor may refill this medication up to five times in 6 months. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don't worry about airport X-ray machines. They can't hurt your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
• Don't put this medication in your car's glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

You and your doctor should monitor certain health issues during your treatment. This can help make sure you stay safe while you take this drug. These issues include:

• Mental health and behavioral problems. You and your doctor should watch for any changes in your behavior and mood. This drug can cause new mental health and behavior problems. It may also worsen problems you already have.
• Liver function. Your doctor will monitor your liver function during your treatment with this drug. If your liver isn't working well, your doctor may lower your dosage of this drug.

Availability

Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

Insurance

Many insurance companies require a prior authorization for this drug. This means your doctor may need to get approval from your insurance company before your insurance company will pay for the prescription.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk with your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.