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 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.

Side effects of Zolpidem

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.

The more common side effects of zolpidem can include:

• headache
• drowsiness
• dizziness
• diarrhea
• dry mouth
• chest 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

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

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.

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.

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.

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.

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 m