Zolpidem (Ambien) Dosing Recommendations
For adults with insomnia, the recommended initial dose of zolpidem is 5 mg for women and either 5 or 10 mg for men, taken once daily immediately before bedtime with at least 7-8 hours remaining before planned awakening. 1
Dosing Algorithm by Patient Population
Standard Adult Dosing
- Women: 5 mg once daily immediately before bedtime
- Men: 5 mg or 10 mg once daily immediately before bedtime
- If the 5 mg dose is ineffective, may increase to 10 mg
- Maximum dose: 10 mg once daily
Special Populations
- Elderly or debilitated patients: 5 mg once daily immediately before bedtime 1
- Patients with mild to moderate hepatic impairment: 5 mg once daily immediately before bedtime 1
- Patients with severe hepatic impairment: Avoid use (may contribute to encephalopathy) 1
Formulation-Specific Dosing
- Immediate-release tablets: Standard dosing as above
- Extended-release (Ambien CR): 6.25 mg for elderly; 6.25 mg or 12.5 mg for non-elderly 2
- Oral spray (ZolpiMist): 5 mg (one spray) for elderly; 10 mg (two sprays) for non-elderly 3
- Sublingual tablets: 5 mg for middle-of-night awakening; 10 mg for sleep onset insomnia 4
Administration Guidelines
- Take as a single dose only
- Do not readminister during the same night
- Take on an empty stomach for faster onset (effect may be slowed by ingestion with or immediately after a meal) 1
- Ensure at least 7-8 hours of time available for sleep after taking medication
Clinical Efficacy
Zolpidem at recommended doses has demonstrated efficacy for:
- Reducing sleep onset latency by approximately 15-18 minutes 5
- Increasing total sleep time by approximately 23-29 minutes 5
- Reducing wake after sleep onset by approximately 25 minutes 5
- Improving sleep quality with moderate improvement compared to placebo 5
Important Considerations and Cautions
Drug Interactions
- Dosage adjustment may be necessary when combined with other CNS depressants due to potentially additive effects 1
- Monitor for increased adverse effects with CYP3A4 inhibitors (e.g., cimetidine) 6
Safety Concerns
- Risk of next-day impairment, especially with the 10 mg dose 1
- Increased risk of falls, confusion, and complex sleep behaviors in elderly patients 7, 1
- Women clear zolpidem more slowly than men (45% higher blood levels), hence the lower recommended starting dose 1
- Risk of amnesia, dizziness, and somnolence 5, 1
Important Caution for Elderly Patients
The American Academy of Sleep Medicine suggests avoiding zolpidem and other Z-drugs in elderly patients due to increased risk of falls, confusion, and complex sleep behaviors 7. For elderly patients with insomnia, low-dose doxepin (3-6 mg) may be a safer alternative for sleep maintenance issues 7.
Duration of Treatment
Zolpidem is indicated for short-term treatment of insomnia (≤4 weeks) 8. While some studies show no evidence of tolerance developing in studies up to 6 months, tolerance has been reported in patients taking higher doses for extended periods 8.
Remember that the lowest effective dose should always be used to minimize adverse effects, particularly in elderly patients or those with hepatic impairment.