What is the recommended dosage of Zolpidem (non-benzodiazepine hypnotic) for treating insomnia in adults?

Zolpidem Dosage for Treating Insomnia in Adults

The recommended dosage of zolpidem for treating insomnia in adults is 10 mg for men and 5 mg for women taken immediately before bedtime, with elderly patients and those with hepatic impairment receiving 5 mg regardless of gender. 1, 2

Dosage Guidelines by Population

Standard Adult Dosing

• Men: 10 mg immediate-release formulation once daily at bedtime 2, 1
• Women: 5 mg immediate-release formulation once daily at bedtime 1
  • Women clear zolpidem at a lower rate than men, resulting in approximately 45% higher blood levels at the same dose 1

Special Populations

• Elderly patients (≥60 years): 5 mg once daily at bedtime regardless of gender 1
  • Lower dose minimizes adverse effects related to impaired motor/cognitive performance and increased sensitivity to sedative drugs 1
• Hepatic impairment:
  • Mild to moderate impairment: 5 mg once daily at bedtime 1
  • Severe impairment: Avoid use (may contribute to encephalopathy) 1

Extended-Release Formulation

• Extended-release zolpidem: FDA has reduced the recommended starting dosage from 12.5 mg to 6.25 mg 2

Efficacy and Clinical Considerations

Zolpidem is effective for:

• Sleep onset insomnia (moderate improvement in sleep latency) 2, 3
• Sleep maintenance insomnia (approximately 25 minutes improvement) 3
• Sleep quality (moderate improvement) 3

The American Academy of Sleep Medicine provides a weak recommendation for zolpidem use versus no treatment for both sleep onset and sleep maintenance insomnia 2.

Important Precautions

• Duration of treatment: Indicated for short-term treatment (≤4 weeks) 4
• Monitoring: Watch for:
  • Next-day psychomotor impairment 2
  • Dizziness (more common in elderly: 3% vs 0% placebo) 1
  • Drowsiness (5% vs 2% placebo in elderly) 1
  • Falls risk (particularly in patients ≥70 years taking >10 mg) 1

Common Adverse Effects

• Amnesia, dizziness, headache, nausea, somnolence, and taste perversion 2
• Risk of complex sleep behaviors (e.g., sleep driving) 1
• Minimal next-day effects on cognition when administered at bedtime 4

Clinical Pearls

• Efficacy is maintained with repeated nightly use with low risk of rebound insomnia 5
• Little evidence of tolerance development when used at recommended dosages for the indicated duration 4
• Avoid use in pediatric patients under 18 years (safety and effectiveness not established) 1
• Bioequivalence has been demonstrated between oral spray formulation (ZolpiMist™, 5 mg per spray) and immediate-release tablets 6

By following these dosing guidelines and considering patient-specific factors such as gender, age, and hepatic function, zolpidem can be effectively and safely used for the short-term management of insomnia in adults.