What are the contraindications for Ambien (zolpidem)?

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Last updated: September 26, 2025 • View editorial policy

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Contraindications of Ambien (Zolpidem)

Zolpidem (Ambien) is absolutely contraindicated in patients who have experienced complex sleep behaviors after taking zolpidem and in patients with known hypersensitivity to zolpidem. 1

Absolute Contraindications

  • History of complex sleep behaviors: Sleep-walking, sleep-driving, or engaging in other activities while not fully awake after taking zolpidem 1
  • Hypersensitivity reactions: Including anaphylaxis and angioedema 1

Relative Contraindications and Precautions

High-Risk Patient Populations

  • Elderly patients: Increased risk of falls due to drowsiness and decreased level of consciousness 1
  • Hepatic impairment: Reduced dosage (5 mg) recommended due to decreased clearance 2
  • Respiratory conditions: Not recommended in patients with compromised respiratory function (e.g., asthma, COPD, sleep apnea) 2
  • Pregnancy and nursing: Not recommended during pregnancy or breastfeeding 2

Psychiatric and Neurological Considerations

  • Primary psychiatric disorders: Should be evaluated for underlying psychiatric conditions if insomnia persists beyond 7-10 days of treatment 1
  • History of substance abuse: Zolpidem has potential for abuse, though lower than benzodiazepines 3
  • Depression: Caution in patients with signs/symptoms of depression 2

Drug Interactions

  • CNS depressants: Increased risk with concomitant use of other CNS depressants 1:
    • Benzodiazepines
    • Opioids
    • Tricyclic antidepressants
    • Alcohol
  • Monoamine oxidase inhibitors (MAOIs): Contraindicated for use in combination 4

Special Warnings

Complex Sleep Behaviors

  • Complex sleep behaviors may occur following the first or any subsequent use of zolpidem 1
  • These behaviors can result in serious injuries or death 1
  • Patients usually do not remember these events 1
  • May occur with zolpidem alone at recommended doses, with or without alcohol or other CNS depressants 1

Next-Day Impairment

  • Increased risk of next-day psychomotor impairment, including impaired driving if 1:
    • Taken with less than 7-8 hours of sleep remaining
    • Higher than recommended dose is taken
    • Coadministered with CNS depressants or alcohol
    • Coadministered with drugs that increase zolpidem blood levels

Monitoring Considerations

  • QTc interval: In elderly patients or those with cardiac risk factors, monitor for QTc prolongation, especially if combined with other QTc-prolonging medications 4
  • Residual effects: Monitor for morning drowsiness, coordination problems, and cognitive impairment 3
  • Tolerance development: While uncommon with short-term use, tolerance has been reported with high doses over extended periods 3

Clinical Pearls

  • Administration on an empty stomach is advised to maximize effectiveness 2
  • Zolpidem should be discontinued immediately if a patient experiences a complex sleep behavior 1
  • The FDA recommends lower doses (5 mg for immediate-release products and 6.25 mg for extended-release formulations) due to risk of next-morning impairment 2
  • Short-term use (≤4 weeks) is recommended to minimize risk of dependence 3
  • Patients should be cautioned about the importance of allowing appropriate sleep time (7-8 hours) 2, 1

By understanding these contraindications and precautions, clinicians can better assess the risk-benefit ratio of prescribing zolpidem for individual patients and minimize potential adverse outcomes.

References

2
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

4
Guideline

QTc Interval Management and Agitation in Elderly Patients

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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