What is the recommended dosing for Ambien (zolpidem)?

Zolpidem (Ambien) Dosing Recommendations

The recommended initial dose of zolpidem is 5 mg for women and either 5 or 10 mg for men, taken only once per night immediately before bedtime with at least 7-8 hours remaining before planned awakening. 1

Dosing Algorithm Based on Patient Characteristics

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 not effective, the dose can be increased to 10 mg, but total dose should not exceed 10 mg daily 1

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 as it may contribute to encephalopathy 1
• Patients taking CNS depressants: Dosage adjustment may be necessary due to potentially additive effects 1

Important Administration Considerations

• Zolpidem should be taken as a single dose and should not be readministered during the same night 1
• The effect of zolpidem may be slowed if taken with or immediately after a meal 1
• Use the lowest effective dose for the patient to minimize adverse effects 1
• Higher morning blood levels following the 10 mg dose increase the risk of next-day impairment of driving and other activities requiring alertness 1

Duration of Treatment

• The FDA has approved zolpidem for short-term use only (4-5 weeks) 2
• Patients whose insomnia doesn't improve within 7-10 days should be further evaluated 2

Safety Considerations

• Zolpidem may be associated with serious adverse effects, including:

  • Next-day impairment of driving and activities requiring alertness
  • "Sleep driving" and behavioral abnormalities
  • Falls (particularly in elderly patients)
  • Confusion (more common in elderly patients)
  • Potential for dependence with long-term use 2

• Common adverse events include dizziness, drowsiness, and diarrhea, particularly in elderly patients 1

Clinical Pearls

• The American College of Physicians recommends Cognitive Behavioral Therapy for Insomnia (CBT-I) as the first-line treatment for chronic insomnia before considering pharmacologic options 2
• Zolpidem is primarily indicated for sleep onset insomnia but has also shown efficacy for sleep maintenance insomnia, improving total sleep time by approximately 29 minutes and reducing wake after sleep onset by 25 minutes 3
• For elderly patients, the American Geriatrics Society recommends reducing the dose of zolpidem from 10 mg to 5 mg at bedtime, with a goal of complete discontinuation when possible 3
• Follow-up within 2-4 weeks is recommended to assess efficacy, side effects, and need for treatment adjustment 2

Remember that zolpidem has a rapid onset of action (30-40 minutes) and a short elimination half-life (1.5-3.2 hours), making it particularly suitable for sleep onset insomnia 4, 5.