Zolpidem Dosing in Elderly Patients
The recommended dose of zolpidem for elderly patients is 5 mg once daily immediately before bedtime, which is half the standard adult dose due to reduced drug clearance in older adults. 1
Pharmacokinetic Considerations in the Elderly
- Zolpidem clearance is significantly lower in elderly patients compared to younger adults, resulting in higher blood levels and increased risk of adverse effects 2
- The elimination half-life of zolpidem is prolonged in very elderly people, necessitating the lower dosage 2
- Absolute bioavailability of zolpidem is approximately 70%, with peak plasma concentrations occurring 0.75 to 2.6 hours after administration 2
Dosing Guidelines for Elderly Patients
- The FDA-approved initial dose for elderly or debilitated patients is 5 mg once daily immediately before bedtime 1
- The total dose should not exceed 5 mg in elderly patients to minimize next-day impairment of driving and other activities requiring alertness 1
- Zolpidem should be taken as a single dose and should not be readministered during the same night 1
- The medication should be taken with at least 7-8 hours remaining before the planned time of awakening 1
Special Considerations for Elderly Patients
- Elderly patients with hepatic impairment require particular caution when using zolpidem, as they may be especially sensitive to its effects 1
- The effect of zolpidem may be slowed if taken with or immediately after a meal 1
- Dosage adjustment may be necessary when zolpidem is combined with other CNS depressants due to potentially additive effects 1
- Extended-release zolpidem should be dosed at 6.25 mg in elderly patients instead of the standard 12.5 mg dose 3
Efficacy in Elderly Patients
- One study in older adults (n = 166) reported that zolpidem 5 mg reduced sleep onset latency by 18 minutes compared with placebo 3
- A single study evaluating extended-release zolpidem 6.25 mg in elderly adults found moderate reduction in PSG-determined wake after sleep onset and minimal improvement in latency to persistent sleep 3
- Zolpidem has been shown to be effective in inducing and maintaining sleep in elderly individuals at the reduced 5 mg dose 4
Safety Concerns in Elderly Patients
- Elderly patients are more sensitive to the effects of zolpidem and have increased risk of adverse events including cognitive impairment, falls, and next-day sedation 1
- Morning blood levels following zolpidem use can increase the risk of next-day impairment of driving and other activities requiring full alertness 1
- Elderly patients typically require more gradual tapering schedules when discontinuing zolpidem to minimize withdrawal symptoms 5
- Avoid concurrent use with benzodiazepines due to increased risk of respiratory depression and overdose, particularly in elderly patients 5
Tapering Considerations for Elderly Patients
- For elderly patients who have been taking zolpidem long-term, a slow taper of 10% per month or slower is better tolerated than more rapid tapers 5
- For immediate-release zolpidem in elderly patients (5 mg), reduction by 1.25 mg every 2-4 weeks may be appropriate 5
- For extended-release zolpidem in elderly patients (6.25 mg), reduction by approximately 1.56 mg (1/4 tablet) every 2-4 weeks is recommended 5
- Non-pharmacologic sleep interventions should be maximized during tapering, including sleep hygiene education and cognitive behavioral therapy for insomnia 5