What is the recommended dose of Ambien (zolpidem) for adults?

Recommended Ambien (Zolpidem) Dosing for Adults

The FDA-approved starting dose is 5 mg for women and either 5 or 10 mg for men, taken once nightly immediately before bedtime with at least 7-8 hours remaining before planned awakening. 1

Standard Adult Dosing

• Women require lower doses (5 mg immediate-release) due to slower drug clearance and higher plasma concentrations compared to men 1, 2
• Men may start with 5 mg or 10 mg immediate-release, though the 5 mg dose should be tried first 1
• The maximum total dose should not exceed 10 mg once daily immediately before bedtime 1
• If 5 mg proves ineffective, the dose may be increased to 10 mg, but clinicians must weigh this against increased risk of next-morning impairment 1

Special Population Dosing

Elderly Patients (≥65 years)

• Start with 5 mg once daily regardless of sex due to increased sensitivity to zolpidem's effects 1, 2
• Elderly patients are especially sensitive and should not exceed 5 mg 1

Hepatic Impairment

• Patients with mild to moderate hepatic impairment require 5 mg once daily 1
• Avoid zolpidem entirely in severe hepatic impairment as it may contribute to encephalopathy 1

Renal Impairment

• Dosage adjustment is prudent in patients with renal disease, though specific FDA guidance defaults to standard precautions 3

Extended-Release Formulation Dosing

• Women: 6.25 mg extended-release 2, 4
• Men: 6.25-12.5 mg extended-release, with maximum dose of 12.5 mg 2, 4
• Elderly patients: 6.25 mg extended-release regardless of sex 4

Critical Administration Guidelines

• Take on an empty stomach immediately before bedtime to maximize effectiveness 2, 1
• Do not take with or immediately after a meal, as food delays absorption and reduces efficacy 1
• Ensure at least 7-8 hours available for sleep before planned awakening 1
• Take as a single dose; do not readminister during the same night 1

Important Safety Considerations

CNS Depressant Interactions

• Dosage reduction may be necessary when combined with other CNS depressants due to potentially additive effects 1
• Avoid combining with alcohol 2

Next-Day Impairment Risk

• The 10 mg dose carries higher risk of next-morning impairment affecting driving and activities requiring full alertness, which is why the FDA lowered recommended starting doses from the original recommendations 1, 2
• This concern was significant enough that the FDA mandated dose reductions in 2013, particularly emphasizing the risk in women 5, 2

Duration of Use

• Zolpidem is indicated for short-term treatment (≤4 weeks) 6
• For patients requiring longer-term management, cognitive behavioral therapy for insomnia (CBT-I) should be considered as first-line treatment 4

Common Pitfalls to Avoid

• Do not prescribe 10 mg as initial dose for women or elderly patients - this is the most common dosing error given the sex-based pharmacokinetic differences 1
• Do not ignore the timing of food intake - taking zolpidem with meals significantly reduces its effectiveness 1
• Do not use in patients with insufficient time in bed - less than 7-8 hours available for sleep increases next-day impairment risk 1
• Avoid abrupt discontinuation after prolonged use - gradual dose reduction minimizes withdrawal symptoms 4