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

Ambien Starting Dose

The recommended starting dose of Ambien (zolpidem) is 5 mg for women and either 5 or 10 mg for men, taken immediately before bedtime with at least 7-8 hours remaining before planned awakening. 1

Sex-Based Dosing Differences

The FDA mandates different starting doses based on sex due to pharmacokinetic differences:

• Women should receive 5 mg as the initial dose 1
• Men may receive either 5 or 10 mg as the initial dose 1

This sex-based dosing exists because women clear zolpidem 45% slower than men, resulting in higher blood levels and greater risk of next-day impairment, particularly affecting driving ability and psychomotor function 2. The FDA specifically reduced doses for women in 2013 after identifying increased risk of morning impairment at the 10 mg dose 2, 1.

Special Population Dosing

Elderly Patients (≥65 years)

• Start with 5 mg once daily regardless of sex 1
• Elderly patients show increased sensitivity to zolpidem's effects and higher fall risk 2, 1
• In non-U.S. trials, 93% of falls occurred in patients ≥70 years, with 82% receiving doses >10 mg 1

Hepatic Impairment

• Mild to moderate hepatic impairment: 5 mg once daily 1
• Severe hepatic impairment: Avoid zolpidem entirely as it may contribute to encephalopathy 1

Debilitated Patients

• Use 5 mg once daily due to increased sensitivity to effects 1

Critical Administration Guidelines

• Take on an empty stomach immediately before bedtime to maximize effectiveness 2
• Do not take with or after meals as food delays drug effect 2, 1
• Ensure 7-8 hours available for sleep before taking the dose 1
• Take as single dose only—do not readminister during the same night 1

Dose Titration

If the 5 mg dose proves ineffective, the dose may be increased to 10 mg 1. However, recognize that the 10 mg dose carries increased risk of next-day impairment, particularly for driving and activities requiring full alertness 1. The total daily dose should never exceed 10 mg 1.

Common Prescribing Pitfall

The most significant error is prescribing 10 mg doses to women despite FDA warnings—this occurred in approximately 50% of female veterans even after the 2013 FDA mandate, highlighting a dangerous translation gap between guidelines and practice 2. Always verify the patient's sex before prescribing and default to 5 mg for women.

Contraindications and Cautions

Before prescribing, assess for:

• Respiratory conditions (asthma, COPD, sleep apnea) which increase adverse effect risk 2
• Severe hepatic impairment (absolute contraindication) 1
• Psychiatric conditions which may be exacerbated 2
• Concurrent CNS depressants which require dose adjustment due to additive effects 1
• Pregnancy or nursing status (avoid use) 2