What is the recommended usage of Ambien (zolpidem)?

From the Guidelines

Ambien (zolpidem) is recommended for short-term treatment of insomnia, typically prescribed at 5-10 mg taken once daily immediately before bedtime, as suggested by the American Academy of Sleep Medicine 1. The lower 5 mg dose is generally recommended for women and elderly patients, while 10 mg is the standard adult dose.

• Patients should only take Ambien when they have 7-8 hours available for sleep to avoid next-day impairment.
• The medication works quickly, usually within 30 minutes, by enhancing the effect of GABA, a neurotransmitter that inhibits brain activity, helping to induce sleep.
• Ambien should be used for the shortest duration possible, ideally 7-10 days and rarely beyond 2-4 weeks, as prolonged use can lead to tolerance, dependence, and rebound insomnia, as noted in the American College of Physicians guideline 1.
• Patients should avoid alcohol while taking Ambien, not drive or operate machinery after taking it, and should not abruptly discontinue the medication after extended use without medical supervision.
• For optimal effectiveness, Ambien should be part of a comprehensive approach to managing insomnia that includes good sleep hygiene practices, as recommended by the American College of Physicians 1. Key considerations for the use of Ambien include:
• The potential for adverse effects, such as next-morning impairment and sleep driving, as highlighted in the FDA labels and observational studies 1.
• The importance of shared decision-making between clinicians and patients, including discussions of the benefits, harms, and costs of short-term medication use, as recommended by the American College of Physicians 1.
• The need for careful assessment of clinical effectiveness, targeting global outcomes that encompass sleep variables, daytime dysfunction, and distress, as suggested by the American College of Physicians 1.

From the FDA Drug Label

The recommended initial dose 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 to 8 hours remaining before the planned time of awakening. The total dose of zolpidem tartrate tablets should not exceed 10 mg once daily immediately before bedtime. Zolpidem tartrate tablets should be taken as a single dose and should not be readministered during the same night.

The recommended dosage of Ambien (zolpidem) is:

• 5 mg for women, taken once per night immediately before bedtime
• 5 or 10 mg for men, taken once per night immediately before bedtime
• The dose should not exceed 10 mg once daily
• It should be taken as a single dose and not readministered during the same night 2

From the Research

Ambien Recommendation

• Ambien, also known as zolpidem, is a nonbenzodiazepine hypnotic indicated for the short-term treatment of insomnia 3.
• The recommended use of Ambien is for the short-term treatment of insomnia, with a low propensity to cause clinical residual effects, withdrawal, dependence, or tolerance 3.
• Ambien is generally well tolerated and presents a favorable safety profile in comparison with older benzodiazepines and barbiturates 4.
• The appropriate therapeutic use of Ambien is generally not associated with physiological responses that are commonly thought to lead to dependence, such as tolerance or discontinuation effects 4.

Dosage and Administration

• The dosage and administration of Ambien should be according to the manufacturer's prescribing information 3.
• The use of Ambien in an 'as-needed' regimen has been investigated in clinical trials, and it has been shown to produce a global improvement in sleep 3.

Comparison with Other Hypnotics

• Ambien has been compared with other hypnotics, such as eszopiclone, and has been shown to have a similar efficacy and safety profile 5, 6.
• Eszopiclone, a newer hypnotic agent, has been shown to be effective and safe for the treatment of chronic primary insomnia in non-elderly and elderly subjects 5, 6.

Special Populations

• The use of Ambien in special populations, such as elderly individuals, should be done with caution, as they may be at increased risk of adverse events 4, 6.
• The use of Ambien in patients with a history of substance abuse or dependence should also be done with caution, as they may be at increased risk of abuse or dependence 4.