Zolpidem

What is Zolpidem

Zolpidem is a non-benzodiazepine sedative-hypnotic used for the treatment of insomnia.

Zolpidem is available in various orally administered formulations (e.g., Ambien, Ambien CR, Zolpimist) for difficulty with sleep initiation, with one formulation (Intermezzo) granted the first FDA approval for difficulty falling back to sleep following middle-of-the-night awakenings.

Zolpidem has a rapid onset of action and should be taken immediately before retiring. When used for middle-of-the-night awakenings, there should be at least 4 hours of bedtime remaining before the planned time of waking.

Zolpidem can cause next-day psychomotor impairment. Although generally mild and transient, signs and symptoms of withdrawal may occur following rapid dose reduction or abrupt discontinuation of zolpidem.

Unlike benzodiazepines, there is a lack of myorelaxant, anxiolytic, and anticonvulsant effects with zolpidem at therapeutic doses.

Some sedative-hypnotics, including zolpidem, have been associated with complex sleep-related behaviors (e.g., making phone calls, eating, or driving while not fully awake).

All sedative-hypnotics have the potential to cause sleep-related behaviors; therefore, patients should be informed of the risks prior to receiving any medication from this class.

Indications

  • insomnia

Side Effects

  1. abdominal pain
  2. abnormal dreams
  3. acne vulgaris
  4. agitation
  5. amnesia
  6. anaphylactic shock
  7. anaphylactoid reactions
  8. anemia
  9. angina
  10. angioedema
  11. anorexia
  12. anxiety
  13. appetite stimulation
  14. arrhythmia exacerbation
  15. arthralgia
  16. asthenia
  17. ataxia
  18. azotemia
  19. back pain
  20. blurred vision
  21. bone fractures
  22. bronchospasm
  23. bullous rash
  24. chest pain (unspecified)
  25. chills
  26. complex sleep-related behaviors
  27. confusion
  28. conjunctival hyperemia
  29. conjunctivitis
  30. constipation
  31. cough
  32. cystitis
  33. dental caries
  34. depression
  35. diarrhea
  36. diplopia
  37. dizziness
  38. drowsiness
  39. dysarthria
  40. dysgeusia
  41. dyspepsia
  42. dysphagia
  43. dyspnea
  44. dysuria
  45. edema
  46. elevated hepatic enzymes
  47. emotional lability
  48. epistaxis
  49. eructation
  50. erythema
  51. euphoria
  52. fatigue
  53. fever
  54. flatulence
  55. flushing
  56. furunculosis
  57. gastritis
  58. gastroesophageal reflux
  59. GI obstruction
  60. gout
  61. hallucinations
  62. headache
  63. hemorrhoids
  64. hepatic encephalopathy
  65. hiccups
  66. hot flashes
  67. hyperbilirubinemia
  68. hypercholesterolemia
  69. hyperglycemia
  70. hyperhidrosis
  71. hyperlipidemia
  72. hypersalivation
  73. hypertension
  74. hypoesthesia
  75. hypotension
  76. hypoxia
  77. impaired cognition
  78. impotence (erectile dysfunction)
  79. increased urinary frequency
  80. infection
  81. influenza
  82. insomnia
  83. intracranial bleeding
  84. jaundice
  85. lacrimation
  86. laryngeal edema
  87. laryngitis
  88. lethargy
  89. leukopenia
  90. libido decrease
  91. lymphadenopathy
  92. malaise
  93. mastalgia
  94. memory impairment
  95. menorrhagia
  96. migraine
  97. muscle cramps
  98. myalgia
  99. myasthenia
  100. myocardial infarction
  101. nausea
  102. nightmares
  103. nocturia
  104. ocular irritation
  105. ocular pain
  106. oral ulceration
  107. orthostatic hypotension
  108. pallor
  109. palpitations
  110. paresthesias
  111. pharyngitis
  112. phlebitis
  113. photopsia
  114. photosensitivity
  115. physiological dependence
  116. polyuria
  117. pruritus
  118. psychological dependence
  119. psychomotor impairment
  120. pulmonary edema
  121. pulmonary embolism
  122. purpura
  123. rash
  124. renal failure (unspecified)
  125. respiratory depression
  126. restless legs syndrome (RLS)
  127. rhinitis
  128. sinus tachycardia
  129. sinusitis
  130. somnambulism
  131. suicidal ideation
  132. syncope
  133. tenesmus
  134. tetany
  135. thrombosis
  136. tinnitus
  137. tolerance
  138. tremor
  139. urinary incontinence
  140. urinary retention
  141. urticaria
  142. vaginal irritation
  143. vaginitis
  144. ventricular tachycardia
  145. vertigo
  146. visual impairment
  147. vomiting
  148. weight loss
  149. withdrawal
  150. xerostomia
  151. yawning

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • abrupt discontinuation
  • alcoholism
  • angioedema
  • behavioral changes
  • breast-feeding
  • children
  • chronic obstructive pulmonary disease (COPD)
  • coadministration with other CNS depressants
  • complex sleep-related behaviors
  • depression
  • driving or operating machinery
  • drug-induced complex sleep-related behaviors
  • encephalopathy
  • ethanol ingestion
  • females
  • geriatric
  • hepatic disease
  • infants
  • labor
  • myasthenia gravis
  • neonates
  • obstetric delivery
  • pregnancy
  • pulmonary disease
  • respiratory depression
  • sleep apnea
  • substance abuse
  • suicidal ideation

Interactions

  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Codeine
  • Acetaminophen; Dextromethorphan; Doxylamine
  • Acetaminophen; Diphenhydramine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Pentazocine
  • Acetaminophen; Propoxyphene
  • Acetaminophen; Tramadol
  • Acrivastine; Pseudoephedrine
  • Aldesleukin, IL-2
  • Alfentanil
  • Alprazolam
  • Amiodarone
  • Amitriptyline
  • Amitriptyline; Chlordiazepoxide
  • Amobarbital
  • Amoxapine
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Amprenavir
  • Apalutamide
  • Apomorphine
  • Apraclonidine
  • Aprepitant, Fosaprepitant
  • Aripiprazole
  • Asenapine
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Oxycodone
  • Atazanavir
  • Atazanavir; Cobicistat
  • Atropine; Difenoxin
  • Atropine; Diphenoxylate
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • atypical antipsychotic
  • Azelastine
  • Azelastine; Fluticasone
  • Baclofen
  • Barbiturates
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Belladonna; Opium
  • Benzhydrocodone; Acetaminophen
  • Benzodiazepines
  • Benztropine
  • Bexarotene
  • Boceprevir
  • Bosentan
  • Brexpiprazole
  • Brimonidine
  • Brimonidine; Brinzolamide
  • Brimonidine; Timolol
  • Brompheniramine
  • Brompheniramine; Carbetapentane; Phenylephrine
  • Brompheniramine; Dextromethorphan; Guaifenesin
  • Brompheniramine; Guaifenesin; Hydrocodone
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Brompheniramine; Pseudoephedrine
  • Buprenorphine
  • Buprenorphine; Naloxone
  • Bupropion
  • Bupropion; Naltrexone
  • Buspirone
  • Butabarbital
  • Butorphanol
  • Caffeine
  • Caffeine; Ergotamine
  • Cannabidiol
  • Capsaicin; Metaxalone
  • Carbamazepine
  • Carbetapentane; Chlorpheniramine
  • Carbetapentane; Chlorpheniramine; Phenylephrine
  • Carbetapentane; Diphenhydramine; Phenylephrine
  • Carbetapentane; Guaifenesin
  • Carbetapentane; Guaifenesin; Phenylephrine
  • Carbetapentane; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbetapentane; Pseudoephedrine
  • Carbetapentane; Pyrilamine
  • Carbidopa; Levodopa; Entacapone
  • Carbinoxamine
  • Carbinoxamine; Dextromethorphan; Pseudoephedrine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carbinoxamine; Phenylephrine
  • Carbinoxamine; Pseudoephedrine
  • Cariprazine
  • Carisoprodol
  • Cenobamate
  • Ceritinib
  • Cetirizine
  • Cetirizine; Pseudoephedrine
  • Chlophedianol; Dexbrompheniramine
  • Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
  • Chloramphenicol
  • Chlorcyclizine
  • Chlordiazepoxide
  • Chlordiazepoxide; Clidinium
  • Chlorpheniramine
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dextromethorphan
  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Phenylephrine
  • Chlorpheniramine; Pseudoephedrine
  • Chlorzoxazone
  • Ciprofloxacin
  • Citalopram
  • Clarithromycin
  • Clemastine
  • Clobazam
  • Clomipramine
  • Clonazepam
  • Clorazepate
  • Clozapine
  • Cobicistat
  • Codeine
  • Codeine; Guaifenesin
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • COMT inhibitors
  • Conivaptan
  • Cyclizine
  • Cyclobenzaprine
  • Cyproheptadine
  • Dabrafenib
  • Danazol
  • Dantrolene
  • Darunavir
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Deferasirox
  • Delavirdine
  • Desipramine
  • Desvenlafaxine
  • Deutetrabenazine
  • Dexamethasone
  • Dexchlorpheniramine
  • Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Dexmedetomidine
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Diazepam
  • Dicyclomine
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Diltiazem
  • Dimenhydrinate
  • Diphenhydramine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Diphenhydramine; Phenylephrine
  • Doxepin
  • Doxylamine
  • Doxylamine; Pyridoxine
  • Dronabinol
  • Dronedarone
  • Droperidol
  • Duloxetine
  • Duvelisib
  • Efavirenz
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elagolix
  • Elagolix; Estradiol; Norethindrone acetate
  • Elbasvir; Grazoprevir
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Enflurane
  • Entacapone
  • Enzalutamide
  • Erythromycin
  • Erythromycin; Sulfisoxazole
  • Escitalopram
  • Esketamine
  • Eslicarbazepine
  • Estazolam
  • Ethanol
  • Ethotoin
  • Etomidate
  • Etravirine
  • Ezogabine
  • Fedratinib
  • Fentanyl
  • Fluconazole
  • Flumazenil
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Flurazepam
  • Fluvoxamine
  • Fosamprenavir
  • Fosphenytoin
  • Fospropofol
  • Fostamatinib
  • Gabapentin
  • General anesthetics
  • Green Tea
  • Guaifenesin; Hydrocodone
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Haloperidol
  • Halothane
  • Homatropine; Hydrocodone
  • Hydantoins
  • Hydrocodone
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hydromorphone
  • Hydroxyzine
  • Ibuprofen; Oxycodone
  • Idelalisib
  • Iloperidone
  • Imatinib
  • Imipramine
  • Indinavir
  • Isavuconazonium
  • Isocarboxazid
  • Isoflurane
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Itraconazole
  • Ketamine
  • Ketoconazole
  • Lasmiditan
  • Lefamulin
  • Lemborexant
  • Letermovir
  • Levocetirizine
  • Levomethadyl
  • Levomilnacipran
  • Levorphanol
  • Lithium
  • Lofexidine
  • Lopinavir; Ritonavir
  • Lorazepam
  • Loxapine
  • Lumacaftor; Ivacaftor
  • Lumateperone
  • Lurasidone
  • Maprotiline
  • Meclizine
  • Melatonin
  • Mepenzolate
  • Meperidine
  • Meperidine; Promethazine
  • Mephobarbital
  • Metaxalone
  • Methadone
  • Methocarbamol
  • Methohexital
  • Methscopolamine
  • Metoclopramide
  • Metyrapone
  • Midazolam
  • Mifepristone
  • Milnacipran
  • Mirtazapine
  • Mitotane
  • Modafinil
  • Molindone
  • Monoamine oxidase inhibitors
  • Morphine
  • Morphine; Naltrexone
  • Nabilone
  • Nalbuphine
  • Nefazodone
  • Nelfinavir
  • Netupitant, Fosnetupitant; Palonosetron
  • Nevirapine
  • Nilotinib
  • Nortriptyline
  • Octreotide
  • Olanzapine
  • Ombitasvir; Paritaprevir; Ritonavir
  • Omeprazole; Amoxicillin; Rifabutin
  • Oritavancin
  • Orphenadrine
  • Oxazepam
  • Oxybutynin
  • Oxycodone
  • Oxymorphone
  • Palbociclib
  • Paliperidone
  • Papaverine
  • Paroxetine
  • Pazopanib
  • Pentazocine
  • Pentazocine; Naloxone
  • Pentobarbital
  • Perampanel
  • Perphenazine; Amitriptyline
  • Phenelzine
  • Phenobarbital
  • Phenothiazines
  • Phentermine; Topiramate
  • Phenytoin
  • Pimozide
  • Posaconazole
  • Pramipexole
  • Pregabalin
  • Primidone
  • Propofol
  • Propoxyphene
  • Protease inhibitors
  • Protriptyline
  • Quazepam
  • Quetiapine
  • Quinine
  • Ramelteon
  • Ranolazine
  • Rasagiline
  • Remifentanil
  • Ribociclib
  • Ribociclib; Letrozole
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Risperidone
  • Ritonavir
  • Ropinirole
  • Rotigotine
  • Rucaparib
  • Rufinamide
  • Safinamide
  • Saquinavir
  • Scopolamine
  • Secobarbital
  • Sedating H1-blockers
  • Selegiline
  • Sertraline
  • Sevoflurane
  • Simeprevir
  • Sodium Oxybate
  • St. John’s Wort, Hypericum perforatum
  • Sufentanil
  • Suvorexant
  • Tapentadol
  • Telaprevir
  • Telithromycin
  • Temazepam
  • Terbinafine
  • Tetrabenazine
  • Thalidomide
  • Thiopental
  • Thiothixene
  • Tipranavir
  • Tizanidine
  • Tolcapone
  • Topiramate
  • Tramadol
  • Trandolapril; Verapamil
  • Tranylcypromine
  • Trazodone
  • Triazolam
  • Tricyclic antidepressants
  • Trihexyphenidyl
  • Trimethobenzamide
  • Trimipramine
  • Triprolidine
  • Tucatinib
  • Valerian, Valeriana officinalis
  • Valproic Acid, Divalproex Sodium
  • Vemurafenib
  • Venlafaxine
  • Verapamil
  • Vigabatrin
  • Vilazodone
  • Voriconazole
  • Ziconotide
  • Ziprasidone
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