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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
- abdominal pain
- abnormal dreams
- acne vulgaris
- agitation
- amnesia
- anaphylactic shock
- anaphylactoid reactions
- anemia
- angina
- angioedema
- anorexia
- anxiety
- appetite stimulation
- arrhythmia exacerbation
- arthralgia
- asthenia
- ataxia
- azotemia
- back pain
- blurred vision
- bone fractures
- bronchospasm
- bullous rash
- chest pain (unspecified)
- chills
- complex sleep-related behaviors
- confusion
- conjunctival hyperemia
- conjunctivitis
- constipation
- cough
- cystitis
- dental caries
- depression
- diarrhea
- diplopia
- dizziness
- drowsiness
- dysarthria
- dysgeusia
- dyspepsia
- dysphagia
- dyspnea
- dysuria
- edema
- elevated hepatic enzymes
- emotional lability
- epistaxis
- eructation
- erythema
- euphoria
- fatigue
- fever
- flatulence
- flushing
- furunculosis
- gastritis
- gastroesophageal reflux
- GI obstruction
- gout
- hallucinations
- headache
- hemorrhoids
- hepatic encephalopathy
- hiccups
- hot flashes
- hyperbilirubinemia
- hypercholesterolemia
- hyperglycemia
- hyperhidrosis
- hyperlipidemia
- hypersalivation
- hypertension
- hypoesthesia
- hypotension
- hypoxia
- impaired cognition
- impotence (erectile dysfunction)
- increased urinary frequency
- infection
- influenza
- insomnia
- intracranial bleeding
- jaundice
- lacrimation
- laryngeal edema
- laryngitis
- lethargy
- leukopenia
- libido decrease
- lymphadenopathy
- malaise
- mastalgia
- memory impairment
- menorrhagia
- migraine
- muscle cramps
- myalgia
- myasthenia
- myocardial infarction
- nausea
- nightmares
- nocturia
- ocular irritation
- ocular pain
- oral ulceration
- orthostatic hypotension
- pallor
- palpitations
- paresthesias
- pharyngitis
- phlebitis
- photopsia
- photosensitivity
- physiological dependence
- polyuria
- pruritus
- psychological dependence
- psychomotor impairment
- pulmonary edema
- pulmonary embolism
- purpura
- rash
- renal failure (unspecified)
- respiratory depression
- restless legs syndrome (RLS)
- rhinitis
- sinus tachycardia
- sinusitis
- somnambulism
- suicidal ideation
- syncope
- tenesmus
- tetany
- thrombosis
- tinnitus
- tolerance
- tremor
- urinary incontinence
- urinary retention
- urticaria
- vaginal irritation
- vaginitis
- ventricular tachycardia
- vertigo
- visual impairment
- vomiting
- weight loss
- withdrawal
- xerostomia
- 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