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Zolpidem Tartrate: What are the Side Effects?

If you’re struggling to get a good night’s sleep, you’re not alone. A 2005 poll conducted by the National Sleep Foundation found that more than half of adults in the United States experience at least one symptom of insomnia several times a week over the course of a year. With increasingly busy schedules that leave few boundaries between work and home and even less down time, sleep is getting pushed to the side as we struggle to cram more productivity into each day. Insomnia affects women more commonly than men, with an estimated 63 percent and 54 percent, respectively, experiencing symptoms of insomnia on a regular basis. Zolpidem tartrate, a prescription medication used to treat insomnia, has been available since 1992. However, the medication is not without side effects, and it’s not right for everyone. 

What is zolpidem tartrate?

Zolpidem tartrate is a sedative or hypnotic medication that has undergone many clinical trials, and was FDA approved for the treatment of insomnia in 1992. The medication was originally introduced to the U.S. market under the brand name Ambien, which it is best known by to this day. Zolpidem tartrate is currently manufactured in both a generic form and under numerous brand names, including Ambien, Ambien CR, Intermezzo, Edluar, and Zolpimist. The drug comes in numerous forms, including immediate release tablets, extended release tablets, sublingual tablets, and an oral spray. It has a half life of about 3.5 hours with any dose of zolpidem tartrate. It is classified as a controlled substance by the U.S. Drug Enforcement Agency due to its potential for abuse and dependence, and it is recommended for short term use only.

What is zolpidem tartrate used to treat?

Zolpidem tartrate is a prescription medication that addresses various components of insomnia, or difficulty sleeping. Because the medication can be habit forming and can be abused, it is typically prescribed to patients who have already tried counseling or behavioral changes to improve their sleep. Zolpidem tartrate can benefit people who have trouble falling asleep, staying asleep, or both. 

Insomnia

The National Sleep Foundation estimates that insomnia affects about 10 percent of the population, and an estimated 30 percent of people suffer from disrupted sleep. Common symptoms of insomnia include difficulty falling asleep, waking up throughout the night, waking up too early, waking up feeling tired, and being unable to fall back asleep after waking up at the wrong time. To receive a diagnosis of insomnia, patients generally experience these symptoms at least a few nights per week over the course of a year. There are two main types of insomnia: acute insomnia, which generally lasts anywhere from one night to several weeks, and chronic insomnia, in which symptoms are experienced three or more nights each week for a period of three months or more. Insomnia that is not linked to any other health condition or problem is called primary insomnia. When insomnia is the result of an underlying medical condition or substance abuse, it is referred to as secondary insomnia.

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How does zolpidem tartrate work to treat insomnia?

People with insomnia often suffer from a chemical imbalance that causes disrupted sleep patterns;  zolpidem tartrate works to treat insomnia by acting on the chemicals in the brain that impact sleep. The medication triggers additional activity in a neurotransmitter called GABA, which counteracts the neuron activity that is associated with insomnia. As a result, brain activity begins to slow down, allowing people to fall asleep and stay asleep. There are two different types of zolpidem tartrate, each of which works in a different way. The immediate release form of the medication is designed to help people fall asleep quickly, while the extended release version uses two layers of medication to help you fall asleep quickly and stay asleep. 

How much does zolpidem tartrate cost?

The cost of zolpidem tartrate varies depending on which form of the medication is purchased and whether it is prescribed in the generic or brand name version of the drug. Ambien, the most popular brand name form of zolpidem tartrate, is considerably more expensive; the costs of Ambien and zolpidem tartrate are compared below for reference. Zolpidem tartrate can be purchased in the form of an immediate release oral tablet, a sublingual tablet, an extended release oral tablet, or an oral spray. Generic zolpidem tartrate is covered by most commercial insurance plans, as well as Medicare and Medicaid, while Ambien is less likely to be covered. Regardless of your insured status, it is possible to receive significant savings on your prescription through the use of a pharmacy discount card. Manufacturer’s coupons and patient assistance programs may be available for the brand name version of the drug through the manufacturer’s website.

Approximate Costs of Ambien and Zolpidem Tartrate

Ambien

Zolpidem Tartrate

Per Pill

30 Day Supply

Per Pill

30 Day Supply

5 mg dose immediate release

$19.51

$585.30

$1.19

$35.70

10 mg tablet immediate release

$19.51

$585.30

$0.56

$16.80

6.25 mg extended release 

$19.51

$585.30

$1.22

$36.60

12.5 mg extended release

$8.98

$269.32

$1.22

$36.60

What are the benefits of using zolpidem tartrate?

Zolpidem tartrate can benefit people who struggle with insomnia, sleep problems, and have trouble sleeping through the night. Because the medication was released nearly three decades ago, it has been conclusively studied and its effects are well understood. The benefits of zolpidem tartrate include:

  • Zolpidem tartrate helps people fall asleep more quickly
  • The medication starts working in about 30 minutes
  • Taking zolpidem tartrate for just seven to ten days can result in significant improvements in your sleep

What side effects are associated with zolpidem tartrate?

Zolpidem tartrate tablets are a popular and commonly prescribed GABA-A sedative-hypnotic that affects the central nervous system, but there are many adverse effects that can occur while taking the sleep disorder medication, some of which can be serious. Common side effects of zolpidem tartrate use include:

  • Weakness
  • Nausea
  • Constipation
  • Lightheadedness
  • Sore throat
  • Confusion
  • Insomnia
  • Somnolence
  • Dry mouth
  • “Drugged” feeling
  • Stuffy nose
  • Dizziness
  • Muscle pain
  • Headache
  • Euphoria
  • Tiredness and sleepiness during the day
  • Loss of coordination
  • Diarrhea
  • Stomach upset
  • Nasal irritation
  • Daytime drowsiness
  • Ataxia (balance problems)
  • Visual changes

Serious but rare adverse events associated with zolpidem tartrate include:

  • Abnormal thoughts or behaviors, as indicated by:
    • Being more outgoing than normal
    • Increased agitation
    • Hallucinations
  • Symptoms of depression, such as:
    • Loss of interest in activities you enjoy
    • Feelings of worthlessness or guiltLack of energy
    • Suicidal thoughts or thoughts of harming yourself
    • Weight loss or weight gain
    • Trouble concentrating or thinking
  • Amnesia
  • Chest pain
  • Trouble breathing, as demonstrated by:
    • Tiredness
    • Shallow breathing
    • Slowed breathing
    • Decreased oxygen in your blood
  • Doing activities in the middle of the night that you have no memory of the next day or next morning, including:
    • Sleep-driving
    • Sleep-walking
    • Sleep-phone calls
    • Sleep-sex
    • Sleep-eating
  • Allergic reactions, as evidenced by:
    • Swelling of the tongue or face
    • Trouble breathing

Are there any warnings associated with zolpidem tartrate use?

Zolpidem tartrate affects everyone and their sleep onset differently, so it comes with numerous warnings for use. Patients, especially older adults, should use caution when first taking the prescription drug until they know how the drug affects them. Zolpidem tartrate comes with the following warnings for use:

  • The medication should be taken on an empty stomach in order to maximize its effects. When taken on a full stomach, the medication may not work as intended.
  • Patients should not drink alcohol when taking zolpidem tartrate. The sedative effects of the alcohol, combined with the sedative effects of the medication, can cause dangerous drowsiness and sedation. 
  • Zolpidem tartrate can cause abnormal behaviors, including feelings of increased agitation, an “out of body” feeling, and hallucinations. Patients who experience any of these side effects should seek medical attention. 
  • It is important to get a full night’s sleep (approximately seven to eight hours) when taking zolpidem tartrate. When awakening prematurely, the medication can cause slower reaction times and decreased awareness, which can be dangerous, especially when driving. 
  • Zolpidem tartrate can cause withdrawal symptoms when use of the medication is stopped abruptly. Patients should not stop taking the medication abruptly and should instead gradually reduce their usage under a doctor’s medical advice and supervision. Common withdrawal symptoms caused by zolpidem tartrate can include muscle cramps, vomiting, sweating, reddening or warming of the skin,  and emotional changes. Rebound insomnia is also a risk. 
  • Women who are pregnant or nursing should not take zolpidem tartrate as it may pass to the baby or into breast milk. 
  • Because use of zolpidem tartrate can be habit-forming CNS depressant, the medication is only intended for the short term treatment of insomnia. 
  • If you have had an allergic reaction to zolpidem tartrate or any of its ingredients in the past, you should not take the medication. A second allergic reaction to zolpidem tartrate or its ingredients could be fatal.
  • Having liver problems or liver disease can cause some patients to process zolpidem tartrate more slowly. Therefore, these patients may need to take a lower dose of the medication in order to reduce their risk of experiencing possible side effects.
  • Use of zolpidem tartrate has not been studied in people under the age of 18. Children and adolescents should not take the medication.
  • St. John's Wort and ketoconazole affect CYP3A4, and may cause affected metabolism and drug interactions, potentially calling for an altered recommended dose.
  • Those with mental illness should discuss the appropriateness of this drug with their healthcare provider. 
  • Those with myasthenia gravis, sleep apnea, or other breathing problems should discuss the appropriateness of this drug with their healthcare professional. 

Sources:

https://www.webmd.com/drugs/2/drug-8862-8110/zolpidem-oral/zolpidem-oral/details 

https://www.drugs.com/zolpidem.html 

https://www.rxlist.com/ambien-drug/patient-images-side-effects.htm 

Published October 1st, 2020 by Bridget Reed
Fact Checked by Chris Riley

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