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Zolpidem: What is Zolpidem? Uses, Costs, Benefits, and Doses

With our busy schedules and the often non-existent boundaries between work and home life, it seems like no one is getting enough sleep these days. “I’m so tired” is a common refrain from pretty much everyone. A 2005 poll by the National Sleep Foundation found that over half of adults reported experiencing at least one symptom of insomnia multiple times a week over the past year. Insomnia is more likely to affect women than men, without about 63 percent of women and 54 percent of men struggling with the condition. In 1992, a blockbuster drug called Ambien was released, offering the first viable insomnia medication since the much-maligned (and frequently outlawed) Halcion. Since then, a generic form of Ambien, called zolpidem, has been released, offering affordable and effective short-term relief to insomnia sufferers.

What is zolpidem?

Zolpidem is an FDA approved prescription drug that is classified as a sedative or hypnotic. Zolpidem is the generic form of the drug that was originally marketed under the brand name Ambien. Today, zolpidem is manufactured under the brand names Ambien, Ambien CR, Intermezzo, Edluar, and Zolpimist. It is sold in the form of immediate release tablets, extended release tablets, sublingual tablets, and an oral spray. Zolpidem is a controlled substance due to its potential to be habit-forming, and it is recommended for short term use only.

What is zolpidem used to treat?

Zolpidem is one of several different medications used to treat insomnia, or difficulty sleeping, in people who have already tried counseling and behavioral changes to improve their sleep. Zolpidem is helpful for people who have trouble falling asleep, staying asleep, or both, depending on the dosage and the formula used. 

What is insomnia and what causes it?

Insomnia, or difficulty sleeping, is a common issue for many people. The National Sleep Foundation estimates that about 30 percent of the population complains about disrupted sleep, while 10 percent meet the criteria for insomnia. Insomnia is characterized by symptoms like trouble falling asleep, waking up frequently, waking up too early and being unable to fall back asleep, and waking up feeling tired; when these symptoms occur at least a few nights per week within the past year, they are categorized as insomnia. The condition can be acute, or short term, lasting from one night to a few weeks, or it can be chronic, happening three or more nights per week for three months or more. 
 
Insomnia is more likely to affect young people and decreases in likelihood as people age. The National Sleep Foundation reports that 68 percent of adults between the ages of 18 and 29 report experiencing symptoms of insomnia, as compared to 59 percent of people aged 30 to 64, and 44 percent of older adults over age 65. 
 
The condition is called primary insomnia when it cannot be linked to any other health condition or problem, and is considered secondary insomnia when linked to a health condition or substance abuse. Insomnia has a number of different causes, including both environmental factors and health issues. It can be caused by stress or significant life changes such as a birth, death, or divorce. The noise level, lighting, and temperature in the room where you’re trying to sleep can also play a role in insomnia, as can changes to your sleep schedule and jet lag. People suffering from depression and anxiety often struggle with insomnia, as do those dealing with hyperthyroidism and pain or discomfort at night. Certain medications can make people more alert, preventing them from falling asleep and staying asleep. Insomnia can also be influenced by what we consume, as things like alcohol, caffeine, nicotine, and heavy meals can all disrupt your sleep. There also appears to be a genetic component to insomnia, as some people are biologically opposed to the condition and may struggle with sleep for years with no identifiable cause, even while practicing health sleep hygiene.
 
Sometimes, difficulty sleeping might seem like it is being caused by insomnia, but it is actually a symptom of underlying sleep disorders such as restless legs syndrome or sleep apnea. If you struggle with insomnia on a regular basis and have been unable to find relief even with treatment, you should see a sleep specialist. Don’t accept poor sleep as the norm - your body needs rest!

How does zolpidem work to treat insomnia?

Zolpidem works by influencing the chemicals in the brain that may be unbalanced for individuals who have difficulty sleeping. The medication binds to the neurotransmitter, GABA, and triggers extra activity. This extra activity works against the neuron activity that is associated with insomnia. In layman’s terms, zolpidem works by slowing down the brain. When taken in its original, immediate release form, zolpidem dissolves quickly to help people fall asleep fast. The extended release version of the drug is made up of two layers: one to help you fall asleep quickly and a second that dissolves slowly to help you stay asleep. 

What is the cost of zolpidem?

Zolpidem is available in an immediate release oral tablet, an extended release oral tablet, a sublingual tablet, and an oral spray. Although there are numerous brand name manufacturers for the drug, the original and most popular brand name version is Ambien. The costs of Ambien and zolpidem are compared below for reference. The generic form of the medication is covered by nearly all commercial and Medicare drug insurance plans, and pharmacy discount cards can offer savings as well. Manufacturers 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

 

 

Ambien

Zolpidem

 

Per Pill

30 Day Supply

Per Pill

30 Day Supply

5 mg immediate release

$19.51

$585.30

$1.19

$35.70

10 mg 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?

If you struggle to get a restful night’s sleep, zolpidem has been found to help. Introduced in 1992 under the brand name Ambien, this medication has a long track record of helping people overcome their insomnia. The benefits of zolpidem include:
It works quickly - usually within 30 minutes
Studies confirm that it works to initiate the sleep process
Many patients see their sleep problems improve in just seven to ten days when taking the medication.

How do I know what dose of zolpidem to take?

Your doctor will prescribe zolpidem for you based on the type of insomnia you need to treat, your age, gender, your medical history, and what type of zolpidem might be right for you. The immediate release oral tablet comes in 5 mg and 10 mg strengths and is taken right before bedtime. No more than 10 mg should be taken per day. The extended release oral tablets come in 6.25 mg and 12.5 mg strengths, while the sublingual tablets come in 1.75 mg, 3.5 mg, 5 mg, and 10 mg strengths. Your doctor will likely prescribe a low dose of zolpidem to start with so you can see how it works for you. Because zolpidem can be habit-forming and is a controlled substance, your doctor will want you to use the lowest dose possible to help treat your insomnia.

Are there any side effects I should be aware of?

While zolpidem is a popular medication, it does carry with it the risk of many side effects, some of which can be serious. Common side effects associated with zolpidem use include:

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

Serious but rare side effects associated with zolpidem include:

  • Allergic reactions
  • Swelling of the tongue or face
  • Trouble breathing
  • Symptoms of depression
  • Suicidal thoughts or thoughts of harming yourself
  • Loss of interest in activities you enjoy
  • Lack of energy
  • Weight loss or weight gain
  • Feelings of worthlessness or guilt
  • Trouble concentrating or thinking
  • Abnormal thoughts or behaviors
  • Increased agitation
  • Hallucinations
  • Being more outgoing than normal
  • Doing activities while asleep that you have no memory of
  • Driving
  • Eating or preparing food
  • Talking on the phone
  • Having sex
  • Trouble breathing
  • Slowed breathing
  • Tiredness
  • Shallow breathing
  • Decreased oxygen in your blood
  • Amnesia

What does the research say about taking zolpidem while pregnant or breastfeeding?

Use of zolpidem is not recommended for pregnant women. Effects on the fetus in the first and second trimester are unknown; however, research in animals has shown negative impacts to the fetus when the mother is given zolpidem. When taken in the third trimester of pregnancy, newborns may experience slowed breathing or excessive sleepiness. Newborns should be monitored closely by a doctor if exposed to zolpidem during pregnancy. 

Zolpidem has been found to pass into breast milk and can cause side effects in breastfed children. Zolpidem should not be taken by breastfeeding mothers.

Are there any warnings associated with zolpidem use?

People taking zolpidem should use caution, particularly when getting used to how the medication affects them. Zolpidem comes with the following warnings for use:

  • You should get at least a full 7 - 8 hours of sleep when taking zolpidem. Getting less than a full night’s sleep can cause decreased awareness and slower reaction times, which can be particularly dangerous when driving. 
  • Zolpidem can cause abnormal behaviors, such as increased agitation, hallucinations, and an “out of body” feeling. You should tell your doctor if you experience any of these side effects.
  • Stopping zolpidem without tapering off the medication can cause withdrawal symptoms. Do not stop taking zolpidem without talking to your doctor. Withdrawal symptoms can include muscle cramps, vomiting, sweating, reddening or warming of the skin, and emotional changes. 
  • Zolpidem should be taken on an empty stomach to maximize effectiveness.
  • You should not drink alcohol while taking zolpidem, as this can increase your risk of sedation and drowsiness.
  • Taking zolpidem can trigger a severe allergic reaction. Do not take zolpidem if you have had an allergic reaction to any of its ingredients. A second allergic reaction could be fatal.
  • Zolpidem should not be used in people under the age of 18, as no studies have been done to determine the effects on children.
  • Individuals with liver disease may have trouble processing zolpidem and should take a lower dose to reduce their risk of side effects.
  • Zolpidem should not be taken by women who are pregnant or nursing.
  • Zolpidem can be habit-forming, so it should be used only for short term treatment of insomnia.

Who should not take zolpidem?

If you regularly drink alcohol, zolpidem may not be the right medication for you, as it increases sedation effects. Zolpidem should not be taken on nights that you drink alcohol. People with depression may see their symptoms worsen, so make sure your doctor is aware of your complete medical history prior to beginning treatment. Individuals with myasthenia gravis, a chronic autoimmune neuromuscular disease that causes weakness in the skeletal muscles, should not take zolpidem. Zolpidem can trigger slowed or shallow breathing in individuals with myasthenia gravis, especially those who already suffer from breathing difficulties. Those with sleep apnea should not take zolpidem, as the medication may cause your breathing to be more shallow or slowed. Individuals with liver problems may not be able to process zolpidem, which can cause issues with brain function. Those with liver disease who take zolpidem may experience increased confusion, start forgetting things, or begin slurring their speech. 

How do I know if zolpidem is right for me?

If you are looking for a short-term treatment to temporary insomnia that is affordable and effective, zolpidem may be right for you. Zolpidem should only be taken if you have a full seven to eight hours to sleep before you wake up, or you might experience considerable drowsiness. Zolpidem is most effective when combined with behavioral changes and improved “sleep hygiene,” such as avoiding screens before bed time, sleeping in a dark, cool room, and going to bed at the same time every night.
 

Published March 28th, 2020 by Bridget Reed
Fact Checked by Chris Riley

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