Skip to content

zolpidem

Adjunctive therapy

Brands: AMBIEN, AMBIEN CR

Last reviewed 2025-12-28

Reviewed by PsychMed Editorial Team.

View details

Quick answers

  • What is zolpidem?

    Zolpidem (brand Ambien; Ambien CR) is a non-benzodiazepine hypnotic (“Z-drug”) approved for insomnia. It is often considered when rapid sleep onset is the primary target symptom.

  • What is AMBIEN?

    AMBIEN is a brand name for zolpidem (other brands: AMBIEN CR).

  • What is AMBIEN (zolpidem) used for?

    Label indications include: Insomnia (label).

  • What drug class is AMBIEN (zolpidem)?

    Non-benzodiazepine hypnotic (“Z-drug”); GABA-A receptor positive allosteric modulator.

  • What strengths does AMBIEN (zolpidem) come in?

    Immediate-release tablets: 5 mg, 10 mg.

Snapshot

  • Class: Adjunctive therapy
  • Common US brands: AMBIEN, AMBIEN CR
  • Therapeutic drug monitoring not routinely recommended.
  • Last reviewed: 2025-12-28

Label indications

Insomnia (label).

View labelExact

Clinical Highlights

Zolpidem (brand Ambien; Ambien CR) is a non-benzodiazepine hypnotic (“Z-drug”) approved for insomnia. It is often considered when rapid sleep onset is the primary target symptom. Immediate-release formulations mainly target sleep-onset insomnia, while extended-release products may help sleep maintenance but can increase next-day impairment; match formulation to the sleep complaint rather than escalating dose.

Read more
  • The key safety issues are complex sleep behaviors (boxed warning), next-day impairment, and additive sedation with alcohol or other CNS depressants—risks that are magnified in older adults and in serious mental illness with polypharmacy.
  • Treat zolpidem as a time-limited adjunct alongside CBT-I and sleep hygiene, and reassess ongoing need at every refill decision.
  • The compare view, zolpidem evidence feed, and zolpidem print page can help weigh alternatives and support safety counseling.
  • Approved for insomnia; treat as a time-limited adjunct to CBT-I and sleep hygiene rather than a chronic nightly default.
  • Generic formulations are widely available, so clear guardrails (short course, refill checkpoints, stop plan) help prevent long-term continuation without reassessment.

Dosing & Formulations

Immediate-release tablets: 5 mg, 10 mg. Extended-release tablets (Ambien CR): 6.25 mg, 12.5 mg.

Read more
  • Take immediately before bedtime, only when able to remain in bed for a full night; avoid dosing after alcohol or when daytime driving is anticipated early the next morning.
  • Food (especially high-fat meals) can delay onset; when rapid sleep onset is the goal, avoid taking with or immediately after a heavy meal.
  • Use the lowest effective dose and avoid escalation to “chase” sleep if insomnia is driven by untreated mood symptoms, substances, pain, or sleep apnea.

Monitoring & Risks

Boxed warning: Complex sleep behaviors (sleepwalking, sleep driving) can cause serious injuries—discontinue if they occur. Next-day impairment: assess driving/work safety and consider lower doses in older adults or when combined with other sedatives.

Read more
  • Cognitive and psychomotor effects: falls, confusion, and amnesia can occur, especially with polypharmacy.
  • Misuse and dependence risk: screen for substance use disorders and avoid open-ended refills.
  • Tolerance, rebound insomnia, and withdrawal symptoms can occur with chronic use; plan periodic taper attempts rather than indefinite continuation.
  • In patients with depression or suicidality risk, monitor mood closely; worsening depression has been reported with sedative-hypnotics (label).

Drug Interactions

Avoid alcohol and other CNS depressants (opioids, benzodiazepines, sedating antipsychotics). CYP3A4 inhibitors (ketoconazole, clarithromycin, ritonavir) can increase exposure—use lower doses and monitor for oversedation.

Read more
  • CYP3A4 inducers (rifampin, St. John’s wort) may reduce effect—avoid combinations and reassess if insomnia persists.

Practice Notes

Favor CBT-I and sleep hygiene first; use zolpidem for short, clearly bounded courses with stop plans. Avoid in untreated sleep apnea or when nighttime wandering is a safety concern; reassess in older adults due to fall risk.

Read more
  • If insomnia is chronic, treat underlying drivers (depression, PTSD, substance use, pain) rather than escalating hypnotic doses.
  • Use short prescriptions with planned follow-up, and discontinue if complex sleep behaviors, next-day impairment, or unsafe nighttime behaviors emerge.

References

  1. Ambien (zolpidem tartrate) prescribing information — DailyMed (2025)
  2. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline — Journal of Clinical Sleep Medicine (2017)
  3. Efficacy and Acceptability of Pharmacological Interventions for Insomnia in Patients With Severe Mental Illness — Acta Psychiatrica Scandinavica (2025)
  4. Residual effects of medications for sleep disorders on driving performance — European Neuropsychopharmacology (2024)
Zolpidem (AMBIEN, AMBIEN CR) — Summary — PsychMed