Zolpidem
📖 About
Always check the BNF link here for up-to-date prescribing guidance.
- 💊 Zolpidem is a short-acting hypnotic commonly used for insomnia.
- Belongs to the “Z-drugs” group (with zopiclone, zaleplon).
- Intended for short-term use only due to tolerance and dependence risk.
⚙️ Mode of Action
- Selective GABA-A receptor agonist → enhances inhibitory neurotransmission.
- Produces sedation and reduces sleep latency.
- Short half-life → less residual “hangover” than benzodiazepines.
📋 Indications
- 🌙 Short-term management of insomnia (ideally ≤4 weeks).
- Not first-line; sleep hygiene and non-drug measures should be prioritised.
💊 Dose Range (check BNF)
| Name | Starting Dose | Frequency | Route |
|---|
| Zolpidem (females) | 5 mg | nocte | PO |
| Zolpidem (males) | 5–10 mg | nocte | PO |
💡 Use the lowest effective dose. In elderly or frail patients, start at 5 mg nocte.
🔄 Interactions
- ⚠️ Potentiated by other CNS depressants (alcohol, benzodiazepines, opioids, antihistamines).
- Avoid in acute psychosis or severe respiratory depression.
⛔ Contraindications / Cautions
- Use lower doses in hepatic impairment.
- Caution in renal impairment, elderly (falls risk), and history of substance misuse.
- Avoid in severe respiratory failure or sleep apnoea (risk of hypoventilation).
⚠️ Side Effects
- 😴 Drowsiness, dizziness, headache.
- 💩 GI upset (diarrhoea, nausea).
- 🚗 “Complex sleep behaviours” (sleep-driving, sleep-eating, sleep-walking) – rare but serious.
- 📉 Dependence, tolerance, and rebound insomnia with prolonged use.
- ↑ Risk of falls and confusion in older adults.
📝 Clinical Pearls
- Prescribe only for short-term use and review regularly.
- Advise patients to avoid alcohol and driving after taking zolpidem.
- Best taken immediately before bedtime when already ready to sleep.
- Discontinue gradually if used for >2–4 weeks to avoid withdrawal.
📚 References
