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Zolpidem Has Different Dose for Women

The popular sleeping pill zolpidem has a lower recommended dose for women because they eliminate it from their bodies more slowly.
Zolpidem Has Different Dose for Women
Sleep, sleeping

The popular sleeping pill zolpidem was first approved by FDA in 1992 under the brand name Ambien. In 2012, nearly 40 million prescriptions for this medication were dispensed. The FDA changed the dose for women in 2013. Its popularity has declined somewhat since then; doctors wrote 16 million prescriptions in a recent year. 

What Is the Zolpidem Dose for Women?

When the FDA announced a change in dose for women, it instructed women to stick to 5 mg of the instant release forms of zolpidem instead of the previous 10 mg dose. The FDA also suggested that women taking the slow release formulation of zolpidem (Ambien CR) not exceed a dose of 6.25 mg.

They recognized that many women taking the original dose end up with higher blood levels that persist longer in the body. Women appear to eliminate the drug more slowly.

The agency has received more than 700 reports of “impaired ability and/or road traffic accidents” associated with zolpidem. The morning hangover effect may impact judgment and reaction times. The agency warns that both men and women may experience “next-morning impairment for activities that require complete mental alertness, including driving.” Some men may also do better on the lower dose of this medication. 

Trouble with the Full Zolpidem Dose:

We heard recently from a reader concerned about her mother’s use of this medication. 

Q. My mom has insomnia and has taken 10 mg of zolpidem for years. She feels psychologically dependent on it. Mom usually takes a divided dose, waking up during the night to take the other half.

When she started taking the full dose all at once she started sleep walking. In the morning she had no memory of what happened. She switched back to divided dosing with no further issues.

A. As we noted above, the FDA revised its dosage recommendation for women taking zolpidem years ago. The dose for women taking immediate-release pills (Ambien, Edluar) should now be 5 mg instead of 10 mg. That’s also the recommendation for the nasal spray form (Zolpimist) and the special middle-of-the-night dosage form of zolpidem (Intermezzo) taken under the tongue.

Not all experts agree with this recommendation. Some have noted that although women do clear the medication 35% more slowly, they are no more impaired than men eight hours after taking the medication (Journal of Clinical Psychopharmacology, May/June 2019). On the other hand, scientists who have reviewed case reports of harm associated with this drug concluded that it is substantial (Journal of Nervous and Mental Disease, Jan. 2020). 

They wrote:

“Zolpidem-associated health, behavioral, and social problems comprise an international pandemic of preventable heath misfortunes.”

The problem of sleep-walking doesn’t affect everyone, but it isn’t uncommon either. You can read some scary stories from readers about their experiences sleep-driving while taking this drug.

Learn More:

Your mother may find our eGuide to Getting a Good Night’s Sleep helpful. It provides information on sleeping pills, dependency and withdrawal, as well as non-drug options for dealing with insomnia.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
Citations
  • Greenblatt DJ et al, "Zolpidem and gender: Are women really at risk?" Journal of Clinical Psychopharmacology, May/June 2019. DOI: 10.1097/JCP.0000000000001026
  • Westermeyer J & Carr TM, "Zolpidem-associated consequences: An updated literature review with case reports." Journal of Nervous and Mental Disease, Jan. 2020. DOI: 10.1097/NMD.0000000000001074
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