TaperCommunityzolpidem
Boxed Warning
Complex sleep behaviors (sleep-driving, sleep-walking, sleep-eating) — discontinue immediately if any episode occurs. Risk of next-day impairment, especially in women and at higher doses.
Zolpidem is a non-benzodiazepine "Z-drug" hypnotic for short-term insomnia. Despite the marketing distinction from benzos, it acts on the same GABA-A receptor system, produces tolerance, dependence, and withdrawal, and carries an FDA boxed warning for complex sleep behaviors.
5mg, 10mg tablets (IR); 6.25mg, 12.5mg tablets (CR); 1.75mg, 3.5mg sublingual (Edluar/Intermezzo)
Tablets (IR): 5mg, 10mg; Tablets (CR): 6.25mg, 12.5mg; Sublingual (Edluar): 5mg, 10mg; Sublingual (Intermezzo, middle-of-night): 1.75mg, 3.5mg; Oral spray (Zolpimist)
Category C
Selective agonist at the alpha-1 subunit of the GABA-A receptor. Functionally similar to benzodiazepines for sedation but with less anxiolytic and muscle-relaxant effect.
Slow taper essential despite marketing of zolpidem as "non-habit-forming." Crossover to a longer-acting benzodiazepine (diazepam) for taper is sometimes used. Compounded liquid useful at low end.
Treat zolpidem withdrawal with the same care as benzodiazepine withdrawal. Hyperbolic taper. Manage rebound insomnia behaviorally where possible — adding another sedative often just shifts dependence.
1-3 days after stopping (often within 24 hours given short half-life)
3-7 days
2-6 weeks for most
Sleep architecture changes can persist 1-3 months; some report long-term sleep dysregulation
Toxicity
Respiratory depression with alcohol or opioids. Complex sleep behaviors (sleep-driving, sleep-eating, sleep-walking) can occur even at therapeutic doses. Anterograde amnesia.
Pharmacokinetics
Hepatic via CYP3A4 (major) and CYP2C9, CYP1A2.
Renal as inactive metabolites.
~92%
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