Zolpidem

Medication name

Zolpidem ("ZOL-pi-dem")
Brand name

Stilnoct® ("STIL-nokt")
Medication type

Non-benzodiazepine hypnotic medicine (also sometimes called a ‘Z drug’)

Tablets: 5mg and 10mg strengths

If you are 18 or over, your doctor can prescribe zolpidem for you as a licensed medicine if you have sleep problems.

If you are under 18, a specialist doctor may still consider this as a treatment option.

About zolpidem

Zolpidem works by boosting the effectiveness of gamma-aminobutyric acid (GABA). GABA is a chemical that the brain naturally releases. It calms nerve excitability in the brain.

Zolpidem boosts the effectiveness of GABA by attaching to the parts of the brain where GABA normally works. If the action of GABA in the brain is boosted, then sleep is improved.

Zolpidem and everyday life

Zolpidem starts to work very quickly in your body. You should start to feel sleepy soon after taking it.

There is no information to suggest that zolpidem affects weight directly.

There have been cases of sleep-related eating disorders (SRED) reported with this medicine. This is a bit like sleepwalking, where people largely remain asleep but are unable to stop the desire to eat food. You may not remember this in the morning.

This is a rare side effect of zolpidem. If you think you are affected by this, talk to your doctor or pharmacist. It is recommended that zolpidem is only taken for short periods of time (two to four weeks), and if this side effect does occur it is reversible when you stop taking zolpidem.

You may want to let your family and friends know you are taking zolpidem so they can support you and help you look out for side effects.

For guidance on this, check out our page on getting support with your medication.

Zolpidem is prescribed to help improve your sleep, so should make you feel sleepy and make it easier to get to sleep and stay asleep after taking it.

It is important to continue following other advice to help improve your sleep alongside zolpidem.

Some people have reported doing things like walking, preparing food, making phone calls, having sex and even driving while they were not fully awake. They do not remember doing these things after they wake up.

If you take zolpidem with alcohol, or with other medicines for mental health conditions like antidepressants, this is more likely to happen.

If this happens to you, go back to your doctor to try another medicine.

Zolpidem can affect your recent memory, especially if you do not go to bed just after taking it, or if your sleep gets interrupted. Make sure to get seven to eight hours of uninterrupted sleep if you are going to take zolpidem.

Zolpidem is not expected to make you feel sleepy the following day, but if it does (or if it makes it more difficult for you to get to sleep or gives you strange nightmares) and this is a problem for you, you should go back to your doctor as soon as possible.

When you stop taking zolpidem you may experience ‘rebound insomnia’. This means your sleep might be worse and you might get more vivid dreams immediately after stopping it, but this should improve again. If it doesn’t, discuss this with your doctor.

Alcohol

Drinking alcohol if you are taking zolpidem is not recommended as this is likely to make you very sleepy. Zolpidem may lower your tolerance to alcohol, and you may experience more side effects which could be dangerous.

If you need to drive a car, ride a bike, or use machines at work, taking alcohol and zolpidem together could impair your ability to do this safely and be dangerous to yourself and others.

Drinking alcohol every day, or in large amounts, can disrupt your sleep and make your symptoms worse.

Street drugs

It is very easy, and serious, to overdose with any combination of zolpidem and street drugs. Any combination could be dangerous.

Using cannabis with zolpidem will make its sedative effect worse. You could go into a very deep sleep where you may have difficulty waking up.

Cannabis and other drugs may have their own side effects on your mental health, like anxiety or psychosis.

Using heroin or methadone with zolpidem may increase their combined sedative effects. You may have difficulty waking up.

Using cocaine or other stimulants (like ecstasy, amfetamines, MDA, or 6-APB) with zolpidem is dangerous. It might lead to less of a high but can cause hallucinations.

There are many other street drugs, but we don’t know what effect taking them with zolpidem will have, so it’s best to be cautious. There is no regulation of street drugs or ‘legal highs’, so even if there are no known issues with the medication you take, the supply you receive might be mixed with other substances that could be dangerous.

Get more advice on our drugs and alcohol guide.

Zolpidem does not mix well with some other medicines, including herbal remedies. It may affect the way in which they work or could cause more side effects.

Tell your doctor if you are taking any other medications including over-the-counter medicines for common illnesses and things you put on your skin.

You should be very careful if you take zolpidem with other medicines that can cause sedation, especially medicines for pain relief that contain opioids (for example dihydrocodeine or morphine). When combined, these medicines may make you extremely sedated or could affect your breathing. Your doctor will monitor this carefully if you are prescribed these medicines together.

Always tell the pharmacist that you are taking zolpidem if you buy any medicines from a pharmacy.

Look at the leaflet inside your medicine box for more information about other medicines that can interact with zolpidem. With some medicines your doctor may need to adjust the dose of your medicines if you take them together. Ask a doctor or pharmacist for more information if you have any questions.

Try not to drink caffeine drinks (like coffee, cola or energy drinks) while you are taking zolpidem.

Caffeine has the opposite effect of zolpidem in your body, and stops it working.

Caffeine can also cause anxiety and sleep loss. Stopping these drinks might help to improve your symptoms.

The tablets may not be suitable for you if you have problems eating some sugars or dairy foods, as they contain lactose.

Always let your pharmacist know if you have any food allergies or intolerances, and always check with them if you’re concerned about any of the ingredients in your medication.

If you need to avoid animal products, please note that non-active ingredients used in the production of medicines may sometimes be of animal origin. Ask your pharmacist if you have any questions about the ingredients.

Further information about practical considerations for medicines if you need to avoid animal products can be found on the Vegan Society website.

Do not drive a car or ride a bike just after you start taking zolpidem.

Taking zolpidem may make you feel tired, dizzy or confused, and may give you double-vision during the day when you start taking it. Even if you don’t feel tired, it could affect your ability to make quick decisions. These effects are made much worse if you drink alcohol whilst taking zolpidem.

This could affect you if you drive a car, ride a bike, or do anything else that needs a lot of focus. If you are not sleeping well, this could also make driving dangerous for yourself and other people.

For these reasons, you should not ride a bike or drive a car until you know how you will be affected.

Most people drive as normal while taking zolpidem. If you are worried about this or have any concerns you would like to discuss, speak to your doctor or pharmacist.

Pregnancy

If you become pregnant while you are on zolpidem, you should carry on taking it and make an appointment to see your doctor as soon as possible. They can discuss the benefits and risks of continuing zolpidem and help you to make a decision that is best for you and your baby.

They may refer you to a specialist perinatal mental health team to support you with this decision.

You can find out more information about taking zolpidem during pregnancy at Bumps (Best Use of Medicines in Pregnancy).

Untreated illness can also be harmful to you and your developing baby, so decisions about medication when you are pregnant need to be discussed carefully with your doctor. If you and your doctor agree that it is best for you to continue taking zolpidem while pregnant, you should tell your midwife. If you are planning to get pregnant, it is recommended that you take folic acid while you are trying for a baby and during pregnancy. It is safe to take this together with zolpidem.

Post-natal

If you take zolpidem regularly leading up to the birth of your baby, let your midwife or doctor know. Some newborns whose mothers take zolpidem might have some withdrawal symptoms at birth or just after. Let your doctor you are taking zolpidem so they can monitor your baby if they have any breathing difficulties, muscle weakness or problems with feeding.

Breastfeeding

Zolpidem is passed to the baby in breastmilk in small amounts.
If your baby was born early or has any health problems, then breastfeeding while you are taking zolpidem may not be recommended.

If you breastfeed while taking zolpidem while taking zolpidem, seek urgent medical advice if your baby becomes restless, very sleepy or develops feeding problems.

Sex

Zolpidem can have side effects that might impact your sex life. These include:

not feeling like you want to have sex

Most side effects happen when you first start taking zolpidem and get better over time. If you have any concerns, speak to your doctor.

Untreated illness can have a negative effect on your sex life, so if zolpidem helps you to recover, positive effects can include improving your desire, experience and enjoyment of sex as your mood lifts and you become interested in life and relationships again.

Fertility

There is no evidence to suggest that zolpidem affects fertility. Talk to your doctor about your zolpidem if you are trying to get pregnant or planning a family.

Zolpidem is not a banned substance in sport.

Most people play sports as normal while taking zolpidem, but if zolpidem affects your concentration, eyesight or co-ordination, then you may want to wait to see if those effects go away before playing sports that need a lot of focus. If you have any concerns, discuss this with your doctor.

Zolpidem can help you to sleep better, so in the long term might help you with your performance in sports.

Zolpidem may affect your concentration, give you double vision or make you feel tired of dizzy when you start taking it.

Ideally it is best not to start or stop zolpidem just before your exams.

It is not possible to predict how the medication will make you feel, and if you do get any side effects, these are more likely to occur when you first start taking zolpidem. Stopping zolpidem quickly can also make you feel more tired.

You should talk to your doctor about any future exams if you are starting or stopping zolpidem. You might decide together to delay starting or stopping it until you have done them.

If they are more than a few weeks to a month away, however, you might find that it is better to start zolpidem to improve your sleep, motivation and ability to study.

It’s important to not drink caffeinated drinks whilst taking zolpidem as it can stop them from working.

Most people take exams as normal while taking zolpidem, but if you have any concerns, discuss this with your doctor.

Information and safety considerations

Your doctor will consider any other medical conditions or symptoms you have before recommending a medicine for you.

Your medicine will come with a ‘patient information leaflet’. It’s important that you read this information. Speak to your pharmacist if:

you’re not given a leaflet
you don’t understand the information
you need it in a different format or language
you’re concerned about something you’ve read

The information leaflet also includes a list of warnings and precautions to consider before you take the medicine. If you think that any of these apply to you and are concerned that your doctor is not already aware of them, check with your doctor or pharmacist before you start to take your medication (or as soon as possible if you are already taking it).

Uses, warnings, safety and side effects

Taking zolpidem

You and your doctor should talk about how long you need to take zolpidem before you start treatment with the medication.

Usually zolpidem is not taken for more than two to four weeks. Some people take zolpidem for a very short time (two to five days). You should not take zolpidem for more than four weeks at a time.

People can become dependent on the effects of zolpidem if they take it for more than a month, and then when they stop, they are more likely to get withdrawal symptoms.

You will get the best effect from zolpidem if you take it at the dose prescribed by your doctor.

Zolpidem should be taken at the lowest dose possible for the shortest possible time.

You should take zolpidem just before you go to bed.

You may agree with your doctor not to take it every night, but perhaps every other night, so you don’t get into the habit of taking it.

If you can make sure that you get seven to eight hours of uninterrupted sleep, you will get fewer side effects like drowsiness the next day.
You can take it before or after food.

If you forget to take a dose before bedtime, take it as soon as you remember or wait and take the dose the next night. Do not try and catch up by taking a double dose the following night.

You must allow yourself between seven and eight hours of sleep after taking it.

If you regularly forget to take zolpidem, you could get your old symptoms back and have difficulty getting to sleep. You could also get withdrawal symptoms if you have been taking this medicine regularly for more than two to four weeks.

If you have taken zolpidem regularly or just as needed for less than four weeks, you should be able to stop it straight away, although your doctor may recommend you reduce the dose gradually over a few days or a week.

Stopping zolpidem too quickly may cause withdrawal or rebound symptoms. You can stop taking zolpidem safely and gradually with the support of your doctor.

Zolpidem is not likely to give you withdrawal symptoms if you have been taking it for less than four weeks, but some people do experience this.

If you have taken zolpidem regularly for longer than four weeks, it is more likely you will experience withdrawal symptoms if you stop it suddenly.

Some of the symptoms you get may be the same or similar to symptoms you had when you were unwell, so understandably, you might may you feel anxious or upset that problems you had with sleep might be returning.

You might get any of the following symptoms:

rebound sleeplessness
muscle pain or aches or cramps
anxiety
shaking
sweating
feeling agitated or confused or panicky or irritable
headache
fast heartbeat
feeling strange or having nightmares or hallucinations (sensing things that are not there)
uncomfortable feelings in your stomach and gut

In serious cases you could also get the following:

feeling unreal in yourself
feeling apart from who you really are
feeling very sensitive to certain sounds
numbness and tingling of fingers and toes
being very sensitive to light, noise and physical contact
hallucinations
having seizures or fits

Even when zolpidem is stopped gradually, you may get some rebound symptoms:

your original sleeplessness may return
you might feel mood changes
you might feel anxious
you might feel restless

If you suffer from any of these symptoms, go back to your doctor for advice.

Warnings and safety

If you have taken more than the dose prescribed by your doctor, contact NHS 111 immediately to ask for advice, or ask a family member or friend to do this for you. This is important even if you don’t feel any different.

NHS 111 can give you advice and direct you to the best place to get more help if you need it.

If you have taken too much medication on purpose, or if after taking this you quickly feel unwell, call 999 or get someone to take you to A&E straight away. This includes any of the following signs:

feeling extremely drowsy
feeling sleepy
passing out
feeling shaky (tremor) or dizzy
feeling unsteady and not being able to keep your balance
feeling dizzy when you stand up
changes in your heart rate
feeling or being sick
headache
feeing disorientated or confused
difficulty breathing
bluish skin, lips or nails

If you have taken zolpidem with other drugs, including alcohol, you could get more serious side effects. You must get help quickly and tell the doctors everything you have taken, so they can help you.

If you need to go to A&E, do not travel alone or drive yourself there. Get your parent, family member or friend to go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you and tell doctors how much you have taken.

Suicidal thoughts

While uncommon, zolpidem can sometimes cause you to have thoughts about hurting yourself or taking your own life.

If you have any thoughts like this, it is important you get urgent help. Contact your doctor immediately for advice and support. This could be your GP or specialist mental health team. If you are able, share how you are feeling with family member or friend as well so they can support you to get help.

If you discussed with your doctor what to do if you get these thoughts and created a safety plan, read this to remind you who to contact for support and what you can do to help you cope.

Read our guide to suicidal feelings

Serious side effects

Zolpidem can cause rare but serious side effects, including allergic reactions.

Stop taking zolpidem and go to a hospital straight away if you get any of the following symptoms:

difficulty breathing or swallowing
swelling of your face or throat
swelling of the hands, feet or ankles
an itchy lumpy rash or nettle rash

Get your parent, family member or friend to take you or go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you.

Contact your doctor immediately but don't stop taking zolpidem, if you get any of the following symptoms:

depression (low mood)
restlessness, agitation, irritability, aggressiveness, violent anger, hallucinations, personality changes (this reaction can be more likely in children and young people but it is still rare)
sleeping difficulties, nightmares or doing things while sleep that you don’t remember e.g. sleep walking, preparing and eating food, driving
feeling that you are becoming reliant on zolpidem and finding it difficult to stop
double vision or blurred vision
memory loss or forgetfulness
sexual arousal, abnormal behaviour, or false beliefs
unexplained bleeding and/or bruising
increased risk of infections e.g. frequent sore throats, mouth ulcers, weakness and pale skin
confusion, numbed emotions
symptoms of jaundice like yellowing of the skin, eyes, nose, mouth, pale coloured faeces (poo) and dark coloured urine
skin problems such as rashes and inflammation

If you are unable to contact your doctor, call NHS 111 for urgent advice.

Side effects and your health

Side effects are more common when you first start taking a new medicine. Many go away as you continue your medicine. If they don’t get better, or if you are worried by them and they are causing you distress, speak to your doctor, specialist team or pharmacist about them.

Common side effects of taking zolpidem (affecting up to one in ten people) include:

diarrhoea (loose poo)
nausea (feeling sick) or vomiting (being sick)
pain in your abdomen (gut)
headache
feeling tired, drowsy or sleepy in the day
feeling agitated
having nightmares
poor memory and slowed thinking
feeling dizzy
having back pain

A study done with children and young people aged six to 17 years showed that the following side effects were most common in this age group:

dizziness
headache
delusions or hallucinations (believing, seeing or hearing things that are not real)

There are other side effects that you can get when taking this medicine. We have only included the most common ones here.
This list of side effects can look scary. You may not experience any of them, but it’s important to be aware of them so you know what to do if they do happen.

Unless your side effects are very severe or distressing, try to continue taking your medication until you can talk to your doctor. Your doctor can make changes to your medication to help if needed.

There is no additional monitoring routinely recommended with zolpidem.
Very rarely zolpidem can affect your liver.

Your doctor may recommend additional checks depending on any other medical conditions you have or if you get any side effects from your medicine. This can include a liver function test. A blood test will be needed to check this.