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Ambien (zolpidem) is the most widely used prescription hypnotic sedative since its introduction in 1992 and is currently the fourth most frequently prescribed psychiatric drug (2013).
Recent US Food and Drug Administration Drug Safety Communications suggest limitations on use to reduce adverse effects; these include (1) short-term use because of loss of efficacy; (2) a lower dose of 5 mg/d for those 65 years or older, and the lower starting dose for women because of 45% to 50% higher blood concentrations; and (3) increased risks when combined with other central nervous system (CNS)-depressant drugs.
A study of the Medical Expenditures Survey in 2015 revealed that over 3.8 million adults reported using one or more prescriptions for zolpidem. Women were twice as likely as men and use increased with age. Two-thirds were using higher doses, were over age 65 yrs and were women.
Zolpidem users were likely (41%) to also be taking other CNS depressants, including 27% narcotics and 20% benzodiazepines. Over three-quarters were not observing 2 or more of the above recommendations on zolpidem use.
This study did not address observed harms; just patterns of zolpidem use. Nonethelss, these findings suggest that optimal safe use of zolpidem is uncommon.