Zolpidem (Sublinox®)

Zolpidem (Sublinox® and generic forms) belongs to a group of medications called “hypnotics” or “sedatives.”

What is this medication used for?

Zolpidem is commonly referred to as a “sleeping pill.” It is approved by Health Canada for short-term relief of sleeping difficulties (insomnia) in adults.

Like many other medications, Health Canada has not approved zolpidem for use by children or adolescents. When potential benefits outweigh risks, zolpidem may be prescribed “off-label” for treatment of sleep disorders (insomnia). Learn more about off-label medication use: http://bit.ly/KMH-off-label-use

Tell your doctor or pharmacist if you:

Have allergies or bad reactions to a medication
Take (or plan to take) other prescription or non-prescription medications, including natural medicines. Some medications interact with zolpidem. Your doctor may adjust medication doses or monitor for side effects.
Have a history of lung disease or breathing problems, kidney or liver disease, sleep apnea, or myasthenia gravis.
Have a history of depression, any other psychiatric condition, thoughts of self-harm, or complex sleep-related behaviors (sleepwalking or sleeptalking).
Miss a menstrual period, are pregnant, breastfeeding, or planning a pregnancy.
Use alcohol or drugs. Taking zolpidem together with certain substances may cause a bad reaction. Learn more at www.DrugCocktails.ca

When will the medication start to work?

Zolpidem is usually prescribed to be taken on an ‘as needed’ basis, but it is sometimes taken regularly. You should start to feel sleepy within 30-60 minutes of taking zolpidem.

Talk with your doctor if you feel that zolpidem has not been helpful or if side effects are too bothersome. Your doctor may recommend switching you to a different medication.

Is this medication addictive?

The use of zolpidem may lead to physical and psychological dependence (such as unable to sleep without medication) or abuse (taking more than prescribed). However, zolpidem appears to have a lower risk of dependence and rebound insomnia compared to other sleeping pills.

As the zolpidem dosage and duration of treatment increase, the risk of dependence or abuse becomes higher. If you have been taking zolpidem for a long period of time and suddenly stop, you may experience worsened sleep problems (rebound insomnia) or feelings of anxiety. Your doctor will explain how to safely lower the dose gradually to prevent uncomfortable withdrawal effects as your body adjusts to being without it.

How do I take this medication?

When used regularly, zolpidem should be taken once daily at bedtime. Usually, you will start with a low dose and may slowly increase this dose over several days or weeks, based on how you tolerate it. It is important to follow the dosing schedule as given by your doctor. Your doctor will determine the dose of zolpidem that works best for you based on your symptoms and your response to this medication. Do not take more than the recommended dosage before talking to your doctor.

Zolpidem is available as an orally disintegrating tablet. Place the tablet under your tongue until it is completely dissolved and absorbed (do not swallow for 2 minutes). Do not chew, crush or take this medication with water. Zolpidem should not be administered with or immediately after a meal.

Possible common or serious side effects:

Side effects may be more common when first starting a medication or after a dose increase. Talk to your doctor, nurse or pharmacist if any side effect concerns you.

Blurred vision, dry mouth or unpleasant taste
Nausea, vomiting, stomach ache or constipation
Dizziness, poor coordination or headache
Agitation, irritability, vivid dreams or nightmares
Memory problems or morning drowsiness
Trouble sleeping or increased anxiety after you stop taking zolpidem

Contact your doctor immediately if you experience:

Mood or behavioral changes or aggression
Hallucinations (hearing or seeing things that are not there)
Thoughts of hurting yourself, suicide, increased hostility or worsening symptoms
Getting out of bed without being fully awake and taking part in activities you are not aware of and do not remember (complex sleep-related behaviors)
Irregular heartbeat
Muscle spasms or stiff muscles

What precautions should my doctor and I be aware of when taking this medication?

Before starting zolpidem, try making small changes to sleep habits to see if you have a need for medication. For example, good sleep habits include:
- avoiding caffeine and other substances that can disrupt sleep (alcohol, nicotine, cannabis)
- sticking to a regular sleep/wake schedule (avoid sleeping in or taking naps)
- powering down devices early in the evening, and avoiding stimulating activities, large meals or exposure to bright lights before bedtime.
- keeping the bedroom only for sleep, free of distractions
Many medications may interact with zolpidem, including other sleep aids, anti-anxiety medications, antidepressants, mood stabilizers, antibiotics, and several others. Check with your doctor or pharmacist if they are safe to use.
While taking this medication, if you feel dizzy, drowsy or slowed down in the morning, do not drive a car or operate heavy machinery. Alcohol could make this worse. Try to avoid alcohol while taking zolpidem.

What special instructions should I follow while using this medication?

Keep all appointments with your doctor.
Tell your doctor about your sleep pattern. Your doctor will monitor your sleep disorder and response to this medication.
Do not allow anyone else to use your medication.

What should I do if I forget to take a dose of this medication?

If you take zolpidem regularly and forget to take it, skip the missed dose and take your next dose at its regularly scheduled time the next day. DO NOT double your next dose to try to ‘catch up’.

How do I store this medication?

Keep this medication in the original container, stored at room temperature away from moisture and heat, and protected from light. Keep this medication out of reach and sight of children.

How does this medication work?

Zolpidem affects actions of the brain chemical GABA. By enhancing the action of GABA, zolpidem helps you fall asleep faster and increases total sleep duration as well as sleep quality.

How well does the medication work in children and adolescents?

Zolpidem may improve sleep by shortening the time it takes you to fall asleep, decreasing the number of times you wake up during the night, and increasing your total sleep duration. Zolpidem has been studied in children and adolescents with ADHD and has been shown to be no better than placebo (an inactive pill). Zolpidem is sometimes prescribed when other treatments are ineffective or not well-tolerated. Studies show that with regular use over time, zolpidem may become less effective for sleep.

How long should I take the medication for?

Zolpidem is usually taken only on an ‘as needed’ basis when you have sleep difficulties. Generally, its use should be limited to 7-10 consecutive days at a time, whenever possible. However, some people may need to take zolpidem regularly for a longer period of time. Your doctor will discuss the benefits and risks of taking zolpidem with you. At this time, you can also discuss how long you might need to take this medication.

If you take zolpidem regularly, do not increase, decrease, or stop taking this medication without discussing it with your doctor. If you stop taking zolpidem suddenly, it is possible that you will experience worsened sleep