Non-benzodiazepine hypnotic (Z-drug)

Zolpidem tartrate

Brand names: Stilnoct

Adult dose

Dose: 10mg at bedtime (elderly/hepatic impairment: 5mg)

Route: Oral

Frequency: OD nocte; use lowest effective dose, shortest possible duration (typically ≤4 weeks)

Clinical pearls

NICE guideline on sleep disorders: non-pharmacological interventions (CBT-I) preferred
If drug treatment necessary: shortest duration, lowest dose; use only when insomnia is severe and disabling
DVLA: warn patients regarding driving — residual sedation risk
High-strength formulation (10mg) not recommended routinely for women and elderly (5mg preferred)

Contraindications

Obstructive sleep apnoea (relative — use with caution if treated)
Severe hepatic impairment
Myasthenia gravis
Respiratory failure
Sleep-related behaviours (parasomnias — absolute relative CI)
Hypersensitivity
Pregnancy and breastfeeding

Side effects

Residual sedation / next-day impairment
Amnesia
Parasomnias (sleepwalking, sleep-driving, sleep-eating)
Tolerance and dependence
Rebound insomnia on withdrawal
Falls in elderly
Psychiatric reactions

Interactions

CNS depressants (additive sedation)
Alcohol
Opioids (respiratory depression)
CYP3A4 inhibitors (increase exposure)
Rifampicin (markedly reduces levels)

Monitoring

Duration of use
Dependence
Next-day function
Falls risk (elderly)

Reference: BNF; NICE CKS Insomnia; DVLA guidance; https://bnf.nice.org.uk/drugs/zolpidem-tartrate/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways