What Is Ambien 5 mg?

Ambien 5 mg is the lowest available strength of the immediate-release tablet formulation of zolpidem tartrate, a sedative-hypnotic used for the short-term treatment of insomnia. It is a central nervous system (CNS) depressant classified as a Schedule IV controlled substance in the United States because it can be abused or lead to dependence.

The 5 mg strength is the recommended starting dose for women and the recommended dose for elderly or debilitated patients of either sex. It is also the appropriate starting dose for patients with mild to moderate hepatic impairment.

What Ambien 5 mg Is Prescribed For

Ambien is FDA-approved for one condition:

• Short-term treatment of insomnia characterized by difficulties with sleep initiation.

Important limitation: Ambien has been shown to decrease sleep latency for up to 35 days in controlled clinical studies. Long-term use is not recommended. Treatment should be as short as possible, and extended treatment should not occur without re-evaluation of the patient’s status because the risk of abuse and dependence increases with duration of treatment.

Not for children: Safety and effectiveness of zolpidem have not been established in pediatric patients. In an 8-week study of children ages 6–17 with insomnia associated with ADHD, zolpidem did not decrease sleep latency compared to placebo, and hallucinations were reported in 7.4% of zolpidem-treated patients versus none on placebo.

Active Ingredients

The active ingredient in Ambien 5 mg is zolpidem tartrate, a gamma-aminobutyric acid (GABA) A agonist of the imidazopyridine class.

The 5 mg tablet is described as capsule-shaped, pink, film-coated, with “AMB 5” debossed on one side and “5401” on the other. Tablets are not scored.

Available Strengths

Ambien immediate-release tablets are available in two strengths:

5 mg Capsule-shaped, pink, film-coated Women; elderly; hepatic impairment 10 mg Capsule-shaped, white, film-coated Men (if 5 mg ineffective)

Dosage Guidelines

Adult Women: The recommended initial dose is 5 mg once daily immediately before bedtime, with at least 7–8 hours remaining before planned awakening. The dose may be increased to 10 mg if 5 mg is not effective.

Adult Men: The recommended initial dose is 5 mg or 10 mg once daily immediately before bedtime. If the 5 mg dose is not effective, the dose can be increased to 10 mg.

Elderly or Debilitated Patients: The recommended dose is 5 mg once daily immediately before bedtime, regardless of gender, to minimize adverse effects related to impaired motor and/or cognitive performance.

Hepatic Impairment: The recommended dose is 5 mg once daily immediately before bedtime. Avoid Ambien use in patients with severe hepatic impairment as it may contribute to encephalopathy.

Administration: Ambien should be taken as a single dose immediately before bedtime and should not be readministered during the same night. The effect of Ambien may be slowed by ingestion with or immediately after a meal.

Important Safety Information (Boxed Warning)

Complex Sleep Behaviors: Complex sleep behaviors, including sleep-walking, sleep-driving, and engaging in other activities while not fully awake, may occur following the first or any subsequent use of Ambien. Patients can be seriously injured or injure others during complex sleep behaviors. Such injuries may result in a fatal outcome. Other complex sleep behaviors include preparing and eating food, making phone calls, or having sex. Patients usually do not remember these events. Discontinue Ambien immediately if a patient experiences a complex sleep behavior.

Postmarketing reports have shown that complex sleep behaviors may occur with Ambien alone at recommended doses, with or without the concomitant use of alcohol or other CNS depressants.

Contraindication: Ambien is contraindicated in patients who have experienced complex sleep behaviors after taking Ambien.

Common Side Effects

Short-term trials (up to 10 nights, doses ≤10 mg): Headache, drowsiness, dizziness, diarrhea.

Longer-term trials (up to 35 nights): Drowsiness, dizziness, dry mouth, allergy, back pain, lethargy, drugged feeling, palpitation, lightheadedness, depression, amnesia, abnormal dreams.

Withdrawal symptoms after stopping: Trouble sleeping, nausea, flushing, lightheadedness, uncontrolled crying, vomiting, stomach cramps, panic attack, nervousness, stomach area pain. These symptoms typically last for 1 to 2 days.

Important Warnings

CNS-Depressant Effects and Next-Day Impairment: Ambien has the potential to cause next-day impairment, and this risk is increased if dosing instructions are not carefully followed. Patients should wait at least 8 hours after dosing before driving or engaging in activities requiring full mental alertness. Impairment can be present despite feeling fully awake. Increased drowsiness and decreased consciousness may increase the risk of falls.

Severe Anaphylactic and Anaphylactoid Reactions: Cases of angioedema involving the tongue, glottis, or larynx have been reported after the first or subsequent doses. Some patients have had additional symptoms such as dyspnea, throat closing, or nausea and vomiting that suggest anaphylaxis. If angioedema involves the throat, glottis, or larynx, airway obstruction may occur and be fatal.

Abnormal Thinking and Behavioral Changes: Changes including decreased inhibition, bizarre behavior, agitation, and depersonalization have been reported. Worsening of depression, including suicidal thoughts and actions, has been reported in primarily depressed patients.

Respiratory Depression: Studies did not reveal respiratory depressant effects at hypnotic doses of Ambien in normal subjects or in patients with mild to moderate COPD. However, a reduction in lowest oxygen saturation and increase in times of oxygen desaturation below 80% and 90% was observed in patients with mild-to-moderate sleep apnea treated with Ambien 10 mg. Ambien should be used with caution in patients with sleep apnea syndrome or myasthenia gravis.

Withdrawal Effects: Following rapid dose decrease or abrupt discontinuation, there have been reports of signs and symptoms similar to those associated with withdrawal from other CNS-depressant drugs.

Pregnancy: Use of Ambien late in the third trimester may cause respiratory depression and sedation in neonates. Monitor neonates for signs of sleepiness, breathing difficulties, or limpness.

Lactation: Zolpidem is excreted in human milk. Breastfeeding mothers should monitor infants for increased sleepiness, breathing difficulties, or limpness. A lactating woman may consider pumping and discarding breastmilk during treatment and for 23 hours after Ambien administration to minimize drug exposure.

Drug Interactions

CNS Depressants: Dosage adjustment may be necessary when Ambien is combined with other CNS-depressant drugs because of potentially additive effects. Ambien showed additive effects when combined with alcohol and should not be taken with alcohol.

Opioids: Inform patients and caregivers that potentially serious additive effects may occur if Ambien is used with opioids. Do not use such drugs concomitantly unless supervised by a healthcare provider.

Ketoconazole: A potent CYP3A4 inhibitor. Co-administration with zolpidem 5 mg increased Cmax of zolpidem by 30% and total AUC by 70%, and prolonged the elimination half-life by 30% along with an increase in pharmacodynamic effects. Consideration should be given to using a lower dose of zolpidem when ketoconazole and zolpidem are given together.

Itraconazole: A single-dose interaction study with zolpidem 10 mg and itraconazole 200 mg resulted in a 34% increase in AUC of zolpidem.

Imipramine and Chlorpromazine: Additive effects of decreased alertness and psychomotor performance were observed when these drugs were combined with zolpidem.

Who Should Not Take Ambien 5 mg

Ambien is contraindicated in patients:

• Who have experienced complex sleep behaviors after taking Ambien.
• With known hypersensitivity to zolpidem. Observed reactions include anaphylaxis and angioedema.

How Prescriptions Work

As a Schedule IV controlled substance, Ambien prescriptions are subject to federal and state regulations:

• Refills: Schedule IV prescriptions may be refilled up to 5 times within 6 months from the date written, unless otherwise restricted by state law.
• Short-term use: Long-term use is not recommended. Treatment should be as short as possible.
• Lowest effective dose: Use the lowest effective dose for the patient.
• Maximum dose: The total dose of Ambien should not exceed 10 mg once daily immediately before bedtime.
• Safe storage: Keep Ambien in a safe place to protect it from theft. Never give Ambien to anyone else because it may cause death or harm them. Selling or giving away this medicine is against the law.

Frequently Asked Questions

Is Ambien 5 mg safe for long-term use?
No. Long-term use of Ambien is not recommended. Treatment should be as short as possible. Extended treatment should not take place without re-evaluation of the patient’s status because the risk of abuse and dependence increases with the duration of treatment.

Does Ambien 5 mg affect sleep?
Ambien is used to decrease sleep latency (the time it takes to fall asleep). It has been shown to decrease sleep latency for up to 35 days in controlled clinical studies.

Can I stop taking Ambien 5 mg suddenly?
Following rapid dose decrease or abrupt discontinuation, there have been reports of signs and symptoms similar to those associated with withdrawal from other CNS-depressant drugs. Do not stop taking Ambien without talking to your healthcare provider.

What does “5 mg” mean in Ambien 5 mg?
The 5 mg refers to the amount of zolpidem tartrate active ingredient in each tablet. It is the lowest available immediate-release strength.

Is Ambien 5 mg the same as Ambien CR 6.25 mg?
No. Ambien 5 mg is an immediate-release tablet, while Ambien CR is an extended-release tablet available in 6.25 mg and 12.5 mg strengths. They have different release profiles and dosing.

Can Ambien 5 mg be split?
Ambien tablets are not scored. Splitting is not recommended.

What should I do if I experience a complex sleep behavior?
Stop taking Ambien immediately and tell your healthcare provider right away if you find out that you have done any complex sleep behaviors after taking Ambien, such as sleep-walking, sleep-driving, making and eating food, talking on the phone, or having sex.

Conclusion

Ambien 5 mg is the lowest-strength immediate-release sedative-hypnotic approved for the short-term treatment of insomnia characterized by difficulty with sleep initiation. As a Schedule IV controlled substance, it carries a boxed warning for complex sleep behaviors—including sleep-driving—that can result in serious injury or death, and requires strict prescribing controls. The 5 mg dose is the recommended starting dose for women, elderly patients, and those with hepatic impairment. Common side effects include drowsiness, dizziness, and headache. Serious risks include next-day impairment, respiratory depression, worsening depression, and withdrawal effects. Ambien should be taken immediately before bedtime with at least 7–8 hours remaining before planned awakening, and never with alcohol or other CNS depressants. Patients should use the lowest effective dose for the shortest duration possible, store the medication securely, and never share it with others. Any changes to treatment should be managed under medical supervision.