Long-Term Risks and Alternatives to Zolpidem

Efficacy and Safety

The American College of Physicians recommends that zolpidem was not statistically significantly different from placebo for sleep onset latency, total sleep time, or wake after sleep onset, indicating loss of efficacy with continued use 1
The FDA medical reviews indicate that memory impairment, psychiatric adverse effects, depression, and anxiety occur at higher rates with long-term use 1
Observational studies show a 5-fold increase in memory loss, confusion, and disorientation in older patients using sedative-hypnotics compared to placebo 2
The American Geriatrics Society recommends avoiding benzodiazepine-like GABA receptor hypnotics, including zolpidem, in older adults, due to concerns of sedation, cognitive impairment, and unsafe mobility with injurious falls 4

Zolpidem is associated with an adjusted odds ratio of 1.72 for fractures and major head injuries requiring hospitalization 3
A 3-fold increase in dizziness, loss of balance, or falls occurs in older patients 2
Anxiolytic and hypnotic drugs, including zolpidem, are associated with increased all-cause mortality, according to observational data from the UK General Practice Research Database 2

The American Academy of Sleep Medicine recommends cognitive behavioral therapy for insomnia (CBT-I) as the initial and ongoing treatment for insomnia, with moderate-quality evidence for improving sleep onset latency, wake after sleep onset, and sleep efficiency 5, 6
Sedating antidepressants, such as trazodone, mirtazapine, or doxepin, are recommended as first-line alternatives for patients requiring ongoing pharmacotherapy, due to their lower risk of tolerance, dependence, and serious adverse effects compared to zolpidem 5, 6