| Drug Name: | Ambien / Zolpidem |
| Dosage: | 5 – 10 mg |
| Packages: | 30 – 360 pills |
| Payment Method: | VISA, MASTERCARD, Paypal |
| Shipment: | US2US EU2EU int. |
| Buy Now: | Visit DrugStore |
Objective
This study evaluated prescription and dispensing patterns of zolpidem and benzodiazepines in private pharmacies across the United States between 2014 and 2024.
Methods
A retrospective cohort design was applied using publicly available data from the American Federal Government (January 2014–August 2024). Records were drawn from the National Controlled Products Management System (SNGPC), which documents registered medicines and their distribution.
Results
From January 2014 to August 2024, a total of 32,441,392 sales of 13 hypnotic agents from the z-drug and benzodiazepine classes were identified. Clonazepam was the leading medication, representing 29.8% of all sales. Alprazolam followed with 20.6%, and zolpidem ranked third with 14.4%. The conventional (immediate-release) ambien remained the most prescribed formulation. However, sales of the fast-acting version showed a marked increase beginning in 2020, while the extended-release variant remained relatively stable throughout the decade.
Conclusion
The steady growth in ambien sales in U.S. private pharmacies highlights concerns about overuse and dependence, particularly in the context of insomnia treatment. This trend reflects a growing reliance on short-term pharmacological relief, often diverging from best clinical practice. Targeted education and counseling for both prescribers and the public are crucial to ensure safe use of hypnotics and to reduce risks of misuse.
Background and Discussion
Although chemically distinct from benzodiazepines, z-drugs exert their hypnotic effect by binding to benzodiazepine receptors and potentiating the inhibitory action of GABA. Zolpidem, the most widely known z-drug, was introduced in the 1990s specifically for the management of insomnia. It reduces sleep latency, extends sleep duration, and generally causes less residual daytime drowsiness, making it a suitable option for short-term insomnia (up to four weeks).
Adverse effects linked to zolpidem include sleepwalking and complex nocturnal behaviors (e.g., driving, eating, or performing tasks without awareness), as well as heightened risks of falls, fractures, and traffic accidents, particularly among older adults. While zolpidem is effective for rapid symptom control, its safety profile is compromised by tolerance, dependence, and withdrawal phenomena such as rebound insomnia.
Despite well-documented safety issues, global consumption of zolpidem continues to increase. Case reports and observational data further underscore its potential for misuse, abuse, and dependence, raising significant public health concerns.
| 10mg * 30 pills | $9.78 | $293.40 | $0.00 | + SILVER BONUS |
| 10mg * 60 pills | $6.59 | $395.40 | $191.40 | + GOLD BONUS | |
| 10mg * 90 pills | $5.19 | $467.10 | $413.10 | + GOLD BONUS |
Regulatory Background
Zolpidem received FDA approval in 1992. Since then, the agency has issued two Drug Safety Communications highlighting the risk of next-day impairment and recommending lower starting doses, particularly for women. These actions led to a gradual reduction in prescribed doses and, as a result, a decrease in the incidence of adverse events. Although ambien has been marketed in the United States since the mid-1990s, its promotion intensified after the expiration of the original patent in 2007. By 2023, at least 14 pharmaceutical companies were manufacturing and distributing different zolpidem formulations in the U.S.
A key challenge in the American market is related to prescription monitoring. Zolpidem is consistently among the most frequently falsified prescriptions. To counter this, health authorities have introduced various surveillance mechanisms and regulatory strategies. In contrast, some countries have adopted stricter controls. For example, in France, since April 2017, zolpidem can only be prescribed using secured prescription pads, and its use is limited to a maximum of four weeks, including a tapering phase.
Research Gap
Despite increasing reports of psychotropic drug use—particularly during the COVID-19 pandemic—few studies have specifically examined long-term dispensing patterns of zolpidem in the U.S. compared to benzodiazepines. Previous literature highlights general growth in psychotropic prescribing but does not provide a detailed assessment of zolpidem sales across different formulations over time. Addressing this gap, our study evaluated dispensing data for zolpidem and benzodiazepines in U.S. private pharmacies between 2014 and 2021.
Results
Between January 2014 and August 2021, a total of 32,441,392 sales were recorded for 13 hypnotics (benzodiazepines and z-drugs). Clonazepam was the leading agent, accounting for 29.8% of total sales, followed by alprazolam (20.6%) and zolpidem (14.4%).
Sales analysis showed stability in clonazepam and alprazolam with slight upward trends toward the end of the study period. In contrast, diazepam, bromazepam, and lorazepam demonstrated gradual declines. Ambien, however, displayed the sharpest growth, with pronounced peaks in 2018 and 2020. A temporary dip was noted across all studied drugs in mid-2020.
When broken down by formulation, immediate-release zolpidem consistently dominated sales, but the fast-acting sublingual version showed the steepest upward trajectory beginning in 2020. The extended-release form remained stable without substantial growth.
Discussion
The data reveal that zolpidem’s growth trajectory differs significantly from that of benzodiazepines. While most benzodiazepines maintained stable or declining sales, zolpidem demonstrated accelerated adoption with two major inflection points in 2018 and 2020. Comparative analysis indicates that this increase was not simply due to substitution from other hypnotics but rather reflects an independent expansion in zolpidem use.
Results and Interpretation
Our analysis shows that zolpidem sales have increased consistently over the seven-year study period, with a marked acceleration in the dispensing of its rapid-release formulation since the onset of the COVID-19 pandemic. This emerging pattern of use raises important concerns, given zolpidem’s pharmacokinetic profile, which is characterized by a shorter duration of action compared to most benzodiazepines. Preclinical evidence demonstrates that ambien produces reinforcing effects similar to those of short-acting benzodiazepines such as midazolam, underscoring its potential for misuse and abuse. The availability of even faster-acting formulations may amplify this risk, creating a consumption pattern that warrants careful surveillance.
Two distinct inflection points in zolpidem sales were identified. The first occurred in 2018, coinciding with the European Sleep Research Society’s updated recommendations on insomnia management, which contributed to a 23% increase compared to 2017. The second peak appeared in 2020, reflecting a 20% rise in sales relative to 2019. This increase is attributed to the mental health impact of the COVID-19 pandemic, which intensified demand for psychotropic medications. Interestingly, a temporary decline in sales was observed in mid-2020 across all major hypnotics, likely due to reduced elective consultations and delays in prescription recording during lockdown restrictions.
It is important to note that while our data cover the period 2014–2021, subsequent global events, particularly the pandemic, have continued to shape prescribing and consumption trends. International reports indicate that widespread use of zolpidem has persisted post-pandemic, with alarming increases in dependence and misuse.
Safety Considerations
Zolpidem’s risk profile mirrors that of benzodiazepines, with safety concerns linked to tolerance, dependence, and impaired psychomotor performance. Although the FDA recommends lower starting doses, particularly for women, reports suggest that some patients escalate intake due to tolerance, raising the likelihood of adverse outcomes such as falls, fractures, and motor vehicle accidents.
Beyond its immediate sedative effects, ambien alters sleep architecture by reducing REM sleep and increasing slow-wave sleep, resulting in non-physiological sleep patterns when used chronically. This disruption may carry long-term health consequences, particularly in older adults.
Mechanistic Insights
Like benzodiazepines, zolpidem acts through GABAA receptors, with a high affinity for the α1 subunit. Preclinical research indicates that tolerance and physical dependence are strongly associated with α1GABAA receptor activity. Chronic zolpidem exposure, therefore, likely induces effects similar to long-term benzodiazepine use, including rapid tolerance and significant withdrawal symptoms upon discontinuation. These findings highlight the importance of caution when prescribing zolpidem, especially for long-term therapy.
