Adult Dosing

  • Immediate release: 5-10mg PO immediately prior to bedtime, 7-8h prior to planned awakening
  • Extended release: 6.25-12.5mg PO immediately prior to bedtime, 7-8h prior to planned awakening
  • Intermezzo (for insomnia in middle of night): 1.75-3.5mg SL once per night

Pediatric Dosing

Safety/efficacy not established

Special Populations

Pregnancy Rating

  • Pregnancy category C (fetal risk cannot be ruled out)

Lactation risk

  • Infant risk cannot be ruled out

Renal Dosing

  • Adult: No adjustment

Hepatic Dosing

  • Adult:
    • Mild-moderate impairment: max 5mg PO nightly
    • Severe impairment: avoid use (may precipitate hepatic encephalopathy)


  • Allergy to class/drug
  • Caution with:
    • Elderly patients (minimal improvement in sleep latency, increased risk of adverse effects)
    • Concomitant use of CNS depressants (e.g. ETOH, other sedatives, opioids
    • Sleep apnea, myasthenia gravis (risk of respiratory depression)

Adverse Reactions


  • Tachycardia, chest pain
  • Hepatic encephalopathy
  • Anaphylaxis, angioedema (rare)
  • Complex behavioral mannerisms (e.g. driving, making food, having sex while asleep with no recollection after the fact)
  • Worsening depression, suicidality



  • Half-life: 2-3 hours (up to 9.9h in cirrhotics)
  • Metabolism: Liver
  • Excretion: <1% renal

Mechanism of Action

  • Positive GABA-A receptor modulator, inhibits neuronal excitation


See Also


    • Micromedex
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