Which statement about zolpidem dosing by sex is true?

• A. Women often have higher serum levels; recommend a lower initial nighttime dose (for example, 5 mg IR or 6.25 mg ER) and caution about morning impairment.
• B. Dosing is the same for men and women; sex does not affect zolpidem levels.
• C. Women require higher doses than men to achieve sleep onset.
• D. There is no concern about morning impairment with zolpidem.

Answer: (A)

Dosing zolpidem takes sex-based differences in drug exposure into account. Women tend to have higher serum levels and slower clearance after the same dose, which increases the risk of next-day morning impairment. Because of this, the recommended approach is to start with a lower nighttime dose for women—for example, 5 mg of immediate-release or 6.25 mg of extended-release zolpidem—and to be cautious about morning impairment. This reflects why the statement about lower initial dosing for women and concerns about morning impairment is the best choice. Dosing is not identical between men and women, and higher doses for women would raise the risk of next-day impairment, not reduce it.