Ambien (zolpidem tartrate) is a brand-name prescription sleep-inducing drug used for the occasional treatment of insomnia. Ambien reduces the amount of time it takes to fall asleep and increases sleep duration. As with all sedative-hypnotic drugs, it is important to fully understand the drug’s potential side effects, warnings, and drug interactions before taking the medication.
Common side effects of Ambien
The most common side effects of Ambien are:
- Allergic reactions
- Muscle pain
- Back pain
- Intoxication (drugged feeling)
- Sinus congestion
- Nasal congestion
- Low energy
- Memory problems
- Dry mouth
- Vision problems
- Blurred vision
- Eye redness
- Attention problems
Most of these side effects are short-term and will subside in a few hours to a day after taking Ambien.
Serious side effects of Ambien
Ambien slows down the brain, so Ambien’s most serious side effects are related to its effects on the brain. These include:
- Complex sleep behaviors (sleepwalking, sleep-driving, etc)
- Next-day mental impairment
- Confusion and severe disorientation
- Severe allergic reactions such as a sudden drop in blood pressure (anaphylaxis), shortness of breath, or airway closure
- Dependency, abuse, and withdrawal
Ambien includes an FDA black-box warning for complex sleep behaviors—normal waking activities performed while asleep such as sleepwalking, sleep-driving, sleep cooking, or similar activities. Complex sleep behaviors caused by zolpidem can result in injury, death, and even homicide. Ambien will be immediately discontinued if complex sleep behaviors are experienced while taking the drug.
Because of the risk for dependency and abuse, Ambien is classified as a controlled substance by the Drug Enforcement Agency (DEA). It is not approved for long-term use. Also, zolpidem worsens depression, so Ambien should not be taken by people with depression.
People who take prescription sleep aids may be three to five times more likely to die or contract cancer than people who don’t take sleeping pills. The reasons for this are not well-understood. However, the risk is dose-dependent, so it is lowest for people who take sleep medicine only a few times a year.
Ambien memory loss
In clinical trials, Ambien produced clinically significant memory loss in less than 1% of patients taking the recommended dose.
When zolpidem affects memory, patients do not lose existing memories. Instead, the brain loses the ability to form new memories, a condition called anterograde amnesia. While clinically significant memory loss is very rare, nearly everyone who takes Ambien will experience some degree of memory impairment. The effects are temporary, and memory improves when the drug is discontinued.
Ambien has also been associated with an increased risk of dementia—a general deterioration in mental function—in the elderly. For this and other reasons, the recommended dose for the elderly is half the adult dose.
In clinical trials, less than 1% of patients reported visual or auditory hallucinations (false perceptions). Hallucinations are more likely to be experienced by people with existing neurological disorders, such as attention deficit hyperactivity disorder (ADHD), mental illness, or use of other mind-altering drugs. Hallucinations are more common among children and the elderly than adults.
There are some cases where patients taking zolpidem have experienced delirium, that is, severe confusion, disorientation, and hallucinations. Ambien-induced delirium, however, is an extremely rare side effect and seems to be limited to the elderly.
Ambien vs. Ambien CR side effects
Ambien can be taken in immediate-release (Ambien) or extended-release format (Ambien CR). Immediate-release Ambien is prescribed to help people fall asleep at night, but Ambien CR is intended to help people fall asleep and stay asleep through the night. It combines a standard dose of immediate-release Ambien with a smaller dose of extended-release Ambien.
Because Ambien CR is released more slowly into the body, it causes more pronounced residual effects the day after it was taken. This includes mental impairment, memory impairment, and lack of coordination. Patients taking Ambien CR should avoid next-day activities requiring mental alertness such as driving or operating machinery.
|Ambien vs. Ambien CR common side effects|
|Side effect||Ambien||Ambien CR|
|Daytime drowsiness and mental impairment||✔|
How long do Ambien side effects last?
Ambien is quickly metabolized by the body and falls to undetectable levels in the bloodstream in less than a day. Higher doses, however, may remain in the system for as long as three days. Side effects typically do not last longer than these periods.
If Ambien is used chronically or in high doses, withdrawal symptoms may begin six to eight hours after the drug is discontinued and last as long as one to two weeks.
Ambien contraindications & warnings
Healthcare providers prescribe Ambien cautiously and will monitor patients carefully. Several red flags may prompt a healthcare provider to either avoid prescribing the drug in the first place or discontinue an existing prescription, such as complex sleep behaviors, allergic reactions, depression, underlying medical conditions, history of substance abuse, and other existing conditions.
Complex sleep behaviors
Because Ambien may cause potentially dangerous complex sleep behaviors such as sleepwalking, sleep-driving, sleep-eating, and similar sleep disorders, Ambien is not prescribed to patients who have experienced complex sleep behaviors. Ambien will be immediately discontinued at the first instance of complex sleep behaviors.
Ambien will also be discontinued if it causes a severe allergic reaction involving anaphylaxis—a sudden drop in blood pressure—or angioedema (skin swelling), a condition marked by symptoms such as trouble breathing and airway obstruction.
Ambien can worsen symptoms of depression, so it will be prescribed with caution to patients with depression. In addition, Ambien may interact with certain antidepressant medications (SSRIs and MAO inhibitors), so these prescriptions may need to be modified.
Underlying medical conditions
Problems with falling asleep or staying asleep are often a symptom of an underlying psychiatric or physical illness. Ambien may not be the right therapy if the underlying condition can be treated. Ambien, then, is not prescribed until a thorough physical and psychiatric evaluation has been made.
Existing medical conditions
Ambien slows down breathing, so patients with pre-existing respiratory problems such as chronic obstructive pulmonary disease (COPD), myasthenia gravis, or sleep apnea may require special precautions.
People with liver disease, myasthenia gravis, respiratory disease, or a history of drug abuse or mental illness may also not be suitable candidates for Ambien or Ambien CR. Ambien will be prescribed with caution at a lower dose for the elderly, women, children, and debilitated patients.
Pregnancy and breastfeeding
Zolpidem will cross the placenta and enter a fetus’ bloodstream. Newborns may experience respiratory depression, sedation, poor muscle tone, and withdrawal symptoms if Ambien is taken late in pregnancy. Breastfeeding infants are also exposed to tiny amounts of Ambien in breast milk. Healthcare providers are cautious about using zolpidem in the third trimester of a pregnancy or in women who are nursing.
When used as directed, Ambien causes dependence and withdrawal in less than 1% of patients according to clinical and postmarketing trials. However, if Ambien is used chronically or in high doses, dependence and withdrawal are more likely.
Withdrawal symptoms can be mild or severe depending on how much Ambien is being taken and how quickly the drug is discontinued. These symptoms can start within a few hours of suddenly stopping the medication, reducing the dosage, or missing a dose. Symptoms include sleeplessness (rebound insomnia), anxiety, drug cravings, irritability, aggression, mood changes, tremors, fatigue, panic attacks, and rapid heartbeat. The most serious withdrawal symptoms are seizures.
Ambien is a relatively safe medication when taken at the recommended dosage of 5 mg to 10 mg in a single 24-hour period. Ambien overdose (70 mg in 24 hours) or combining Ambien with similar depressants can cause hazardous and potentially fatal side effects. Ambien primarily slows the brain, so an overdose can result in confusion, delirium, loss of consciousness, or coma. It also slows the heart rate and breathing, a potentially life-threatening side effect. Ambien overdose has been known to cause fatalities.
Ambien is considered a central nervous system (CNS) depressant, that is, it slows down the brain. Ambien can enhance the sedative, motor impairment, and side effects of other CNS depressants or vice versa. For this reason, healthcare providers will try to avoid combining Ambien with other CNS depressants such as:
- Alcohol, marijuana, cannabinoids, melatonin supplements, valerian root, or kava
- Antihistamines such as promethazine, azelastine, or doxylamine
- Barbiturates such as secobarbital, butalbital, or butabarbital
- Narcotics (opioids) such as codeine, hydrocodone, or oxycodone
- Sedatives such as Belsomra (suvorexant), zaleplon, or Dayvigo (lemborexant)
- Benzodiazepines such as alprazolam, diazepam, temazepam, or lorazepam
- Muscle relaxants such as orphenadrine, baclofen, or chlorphenesin
- Anxiety medications such as buspirone
- Nerve pain drugs such as gabapentin or pregabalin
- Nausea medications such as metoclopramide, alizapride, or droperidol
- Anticonvulsants such as carbamazepine, rufinamide, or valproic acid
- Parkinson’s disease medications such as pramipexole, ropinirole, rotigotine, or piribedil
- Some antipsychotic drugs such as levomepromazine, methotrimeprazine, haloperidol, or blonanserin
- The narcolepsy drug Xyrem (sodium oxybate)
If the use of other CNS depressants can’t be avoided, the Ambien dose may be reduced or the other prescriptions may be modified. When taking Ambien, patients should not take CNS depressants or alcohol near bedtime. Combining Ambien with over-the-counter antihistamines such as Benadryl (diphenhydramine) will also increase the risk and severity of Ambien side effects.
Ambien will enhance the side effects and toxicity of selective serotonin reuptake inhibitors (SSRIs), drugs normally prescribed to treat depression. Again, the prescribing doctor may modify therapy or reduce the Ambien dose. MAO inhibitors, another class of antidepressants that include Marplan (isocarboxazid) and Nardil (phenelzine), will decrease the effectiveness of Ambien, so the prescribing physician will need to monitor therapy.
Some drugs, particularly anticancer immunotherapy drugs, increase the body’s ability to metabolize and eliminate Ambien from the body. These drugs decrease the blood concentration and effectiveness of Ambien. Some of the most common are Taflinar (dabrafenib), Tibsovo (ivosidenib), Balversa (erdafitinib), Lorbrena (lorlatinib), Kevzara (sarilumab), Sylvant (siltuximab), Actemra (tocilizumab), Xtandi (enzalutamide), Lysodren (mitotane), and bosentan. Some corticosteroids such as hydrocortisone and budesonide also may decrease Ambien’s effectiveness. St. John’s wort, a popular herbal supplement, also decreases the concentration and effectiveness of Ambien in the body.
Other drugs and foods, however, increase the concentration of Ambien in the blood and so increase the risk of Ambien side effects. These include:
- Grapefruit, peppermint oil, and goldenseal
- Certain types of antibiotics such as ciprofloxacin, clarithromycin, and erythromycin
- Antifungal (azole) drugs such as itraconazole or ketoconazole
- Certain types of antiviral medications such as ritonavir, atazanavir, darunavir, Invirase (saquinavir), and Crixivan (indinavir)
- Blood pressure medications such as verapamil
- Benzodiazepine sedatives such as diazepam and midazolam
- Corticosteroids such as dexamethasone or fluticasone
These drugs, foods, or supplements don’t need to be discontinued or modified. However, it’s important for people taking these drugs along with Ambien to be careful about engaging in potentially risky activities that require mental alertness such as driving, operating machinery, or participating in dangerous activities.
How to avoid Ambien side effects
Most drugs cause side effects, and Ambien is no different. Because Ambien slows down the brain, most of the side effects are related to its sedative properties: sleepiness, dizziness, motor impairment, slow reflexes, and decreased alertness. You can reduce the risk of side effects by following a few simple rules of thumb:
1. Take Ambien as directed
You will be prescribed a nighttime dose of 5 mg, 10 mg, or if taking Ambien CR, 12.5 mg. Do not exceed this dosage or take more than two pills in a 24-hour period even if the first dose doesn’t work. The dose will be reduced for women, the elderly, or people taking other types of drugs, so don’t try to increase the dose to the “normal” dose.
2. Tell your doctor about all your medical conditions and medications
Because of the risk of side effects, you should tell your doctor about:
- Any physical conditions you may have, particularly liver problems or respiratory disease
- Your history with psychiatric conditions
- Any alcohol use, recreational drug use, or history of substance abuse
- Any mental impairment you may be experiencing
- All medications you are currently taking
- All over-the-counter medications and supplements you typically take
- Potentially dangerous daytime activities that you engage in, such as operating heavy machinery or driving to work
Always talk to your doctor about any side effects experienced when taking a prescription medication.
3. Practice good sleep hygiene
You should use Ambien as infrequently as possible. The safest use of Ambien is to develop good sleep hygiene and take the medication only when all else fails.
- Avoid stimulating activities such as television watching or video games before bedtime.
- Develop nighttime relaxation habits such as taking a hot bath, meditating, or doing yoga for a half-hour or an hour before bedtime.
- Go to bed at the same time each night. Some people set an alarm for bedtime.
- Turn off the light and eliminate all distractions when going to bed.
- Exercise every day.
- Avoid foods such as caffeine, alcohol, and sugar that interfere with the ability to fall asleep.
4. Avoid certain foods, supplements, and drugs
Some foods, herbs, and drugs enhance the adverse effects of Ambien. Your healthcare provider can help you navigate the drug interactions between Ambien and any prescription drugs you’re taking. To take Ambien safely, you should avoid alcohol, marijuana, grapefruit, melatonin supplements, valerian root, cannabidiol, chamomile, goldenseal, lemon balm, passionflower, calendula, gotu kola, and over-the-counter antihistamines. All of these substances increase the sedative effects of Ambien and increase the risk of side effects, particularly next-day mental impairment. Before you start taking any dietary supplements or herbal medicines, talk to your prescribing physician first.
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