Are There Any Side Effects of Ambien, and What Are the Risks of Abuse?


Ambien is the brand name for zolpidem tartrate, a sedative-hypnotic medication prescribed for the short-term management of insomnia.1

Although it is an effective short-term treatment for insomnia, Ambien does have risks, including the potential for abuse and dependence. Ambien use may also bring about numerous physical and psychological side effects, some of which can pose a serious risk to a person’s health. Abuse of this medication, especially in combination with other drugs that depress the central nervous system (such as alcohol, opioids, or benzodiazepines) is dangerous and may even be fatal.1

Short-Term Side Effects of Ambien

Drowsy woman

Potential short-term side effects of Ambien include:1,2

  • Daytime drowsiness/fatigue.
  • Dizziness.
  • Lightheadedness and nausea.
  • Unsteady gait.
  • Feeling of being drugged.
  • Dry mouth.
  • Headache.
  • GI symptoms such as diarrhea, constipation, indigestion, or stomach pain.
  • Back pain and muscle aches.
  • Insomnia.
  • Confusion.
  • Visual disturbances, blurred vision or hallucinations.
  • Memory problems.

The risk of experiencing side effects, especially those of next-day psychomotor impairment, may be increased if controlled-release zolpidem (Ambien CR) is taken with less than a full night (7-8 hours) or sleep, at higher doses than prescribed, or with other CNS-depressing substances.3

Serious Side Effects of Ambien

Ambien use is also associated with very serious risks that include complex behaviors (e.g., “sleep-driving”) and the worsening of depression or suicidal thoughts.1

Complex Behaviors

Sedative-hypnotics such as Ambien have a known risk of complex sleep behaviors such as sleep-eating or sleep-driving and subsequent amnesia (the person will forget ever having done it). Performing complex behaviors such as driving, eating, having sex, or cooking while asleep can cause serious problems and potentially put the individual (or others) in a life-threatening situation. The risk of complex behaviors is higher when the drug is taken in large doses or used in combination with alcohol or another CNS depressant.1

The FDA has now required that the drug label include a warning that Ambien is not suitable for any patient who has experienced even one episode of complex behaviors after taking Ambien or another sedative-hypnotic sleep medication such as Lunesta or Sonata.4

Depression and Suicide Risk

The use of Ambien or other sedative-hypnotic medications has been shown to worsen depression or suicidal thoughts and behaviors in primarily depressed patients.1 Ambien should be used with extreme caution in patients with depression or other mental illness. 1,5 The drug’s FDA label advises doctors to prescribe the lowest possible dose to avoid intentional overdose in patients with depression. 1

Ambien Abuse and Dependence

Woman holding pills

Ambien is a Schedule IV controlled substance, indicating that it does have some potential for abuse.6

Ambien has the potential to cause euphoria and a relaxed sleepy feeling, so some users may take it recreationally for these effects.7

Ambien users may attempt to get a greater euphoric effect by upping the doses or taking it with another drug that has similar effects, such as alcohol or benzodiazepines. This can lead to dangerous–even deadly—outcomes.6 For example, the National Institute on Alcohol Abuse and Alcoholism warns that Ambien combined with alcohol increases the risk of:

  • Severe drowsiness.
  • Dizziness.
  • Slow or difficult breathing.
  • Problems with motor control.
  • Problems with memory.

The Ambien drug label warns that patients with a history of substance abuse or addiction are at higher risk for abusing Ambien and that their use should be carefully monitored.6

Ambien’s Schedule IV status also indicates a potential for dependence.6 Though dependence is rare among those using the medication appropriately, it may also be a warning sign of abuse or addiction.8,9 ependence refers to the body’s adaptation to a drug where, without the substance, it goes into withdrawal.1

Ambien Withdrawal Symptoms

When someone is dependent on Ambien and they abruptly lower their dose significantly or stop using the drug, they may have withdrawal symptoms. They symptoms of Ambien withdrawal may include:1,10

  • Flushed skin.
  • Fatigue.
  • Lightheadedness.
  • Nausea.
  • Vomiting.
  • Abdominal cramps.
  • Nervousness.
  • Panic attacks.
  • Inability to stop crying.
  • Seizures.

Risks of Long-Term Use and Abuse

Ambien pills falling out of bottle

Ambien is meant for short-term use. Taking the drug for longer than appropriate and/or abusing this drug may lead to serious mental and physical health issues. Some of the risks of long-term Ambien use include: 1

  • Increased risk for participation in complex activities while asleep. (Depending on the activity, this could lead to very serious health risks such as venereal disease in the case of sleep-sex, burns in the case of sleep-cooking, or car accidents in the case of sleep-driving).
  • Decreased inhibition.
  • Increased risk of dementia (in the elderly).11
  • Bizarre thinking and behaviors.
  • Depersonalization (feeling outside your body or that you aren’t real).
  • Depression.
  • Suicidal thoughts and actions.
  • Dependence.
  • Addiction.
  • Overdose.

Many of these risks are not limited to those who are abusing the medication; however, abuse may heighten these risks or make them more severe.

The risks associated with sleep medications such as Ambien may be mitigated by using other treatments for insomnia. Sleep medications are not the only line of defense for adults suffering from insomnia. Cognitive-behavioral therapy has, in fact, been shown to be equally as effective in the short-term as pharmacological treatments such as Ambien and more effective in the long-term.9

Ambien Overdose

Ambien is a medication that depresses the central nervous system (CNS), and using this drug in very high doses or with other CNS depressants may cause:1

  • Impaired consciousness.
  • Extreme sleepiness.
  • Coma.
  • Cardiovascular compromise.
  • Severe respiratory depression.
  • Death.

Stopping Ambien Use

psychologist taking notes while speaking with her patient

For someone who has been abusing Ambien, especially at high doses or with other substances such as benzodiazepines or alcohol, attempting to detox from the medication may not be the safest choice. Detoxing alone from one or more CNS depressant drugs can be risky, physically and emotionally, with withdrawal symptoms that include psychological distress and seizures. 6,10 Getting help to stop using Ambien in a medical detox environment can ensure your safety. Medical professionals may help you taper your dose to ensure your stability and prevent severe symptoms.12

Detox only addresses physical dependence and withdrawal, so if you have been abusing Ambien compulsively alone or with other drugs, you’ll need continued treatment to sustain your recovery efforts.

After detox, behavioral therapy and other complementary treatments can help you learn skills and tools to avoid triggers, reduce cravings, and stay sober, leading to long-term recovery.

References:

  1. Sanofi-aventis. (2014). Highlights of Prescribing Information.
  2. U.S. National Library of Medicine. (2020). Zolpidem.
  3. U.S. Food and Drug Administration. (2018). Questions and Answers: Risk of next-morning impairment after use of insomnia drugs; FDA requires lower recommended doses for certain drugs containing zolpidem (Ambien, Ambien CR, Edluar, and Zolpimist).
  4. U.S. Food and Drug Administration. (2019). FDA requires stronger warnings about rare but serious incidents related to certain prescription insomnia medicines.
  5. NHS. (2019). Zolpidem.
  6. United States Drug Enforcement Administration. (n.d.). Drug Scheduling.
  7. Chattopadhyay, A. C., Shukla, L., Kandasamy, A., & Benegal, V. (2016). High-dose zolpidem dependence – Psychostimulant effects? A case report and literature reviewIndustrial psychiatry journal25(2), 222–224.
  8. American Psychiatric Association. (2013).Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
  9. Krystal, A. D., Prather, A. A., & Ashbrook, L. H. (2019). The assessment and management of insomnia: an updateWorld psychiatry : official journal of the World Psychiatric Association (WPA)18(3), 337–352.
  10. Haji Seyed Javadi, S. A., Hajiali, F., & Nassiri-Asl, M. (2014). Zolpidem dependency and withdrawal seizure: a case report studyIranian Red Crescent medical journal16(11), e19926.
  11. Shih, H. I., Lin, C. C., Tu, Y. F., Chang, C. M., Hsu, H. C., Chi, C. H., & Kao, C. H. (2015). An increased risk of reversible dementia may occur after zolpidem derivative use in the elderly population: a population-based case-control studyMedicine94(17), e809.
  12. Rappa LR, Larose-Pierre M, Payne DR, Eraikhuemen NE, Lanes DM, Kearson ML. Detoxification from high-dose zolpidem using diazepamAnn Pharmacother.

 

 



About The Contributor

Ryan Kelley, NREMT
Ryan Kelley, NREMT

Medical Editor, American Addiction Centers

Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in... Read More


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