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Ambien Risks and Addiction Potential

Ambien is a popular prescription-only sleep medication. Although it can be an effective medication for those who suffer from insomnia, its use comes with a number of risks and has the potential for dependence and misuse.

What Is Ambien?

Ambien is a brand name of the drug zolpidem, a rapid-onset sedative-hypnotic that’s used primarily to treat insomnia.1,2 Zolpidem is also available under the brand name Intermezzo, a lower dose sublingual tablet that’s used for middle-of-the-night awakening that’s followed by difficulty returning to sleep.3

As a sedative-hypnotic, Ambien both has a calming effect and induces people to fall into a very deep and powerful form of sleep. It does this by triggering the same receptors in the brain that are activated when a person takes benzodiazepines like Valium and Xanax.

Sedative-hypnotic drugs can be habit-forming, and Ambien not only carries with it risks of dependence and addiction, but there are other potential dangers. In April 2019, the U.S. Food and Drug Administration (FDA) required makers of zolpidem to include warnings on boxes of the drug alerting both patients and prescribers of complex sleep behaviors that may occur after taking the drug, such as sleepwalking, sleep driving, and performing other activities while not fully awake. Although considered “rare” by the FDA, there have been numerous reports of serious injuries and death resulting from these behaviors.4

Side Effects of Ambien

Ambien can cause a number of serious and frequent adverse side effects.

Frequently experienced adverse side effects of Ambien include:1,2

  • Headache.
  • Nausea.
  • Nervousness.
  • Fatigue.
  • Feeling dizzy/weak.
  • Decreased daytime recall.

Serious adverse side effects of Ambien include:1–4

  • Sleepdriving, sleepwalking and other complex sleep behaviors that could result in serious injury or even death.
  • Abnormal thinking (e.g., aggressive behavior or agitation, anxiety, worsening depression, hallucinations, confusion, or suicidal ideation).
  • Swelling of the tongue or throat and trouble breathing, or any other sign of a serious allergic reaction.

People who experience any of the above serious adverse side effects, which may occur after the first dose of Ambien,4 should contact their prescriber right away.1,2

Ambien withdrawal and addiction.Ambien Dependence & Withdrawal

Ambien is classified as a federally regulated Schedule IV controlled substance, which is defined by the U.S. Drug Enforcement Agency as a drug with a low potential for abuse and a low risk of dependence.

When Ambien is taken as directed by a physician and without the concomitant administration of another CNS depressant, such as alcohol or benzodiazepines (e.g., Valium, Xanax, etc.), the chances of it becoming habit-forming are low.5

Clinical trials of Ambien have only studied its effectiveness for problems with sleep initiation and maintenance for 4-5 weeks for regular release1 and up to 24 weeks for Ambien CR (controlled release).2 There are notable withdrawal symptoms that may occur when ceasing Ambien after a period of rapid dose reduction or discontinuation.1,2

Withdrawal symptoms of Ambien may include:1,2

  • State of unease or general dissatisfaction.
  • Lightheadedness.
  • Insomnia.
  • Muscle cramps.
  • Vomiting and/or abdominal discomfort.
  • Sweating.
  • Uncontrolled crying.
  • Tremors.
  • Convulsions.

To decrease the risk of potentially dangerous withdrawal symptoms, medically supervised withdrawal management may prove helpful. This might entail checking into a hospital or treatment facility where trained medical staff can observe the process of weaning off Ambien as well as any other substances that may potentially have an additive effect.

Drug Interactions & Additive Effects

Combining Ambien with other drugs that act as CNS depressants (e.g., opioids, alcohol, Elavil (amitriptyline), trazadone, and benzodiazepines can be dangerous due to Ambien’s additive effects on the sedative-hypnotic effects that these drugs are likely to cause. This includes drowsiness, prolonged reaction time, dizziness, sleepiness, blurred/double vision and reduced alertness and impaired driving.1,2

The American Academy of Sleep Medicine (AASM) acknowledges there are significant knowledge gaps that exist surrounding the proper prescribing of sleep medications among prescribers.6 From 1999 to 2014, there was an 850% increase in people being prescribed both benzodiazepines along with zolpidem and other similar so-called “Z-drugs.” Co-usage of these drugs increases the risk for adverse outcomes such as breathing problems and could be potentially life threatening.7

It’s also been well-established by several studies that those with alcohol or other substance use disorders are more likely to experience withdrawal symptoms after discontinuing Ambien, even when taken at regular therapeutic dosages.5

Sleeping Without Ambien

Both the AASM as well as the American College of Physicians recommend cognitive behavior therapy (CBT) as the first-line treatment for chronic insomnia, although both acknowledge that prescription sleep medications may be an appropriate second line of treatment for some patients.6,8

The National Center for Complementary and Integrative Health suggests yoga, hypnotherapy, acupuncture and massage therapy in addition to CBT and advises caution about using prescription and even over-the-counter sleep medications.

References

  1. Food and Drug Administration. (2008). Ambien Label.
  2. Food and Drug Administration. (2008). Ambien CR Label.
  3. 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. Food and Drug Administration. (2019). FDA requires stronger warnings about rare but serious incidents related to certain prescription insomnia medicines.
  5. Schifano, F., Chiappini, S., Corkery, J. M., & Guirguis, A. (2019). An Insight into Z-Drug Abuse and Dependence: An Examination of Reports to the European Medicines Agency Database of Suspected Adverse Drug Reactions. The International Journal of Neuropsychopharmacology, 22(4), 270–277.
  6. Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep Medicine, 13(02), 307-349.
  7. Vozoris, N.T. (2019). Benzodiazepine and opioid co-usage in the US population, 1999-2014: an exploratory analysis. Sleep, 42(4), zsy264.
  8. Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., & Denberg, T. D. (2016). Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine, 165(2), 125.

 

About The Contributor
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 Action, a series... Read More