The active component of the drug Ambien is zolpidem. Zolpidem is a non-benzodiazepine sedative-hypnotic drug that is prescribed to help people sleep. Immediate-release formulations of zolpidem have a fast onset of action and a relatively short half-life, meaning that the medication works quickly and does not remain in a person’s system very long. This makes Ambien primarily useful in helping people fall asleep or to initiate sleep. The drug is not prescribed to help people stay asleep or maintain sleep unless the drug is prescribed in an extended- or controlled-release form.1
- Some research studies suggest that Ambien can also be used as a muscle relaxant and may even be capable of controlling some seizures, although the dosage required for seizure control would be extremely high. However, the drug is not approved by the FDA for these purposes.2
- Zolpidem and similar pharmaceutical agents (e.g., other so called “z-drugs”) were promoted as an alternative to other prescription sedative-hypnotics more likely to cause physical dependence, such as benzodiazepines. However, the U.S. Drug Enforcement Administration (DEA) currently lists zolpidem as a Schedule IV controlled substance, indicating that, though relatively low, there is some risk of abuse and dependence. Thus, products containing zolpidem can only be obtained with a prescription from a physician.
How Does Ambien Work?
Like benzodiazepines, zolpidem works to increase the activity of the inhibitory neurotransmitter GABA (gamma-aminobutyric acid). GABA is the primary inhibitory neurotransmitter in the brain. Increased GABA activity is associated with decreased firing rates of neurons within the brain and spinal cord. This accounts for its sedative effects. Though zolpidem appears to be molecularly distinct from benzodiazepines, it influences activity at the GABAA receptor, which is the same receptor that benzodiazepines interact with to exert their effects. With a similar mechanism of action and physical effects profile as benzos, there is also a risk of overdose on high doses of zolpidem products. The benzodiazepine antagonist drug flumazenil reverses some of the sedative effects of drugs that bind to GABA receptors and can be used in cases of an overdose on both benzodiazepines and zolpidem products.3
Prescription Sleep Aids Like Ambien Are for Short-Term Use
One of the reasons these drugs are only designed to be used in the short-term is that tolerance develops very rapidly and people often need significantly higher amounts of the drug in a short time to get the same effects.4 abstract paragraph 1 Sedative-hypnotic drugs like Ambien and benzodiazepines (when indicated for insomnia) are best used as short-term solutions while the person develops behavioral methods to help them initiate and maintain sleep. This could involve the use of behavioral therapy, relaxation training, diaphragmatic breathing, imagery, and other non-pharmaceutical methods.
Short-Term Effects of Ambien
The primary therapeutic effects of Ambien include:5
- Initiation of sleep.
Side effects may include:5
- Memory impairments.
- Insomnia when the drug is discontinued—commonly referred to as rebound insomnia.
- Unusual dreams.
- Parasomnias—abnormal, sometimes complex sleep events.
- In rare cases, hallucinations.
- Nausea and heartburn.
- Light-headedness and/or dizziness.
- Difficulties with balance.
- Unsteady gait.
- Physiological dependence.
Parasomnias are sleep disorders where individuals engage in activities that they would normally perform while they are awake, but they engage in these activities while they are actually asleep. Zolpidem has been implicated in some cases where people have been driving while asleep, eating while asleep, and even having sex while asleep. These cases are very rare. The most common manifestation of a parasomnia is sleepwalking.6
The use of Ambien with alcohol can increase the risk of parasomnias and other side effects. Misusing the drug (e.g., using it in excess of prescribed parameters) may also contribute to this risk.6
Issues with Memory
Use of drugs that increase the activity of GABA, such as benzodiazepines and zolpidem, may be associated with the development of short-term memory problems.7
Zolpidem is recommended for use with caution in the elderly, as they may be at increased risk for more pronounced cognitive effects, including issues with memory for recent events or with forming new memories.8
MORE ON LONG-TERM EFFECTS:
- Norman, J. L., Fixen, D. R., Saseen, J. J., Saba, L. M., & Linnebur, S. A. (2017). Zolpidem prescribing practices before and after Food and Drug Administration required product labeling changes. SAGE open medicine, 5.
- FooDB. (2015). Showing Compound Zolpidem (FDB023594).
- Has, A., Absalom, N., van Nieuwenhuijzen, P., Clarkson, A., Ahring, P. & Chebib, M. (2016). Zolpidem is a potent stoichiometry-selective modulator of α1β3 GABAA receptors: evidence of a novel benzodiazepine site in the α1-α1 interface. Scientific Reports volume 6, Article number: 28674.
- Wright, B. (2016). Repeated Zolpidem Treatment Effects on Sedative Tolerance, Withdrawal, mRNA Levels, and Protein Expression.Theses and Dissertations (ETD). Paper 406.
- MedlinePlus. (2019). Zolpidem.
- Sanofi-Aventis. (2019). Ambien.
- Telis, G. (2013). A Sleep Aid Without the Side Effects.
- Neel, A. (2012). What Are the Side Effects of Long-term Use of Xanax and Ambien.
- National Sleep Foundation. Sleep Aids and Insomnia.
- Raza, M., Kennedy, C. & Latif, S. (2014). Zolpidem may cause visual distortions and other psychotic symptoms. Current Psychiatry, 13(3):31-32.
- Gagliardi, G. S., Shah, A. P., Goldstein, M., Denua–Rivera, S., Doghramji, K., Cohen, S., & Dimarino, A. J. (2009). Effect of Zolpidem on the Sleep Arousal Response to Nocturnal Esophageal Acid Exposure. Clinical Gastroenterology and Hepatology, 7(9), 948–952.
- Substance Abuse and Mental Health Services Administration. (2016). Prescription Drug Use and Misuse in the United States: Results from the 2015 National Survey on Drug Use and Health.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association.
- Licata, S. C., Mashhoon, Y., Maclean, R. R., & Lukas, S. E. (2011). Modest abuse-related subjective effects of zolpidem in drug-naive volunteers. Behavioural pharmacology, 22(2), 160–166.
- MedlinePlus. (2018). Substance Use Disorder.
- 16. U.S. Food & Drug Administration. (2008). Highlights of Prescribing Information: Ambien.