Ambien, the brand name for zolpidem, is a prescription medication classified as a nonbenzodiazepine hypnotic. It's approved for the short-term treatment of insomnia for the onset of sleep and maintaining sleep. Ambien affects the chemicals in the brain that may be unbalanced and cause insomnia. Ambien induces sleep by balancing these chemicals. Physicians prescribe Ambien only after an evaluation that demonstrates sleep disturbances, because it may cause several unwanted effects.
Failure to Resolve Insomnia
People who take Ambien should see an improvement in their sleeping patterns. According to the Drug Information Handbook, if sleep disturbance does not resolve in 7 to 10 days after starting the medication, it may indicate another medical illness. It's important to seek an evaluation for psychiatric illnesses that may cause sleep disturbance. Ambien is used with caution in patients who have depression because it may worsen the symptoms or cause suicidal ideation.
Abnormal Behavior
Hypnotics such as Ambien are associated with abnormal thinking and behavior changes. These include aggression, agitation, abnormal or bizarre behavior, decreased inhibition, hallucinations and personality changes. They may occur without any particular reason and may indicate a psychiatric disorder. It's important for people who experience these effects to be evaluated by a professional and treated.
Withdrawal Symptoms
Some people may become dependent on Ambien, making it difficult to stop the medication. Furthermore, Ambien and other hypnotics may cause withdrawal symptoms upon abrupt discontinuation. Withdrawal symptoms include unpleasant thoughts, but in more severe cases, it can include abdominal cramps, vomiting, sweating, shaking and muscle cramps. Seizures are rare but have also been reported. In some cases, Ambien causes rebound insomnia as well. This is described as insomnia that is worse after stopping the drug than before starting it. After one or two nights, the insomnia usually resolves. People who are on Ambien for more than two weeks should not abruptly stop taking the medication. The dose needs to be lowered gradually; follow your physician's instructions.
Extreme Sedation
Ambien produces its effects in about 30 minutes and is given at bedtime. Taking it during the day may lead to extreme sedation, or extreme sleepiness and drowsiness. Driving or performing any activities that require alertness may be dangerous. Ambien may also cause memory loss when taken during the day. People have reported odd behavior--including episodes of sleepwalking, eating, and driving with no memory of having done so. It's important to take Ambien only when you are having difficulty sleeping and are able to get a seven- or eight-hour sleep. In pregnancy, Ambien may cause sedation in the unborn baby and lead to the baby being born dependent on the drug.
Precautions for Certain Populations
Ambien is always prescribed at the lowest dose. In elderly or debilitated people, using a lower dose helps to avoid impaired cognitive or motor performance. This population needs close monitoring. Those with hepatic impairment need a lower dose as well. Drinking alcohol while on Ambien can dangerously increase its effects. For this reason, the use of Ambien is avoided in people who have a history of alcohol abuse. Other people who require close monitoring include those with mild to moderate chronic obstructive pulmonary disorder (COPD) and impaired drug metabolism. Therefore, Ambien is not used in people who have difficulty breathing while sleeping, called sleep apnea, or in those who have a history of hypnotic abuse.
References
- "Drug Information Handbook 15th Edition"; Charles F. Lacy, RPh, PharmD, FCSHP, Lora L. Armstrong, RPh, PharmD, BCPS. et al; 2007
- Ambien CR: AMBIEN CR Side Effects
- Ambien CR: Prescribing Information
