Drug interactions are adverse reactions that occur when you take two or more drugs together. Taking certain medications with food, beverages, supplements, or in the presence of certain medical conditions can also lead to drug interactions and adverse effects. This article will describe some of the drug interactions of zolpidem (Ambien)—a drug used to treat insomnia.

What type of medicine is zolpidem tartrate (Ambien)?

Zolpidem tartrate (brand name: Ambien, Ambien CR) belongs to a group of medicines called sedative-hypnotic drugs. It is used for the treatment of insomnia (trouble falling asleep and staying asleep).

This medicine works by slowing activity in the brain and thereby allowing you to fall asleep. Studies evaluating sleep have shown that Ambien can decrease sleep latency (help you fall asleep faster), increase total sleep time, reduce nighttime awakenings, and preserve sleep stages.

The immediate-release Ambien helps you fall asleep when you first go to bed. Whereas the extended-release formula consists of 2 layers — the first layer helps you fall asleep, then the second layer releases the drug slowly to keep you asleep.

What are Ambien CR (zolpidem) doses?

Ambien (zolpidem) should not be given to children.

For immediate-release tablets:

Only take one dose a day as needed for sleep immediately before bedtime; the recommended dose is 5 mg for women and 5 to 10 mg for men.
The recommended dose is 5 mg for older patients.

For extended-release tablets:

Only take one dose a day as needed for sleep immediately before bedtime; the recommended dose is 6.25 mg for women and 6.25 mg to 12.5 mg for men.
The recommended dose is 6.25 mg for older patients.

Other zolpidem products include sublingual tablets that are placed under the tongue (Intermezzo, Edluar) 1.75 mg and 3.5 mg, and an oral spray (Zolpimist) of 5 mg per actuation.

How to take Ambien?

CNS drugs (sedative-hypnotics) like Ambien start working within 30 minutes, and the peak drug effect occurs in 1-2 hours. This medicine should therefore be taken immediately before bedtime when there are at least 7-8 hours remaining before the planned awakening time.

You should not take zolpidem tartrate tablets with a meal or immediately after a meal since food can slow down the effects of Ambien.

Dosage adjustments may be necessary for certain patient populations, including frail individuals, the elderly, and people with health conditions that affect the breakdown of Ambien, such as hepatic insufficiency (reduced liver function). Studies have found that those who do not have normal hepatic function do not clear this medicine as well as others. Therefore a lower dose of 5 mg should be prescribed to elderly patients, frail individuals, and those with moderate hepatic impairment or severe hepatic impairment.

Dose adjustments are often necessary for patients who take zolpidem with other CNS depressant drugs since this drug combination can further dampen the central nervous system leading to respiratory depression.

Remember that Ambien helps in the short term with sleep initiation and maintenance. It is not for chronic insomnia. Ambien is usually prescribed for two weeks or less to people with impaired sleep from a sleep disorder like insomnia. If your insomnia symptoms do not improve within 7-10 days of starting Ambien, you should contact your doctor.

What are the side effects of Ambien?

Common side effects of zolpidem include dizziness, lightheadedness, drowsiness, headache, fatigue, and unsteadiness. Some patients taking zolpidem experience gastrointestinal side effects like heartburn, nausea, gas, constipation, diarrhea, stomach pain, and changes in appetite. Other adverse effects of Ambien include uncontrolled shaking in a part of the body or numbness, tingling, or burning in the hands or feet. Dry mouth, eye redness, ringing in the ears, muscle aches, back pain, neck pain, joint pain, and heavy menstrual periods have also been reported by patients receiving zolpidem.

More serious adverse effects of zolpidem that require careful and immediate evaluation include:

What are the risks of taking Ambien?

Zolpidem administration is associated with the following risks:

An allergic reaction with skin rash and hives, swelling of the face or mouth, or throat closing.
Severe respiratory depression and CNS depression, especially if an Ambien tablet is taken with other CNS depressants.
Potentially life-threatening sleep disturbances such as sleep-driving, eating food, making phone calls, or engaging in sexual activity while not fully awake.
Abnormal thinking and behavioral changes, including odd behaviors, agitation, aggression, visual and auditory hallucinations, and worsening depression in primarily depressed patients.
Lack of complete mental alertness, prolonged reaction time, next-day psychomotor impairment, and impaired driving post-treatment night, which can increase the risk of accidents and injuries.
Rebound insomnia and withdrawal symptoms with abrupt discontinuation of zolpidem.
Drug dependence with long-term use of zolpidem.

Who should not take zolpidem tartrate?

Anyone with a known allergy to zolpidem tartrate (the active ingredient in an Ambien tablet) or any inactive ingredients in zolpidem tartrate tablets should not take this medicine.

Zolpidem is not approved for use in pediatric patients. Clinical trials have shown that pediatric patients treated with zolpidem have frequent adverse effects, and this medicine has no efficacy compared to a placebo. Zolpidem was not found to benefit children with attention deficit hyperactivity disorder (ADHD).

Elderly patients and patients with hepatic insufficiency (reduced liver function) should discuss the risks versus benefits of taking zolpidem tartrate with their doctor or pharmacist.

This medicine may not be suitable for people with medical conditions like chronic obstructive pulmonary disease (COPD), sleep apnea, respiratory depression, pulmonary disease, or myasthenia gravis. Pregnant women and those nursing an infant with breast milk should avoid zolpidem. This medicine may produce respiratory depression in a breastfed infant.

Patients taking other medications, especially other sedative-hypnotics or other CNS depressants, should talk to their doctor or pharmacist about a possible drug interaction between Ambien and their other medicines.

Can I take Ambien with blood pressure medication?

In general, there are no known drug interactions between Ambien and blood pressure medications. However, you should check with your doctor or pharmacist to be sure.

What drugs should not be taken with zolpidem?

The following drugs can interfere with zolpidem pharmacokinetics and cause adverse effects like increased CNS depressant effects, excess sedation, respiratory depression, complex sleep-related behaviors, and lack of full mental alertness. Some drug interactions can make zolpidem less effective. Other drugs can increase plasma concentrations of zolpidem and raise the risk of serious adverse reactions. Some of the medications you should avoid when taking zolpidem include:

Opioid drugs like hydrocodone, oxycodone, tramadol, fentanyl, and codeine.
Benzodiazepines like alprazolam, diazepam, midazolam, lorazepam, clonazepam, flurazepam, temazepam, clorazepate, and chlordiazepoxide.
Other insomnia medications like daridorexant (Quviviq).
Barbiturates like amobarbital, butalbital, pentobarbital, phenobarbital, and secobarbital.
Apalutamide and enzalutamide (medicines used to treat certain types of prostate cancer).
Buprenorphine and naloxone (medications used to treat opioid addiction).
Sodium oxybate (Xyrem), a medicine used to treat narcolepsy (excessive daytime sleepiness).
Antidepressants like esketamine (Spravato nasal spray).
Anticonvulsants like carbamazepine, phenytoin, fosphenytoin, primidone, gabapentin, and pregabalin.
Parkinson’s medications like entacapone, opicapone, and tolcapone.
Cystic fibrosis medications like ivacaftor and lumacaftor.
Cancer drugs like imatinib.
Antibiotics like amoxicillin, clarithromycin, and rifampin.
Supplements like melatonin, valerian root, and St. John’s Wort.

The above list is not a complete list of zolpidem drug interactions. Additionally, Ambien (zolpidem tartrate) can also have a drug interaction with alcohol and cannabis, leading to excessive drowsiness, next-day psychomotor impairment (slowed movements), and impaired driving. Give your doctor and pharmacist a complete list of your medications to lower your risk of zolpidem drug interactions and adverse reactions.

References:

https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/019908s027lbl.pdf
https://medlineplus.gov/druginfo/meds/a693025.html
https://www.pdr.net/drug-summary/Ambien-zolpidem-tartrate-2515.8323

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