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Dangers of Mixing Alcohol and Ambien

More than one-third of Americans suffer from insomnia or other sleep disorders.1 Zolpidem is the most commonly prescribed medication to treat insomnia (difficulty falling asleep or staying asleep) and other sleep disorders.

What is Ambien and Other Forms of the Drug?

Zolpidem, commonly sold under the brand name Ambien, comes in many forms. Tablet forms (Ambien) and an extended-release (long-acting) tablet (Ambien CR) are both taken by mouth. Zolpidem also comes as a tablet to be placed under the tongue (Edular, Intermezzo) and an oral spray (Zolpimist).

Ambien is classified as a sedative-hypnotic, a class of drugs prescribed to help individuals with sleep disorders fall asleep and/or stay asleep throughout the night. It works by increasing gamma-aminobutyric acid (GABA) in the brain which slows activity in the brain and the central nervous system (CNS), working quickly to initiate sleep.3

Is it Safe to Take Ambien Every Day?

Like all sleep aids, Ambien is intended for short-term use (typically no more than two weeks), not a long-term solution or cure.4 Research indicates that there might be a link between those who take Ambien or other sleeping pills daily and an increase in mortality rate.5

Physical Risks and Side Effects of Combining Alcohol and Ambien

The labels on sleeping pills like Ambien carry a warning about using alcohol while taking the drug.4 That’s because mixing Ambien and alcohol can cause dangerous physical and cognitive impairment, and there’s a danger of Ambien overdose as well.2

According to a report by the Drug Abuse Warning Network (DAWN), in 2010, about 57% of ER visits and hospitalizations caused by taking too much Ambien also involved other drugs. Ambien combined with alcohol accounted for 14% of those visits, or 2,851 people total. Combining alcohol and Ambien increased the person’s likelihood of requiring transfer to an intensive care unit (ICU) due to overdose.6

That could be because insomnia and alcohol dependence often go hand in hand. Additionally, alcohol works on the same GABA receptors in the brain as Ambien, increasing the effects of both Ambien and alcohol. Reported rates of sleep problems among people with alcohol use disorders (AUDs) in treatment vary, but have been reported to range from 25-72%.7 Furthermore, even those without alcohol dependence may mix Ambien and alcohol to try and promote a deeper sleep. However, this is when serious interactions can occur. The FDA warns against taking Ambien if you’ve consumed alcohol.2 Both drugs suppress the CNS, which controls breathing, heart rate, and brain function. Together the effects are intensified, which can be dangerous and can lead to serious physical problems, including:8,9

  • Dizziness.
  • Sleepiness or drowsiness.
  • Disorientation.
  • Confusion.
  • Hallucinations.
  • Slowed or compromised breathing.
  • Impaired motor control.
  • Unusual behavior.
  • Memory problems.

While these side effects were studied in heavy drinkers, dangerous interactions may occur when Ambien is mixed during a single episode of alcohol consumption.9 Furthermore, the time it takes the body to eliminate Ambien varies from person to person. Factors such as age, weight, other medications taken, existing medical conditions, kidney function, and liver function, all factor into the amount of time the drug remains in an individual’s system. Research suggests that the average time to eliminate 5 to 10 mg of Ambien from the system is about 14 to 17 hours.10 Therefore, it’s recommended that while taking Ambien, individuals avoid drinking alcohol entirely.

Ambien by itself carries the risk of suffering side effects the morning after sleeping—including impaired driving—especially with less than a full night of sleep (defined by 7 to 8 hours). This is one of the reasons why doctors are careful to limit doses to the lowest required amount (5 mg for women and 5 or 10 mg for men). Ambien and alcohol together may increase the risk of next-day side effects.2      

Ambien Overdose: Signs & Symptoms

The mixture of Ambien and alcohol also increases the risk of Ambien overdose and in rare instances, death.2 Due to the fast-acting sedative nature of Ambien, an individual can quickly go unconscious.

How is Ambien Overdose Treated?

In case of an overdose, seek medical treatment immediately. The individual who took too much Ambien or mixed it with alcohol might need to have their stomach pumped and require intravenous fluids. They will also need to have their breathing and pulse closely monitored by medical professionals.2

Additional Dangers of Mixing Alcohol and Ambien

Sleepwalking, sleep-related eating disorders, and sleep driving have all been reported with Ambien. Somnambulism or sleepwalking and sleep driving are parasomnias consisting of a series of complex behaviors initiated during sleep that results in walking, driving, or performing another task with an altered state of consciousness and impaired judgement. It affects less than 1% of individuals who take Ambien.11 But the risk of automatism (amnesia) and parasomnia increases when the prescribed dose of Ambien is combined with even a small to moderate amount of alcohol or other sedating medications.12

In fact, due to the potential dangers of Ambien alone, and the increased dangers of combining alcohol and Ambien, the Food and Drug Administration (FDA) mandated stronger boxed warnings about the rare but serious incidents related to Ambien and other prescription insomnia medications that went into effect in 2019. This came after the FDA reviewed 66 cases in which individuals taking Ambien and similar medications engaged in activities when they were not fully awake that resulted in serious injury or death.13 The International Council on Alcohol, Drugs and Traffic Safety (ICADTS) classified zolpidem as a Schedule II substance, one that impairs a person’s driving comparable to a blood alcohol content (BAC) of 0.05-0.08%.14

Can Ambien Cause Liver Damage?

Ambien is primarily metabolized by the liver.15 While liver damage can be a side effect of Ambien, it’s rare. However, the FDA notes that patients with hepatic impairment, meaning the liver is unable to perform normal synthetic and metabolic functions, should take the lowest dose (5 mg) of Ambien.2 Those with liver cirrhosis and renal disease, conditions that also tend to reduce the body’s ability to eliminate Ambien, may require lower dosages as well.16


Ambien and Alcohol Abuse Treatment

Polydrug addiction—when an individual becomes addicted to more than one substance—is not uncommon, and it can be dangerous and even deadly in some instances. While it is important for doctors to monitor their patients for symptoms of drug abuse or addiction, it is equally important for patients to inform their doctors if they have a history of drug addiction or abuse.

If you or a loved one has been taking Ambien in high doses for an extended period, or if you or a loved one are mixing this drug with alcohol, get help as soon as possible.

Treatment may include medically managed withdrawal, also known as detox, where the substance is tapered under medical supervision.17After detox, treatment options typically include inpatient rehabilitation, where you stay at the facility to receive intensive individual and group treatment and therapy, or outpatient treatment, where you go to the facility for treatment and counseling sessions but return home or to work each day. The best course of treatment varies for every individual and should be discussed with your doctor or other health care provider. Both options help to educate about addiction and the triggers behind the addiction to drugs and alcohol, help prevent relapse, stress self-care, and help to manage insomnia without the use of sleep-inducing drugs and/or alcohol.

If you or someone you love may be showing signs of a substance abuse disorder, call our free and confidential drug and alcohol hotline to discuss your options and treatment.

Sources

  1. Bhaskar, Swapna, Hemavathy, D., and Prasad, Shankar. (2016). Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities. Journal of Family Medicine and Primary Care, 5(4), 780-784
  2. DailyMed. Ambien.
  3. National Institute on Drug Abuse. (June 2020). Misuse of Prescription Drugs Research Report: What classes of prescription drugs are commonly misused?
  4. Information from Your Family Doctor Insomnia: How to Get a Good Night’s Sleep.(2005). American Family Physician, 72(7), 1,309-1,310.
  5. Silversten, Børge, Madsen, Ida E., Salo, Paula, Tell, Grethe S., and Øverland, Simon. (2015). Use of Sleep Medications and Mortality: The Hordaland Health Study. Drugs Real World Outcomes, 2(2), 123-128.
  6. Substance Abuse and Mental Health Services Administration. (August 7, 2014). The Dawn Report: Emergency Department Visits Attributed to Overmedication That Involved the Insomnia Medication Zolpidem.
  7. Substance Abuse and Mental Health Services Administration. (Fall 2014). Treating Sleep Problems of People in Recovery From Substance Use Disorders.
  8. National Institute in Alcohol Abuse and Alcoholism. Harmful Interactions: Mixing Alcohol with Medicines.
  9. Weathermon, Ron, Pharm. D. and Crabb, David, W., M.D. (1999). Alcohol and Medication Interactions. Alcohol Res Health, 23(1), 40-54.
  10. Gunja, Naren. (2013). The Clinical and Forensic Toxicology of Z-drugs. Journal of Medical Toxicology, 9(2), 155-162.
  11. Hoque, Romy, M.D. and Chesson, Andrew L. Jr., M.D. (2009). Zolpidem-Induced Sleepwalking, Sleep Related Eating Disorder, and Sleep-Driving: Fluorine-18-Flourodeoxyglucose Positron Emission Tomography Analysis, and a Literature Review of Other Clinical Effects of Zolpidem. Journal of Clinical Sleep Medicine, 5(5), 471-476.
  12. Poceta, J. Steven, M.D. (2011). Zolpidem Ingestion, Automatisms, and Sleep Driving: A Clinical and Legal Case Series. Journal of Clinical Sleep Medicine, 7(6), 632-638.
  13. S. Food and Drug Administration. FDA requires stronger warnings about rare but serious incidents related to certain prescription insomnia medicines: Updated warnings for eszopiclone, zaleplon and zolpidem.
  14. Gunja, Naren. (2013). In the Zzz Zone: The Effects of Z-Drugs on Human Performance and Driving. Journal of Medical Toxicology, 9(2), 163-171.
  15. Drugs. Ambien (zolpidem) Disease Interactions.
  16. Langtry, Heather D. and Benfield, Paul. (2012). Zolpidem: A Review of its Pharmacodynamic and Pharmacokinetic and Therapeutic Potential. Drugs, 40, 291-313.
  17. Center for Substance Abuse Treatment. (2015). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series, No 45.

 

Last Updated on November 16, 2021
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