Do you or a loved one struggle with insomnia? Individuals diagnosed with a sleep disorder are sometimes prescribed sedative-hypnotic drugs, often referred to as depressants. These products are specially designed to slow down the activity of the brain, which can help induce and/or maintain sleep.
Some of the most common examples include:
- Ambien (zolpidem)
- Belsomra (suvorexant)
- Butisol (butabarbital)
- Doral (quazepam)
- Edluar (zolpidem)
- Estazolam
- Flurazepam
- Lunesta (eszopiclone)
- Silenor (doxepin)
These drugs and others like them are highly controlled substances because of their potential for misuse and abuse. Self-medication and recreational use for euphoric effects can have very dangerous consequences. Combining any of these prescriptions, or using them in conjunction with alcohol, is never a good idea.
What is Zolpidem?
As a sedative-hypnotic drug, zolpidem is used to treat individuals who experience difficulty falling and staying asleep. While this substance does not force sleep to occur, it does slow down brain function, making it easier to get to sleep. It is generally prescribed in tablet form as Ambien, which is taken by mouth. Other forms include: Ambien CR, a long-acting tablet; Zolpimist, an oral spray; and Edluar and Intermezzo, sublingual tablets.
In all cases, taking this medication exactly as directed, and without food, will produce the best results. Patients should expect to become sleepy shortly after each dose and will likely remain sleepy for several hours. While zolpidem should be taken as needed, it should not be taken multiple times a day. Patients must be able to sleep for seven to eight hours, or at least stay home and not drive any vehicle for an additional four hours when taking sublingual tablets.
Generic forms of zolpidem are also available, but strengths and forms vary. Most prescriptions are limited to one to two weeks. Dosage is determined by a medical professional and will depend on patient gender, age, medical condition, and other medications prescribed.
Common Side Effects of Zolpidem
There are a number of side effects that can present when taking zolpidem. It’s important to speak with a healthcare professional if any symptoms become severe or persist for long periods of time, though many of them will not cause real, long-term damage.
Side effects include:
- Headache
- Dizziness/Lightheadedness
- ‘Drugged Feeling’
- Difficulty Keeping Balance
- Nausea
- Constipation or Diarrhea
- Gas
- Heartburn
- Stomach Pain or Tenderness
- Changes in Appetite
- Uncontrollable Shaking of a Part of the Body
- Pain, Burning, Numbness, or Tingling in the Hands, Arms, Feet, or Legs
- Unusual Dreams
- Redness, Burning, or Tingling of the Tongue
- Dry Mouth or Throat
- Ringing, Pain, or Itching in the Ears
- Eye Redness
- Muscle Aches or Cramps
- Joint, Back, or Neck Pain
- Heavy Menstrual Bleeding
In some cases, more serious side effects can develop. Medical attention should be sought immediately if any of the following symptoms are present::
- Rash or Hives
- Itching
- Swelling of the Eyes, Face, Lips, Tongue, or Throat
- Closing Throat Feeling
- Difficulty Breathing or Swallowing
- Hoarseness
- Shortness of Breath
- Yellow Eyes or Skin
- Light-Colored Stools
- Nausea and Vomiting
- Pounding Heartbeat
- Chest Pain
- Blurred Vision or Other Vision Problems
Zolpidem can cause other side effects not listed here. Those experiencing anything unusual while taking this medication should seek immediate medical attention. It’s also important to know that zolpidem can cause serious and possibly life-threatening sleep behaviors. Some patients have reported performing potentially dangerous activities such as driving, preparing food, having sex, and walking around while not fully awake. It is common, when this happens, for all memories of these activities to be gone upon waking.
Interactions of Alcohol and Zolpidem
There are a number of intoxicating substances that negatively interact with zolpidem. The most common of these is alcohol. As a result, it is important that zolpidem not be taken while drinking alcohol under any circumstances. The combination of these two substances can have very dangerous results, including a significantly higher chance that medical attention and/or intensive care will be necessary. This is mostly because individuals engaging in this behavior are more likely to experience an overdose.
Even alone, both of these substances can produce troubling side effects. Drinking alcohol may cause the following:
- Lowered Inhibitions
- Trouble Concentrating
- Dulled Perception
- Mood Swings
- Vomiting
- Higher Blood Pressure
- Memory Loss
See the most common zolpidem side effects above.
When alcohol and zolpidem are ingested simultaneously, it enhances the more dangerous of the side effects caused by zolpidem. Because zolpidem acts on benzodiazepine receptors in the brain and alcohol has similar central nervous system depressant effects, the results are often amplified.
When mixed, alcohol and zolpidem may cause the following intoxicating effects:
- Dizziness
- Confusion
- Difficulty Concentrating
- Impaired Cognition
- Loss of Physical Coordination
- Impaired Judgement
- Sleepiness or Drowsiness
- Sleepwalking
- Depressed Breathing
- Sleep Apnea
Sleepwalking is one of the most common and dangerous side effects associated with mixing alcohol and zolpidem. According to the Drug Abuse Warning Network (DAWN), approximately 57% of emergency room visits and hospitalization caused by Ambien overdoses involved other substances (mostly alcohol) in 2010. Studies also indicate that the frequency of parasomnia, the act of performing tasks while asleep, dramatically increases when under the influence of both substances. Even a small amount of alcohol can have a significant and dangerous impact and, when mixed with sleepwalking, you’ve got a dangerous situation even if you go to sleep long before you’ve had too much.
Alcohol Poisoning and Zolpidem
Addiction is another a concern for both zolpidem and alcohol. This condition is generally characterized by compulsive habits that become a source of distress and harm to self and others. The symptoms associated with addiction vary and may be mild, moderate, or severe. In both cases, addiction can very easily lead to overdose.
Alcohol overdose, or poisoning, occurs when too much alcohol is present in the bloodstream. When this happens, basic bodily functions begin to shut down.
Signs of alcohol poisoning include:
- Confusion
- Difficulty Remaining Conscious
- Vomiting
- Seizures
- Slow Breathing
- Gaps in Breathing
- Slow Heart Rate
- Clammy Skin
- Dulled Responses
- Extremely Low Body Temperature
You should call poison control immediately if a zolpidem overdose is suspected. If the overdose results in collapse, seizures, trouble breathing, or an inability to wake, emergency services will be required.
Common signs of zolpidem overdoes include:
- Drowsiness
- Pinpoint Pupils
- Slurred Speech
- Inability to Wake Up
- Slowed Breathing
- Slowed Heartbeat
Alcohol poisoning and zolpidem overdose are emergencies. Without immediate medical attention, both situations can result in a coma or death.
Withdrawal
As with any addiction, suddenly discontinuing use of zolpidem and/or alcohol can result in withdrawal. While symptoms of withdrawal are different for every patient, they can certainly be hazardous to your health.
Alcohol Withdrawal
Generally, alcohol withdrawal symptoms will present within eight hours. They usually peak between 24 and 72 hours, but can last for weeks.
The most common symptoms include:
- Anxiety or Nervousness
- Depression
- Fatigue
- Irritability
- Jumpiness
- Shakiness
- Mood Swings
- Nightmares
- Unclear Thoughts
- Sweating or Clammy Skin
- Enlarged Pupils
- Headache
- Insomnia
- Loss of Appetite
- Nausea and Vomiting
- Rapid Heart Rate
- Tremors
Zolpidem Withdrawal
Generally, zolpidem withdrawal symptoms can present within a few hours or several days of taking the final dose. Intensity will largely depend on how much of the drug was regularly taken before discontinuing use.
The most common symptoms include:
- Irritability
- Mood Swings
- Cravings for the Drug
- Anxiety
- Fatigue
- Sweating
- Tremors
- Upset Stomach
- Panic Attacks
- Delirium
- Depression or Uncontrollable Crying
- Increased Breathing Rate
- Increased Heartrate
- Seizures (less than 1% of cases)
Treatment
Zolpidem and alcohol overdoses require immediate medical attention. In both cases, the ability to breath can quickly become an issue. If overdose is suspected, you must ensure the airway is clear, ensure breathing is unconstrained, check for discoloration, and continually monitor breathing until assistance arrives. Those suffering from alcohol poisoning should also be kept awake and given water.
Zolpidem overdose treatment consists of the constant monitoring of breathing, circulation, and heart functions. Depending on the severity of the overdose, stomach pumping may also be necessary. Alcohol poisoning also requires constant vital sign monitoring as alcohol levels drop.
If the situation is severe, the following treatments may also be necessary:
- Breathing Tube
- Intravenous Drip
- Urinary Catheter
- Stomach Pumping
Zolpidem addiction usually requires rehabilitation. Long-term treatment plans vary, but usually consist of three phases: detoxification, psychological therapy, and aftercare. Detoxification is generally conducted slowly, as abruptly discontinuing use of the drug can cause severe withdrawal symptoms from developing. Inpatient programs are preferable, with intensive outpatient rehab afterward. Addiction counseling is also common.
Alcohol addiction is a very complex disease with no single identifiable cause. As a result, long-term treatment plans vary drastically from patient to patient. A primary care provider will establish a personalized recovery plan with actionable and measurable goals. These plans generally consist of therapy, medical prescriptions, and attendance at mutual-support group sessions. An inpatient program may also be necessary. The combination of these strategies can alter drinking behaviors, reduce cravings, and help manage potential triggers.
Addiction cases that involve both zolpidem and alcohol must be approached carefully. Because the overdose, addiction, and withdrawal symptoms are so similar, treatment should occur in the presence of medical professionals.
Sources:
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https://medlineplus.gov/druginfo/meds/a693025.html
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https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/sleep-disorder-sedative-hypnotic-drug-information
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553644/
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https://www.health.harvard.edu/a_to_z/sedative-hypnotic-or-anxiolytic-drug-use-disorder-a-to-z