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Sleep issues continue to affect a major chunk of the worldwide population. While many can successfully keep it under control with good hygiene practices and a healthy lifestyle, others may require pharmaceutical support to make their nights peaceful and comfortable once again. In this respect, zolpidem is a commonly used medication that helps people doze off more easily and quickly and allows their bodies to rest and recover throughout the night. While the benefits of this medication are well-established, many people have reported experiencing various zolpidem adverse effects. Some of them are mild and go away on their own, but many may prove dangerous, especially if the user has no awareness of them. Hence, always familiarize yourself with the side effects profile of zolpidem before beginning treatment with it.
What is Zolpidem? An Overview
Zolpidem is a prescription-based drug available as an oral spray and tablet.  The tablet comes in sublingual, extended-release, and immediate-release versions, which vary in terms of how quickly or slowly they produce the expected benefits. Zolpidem is commonly available in the market under Ambien, Edluar, and Ambien CR. However, many generic versions that cost a bit less than the branded versions are also available.
Most people use zolpidem oral tablets to manage insomnia, a condition that causes them to have trouble falling or staying asleep. More specifically, the sublingual and immediate-release tablets help people fall asleep early. In contrast, the extended-release versions help them maintain this sleep without getting up in the middle of the night.
Belonging to a class of medications called hypnotics, Zolpidem or Ambien works by increasing the activity of a neurotransmitter called gamma-aminobutyric acid or GABA. This neurotransmitter has inhibitory properties, which means it tries to calm the mind and shut down its activities. By promoting the levels of GABA, zolpidem helps improve sleep.
What are the Most Common Side Effects of Ambien?
Zolpidem or Ambien can cause various side effects, ranging from mild to serious ones. While a person may not experience all these side effects, the risk is always there. Following are the most common zolpidem side effects the next day:
- Dry mouth
- Chest pain
- Muscle pain
- Palpitations or skipping beats
Most of the side effects mentioned above are mild and normally go away with some time. However, talking to a doctor or pharmacist is recommended if they persist.
Serious Zolpidem Long-Term Use Side Effects
Experts have noticed many zolpidem 10 mg side effects in people, which can lead to adverse outcomes and require medical attention. Some of these side effects include next-day impairments, complex sleep behaviors, and abnormal behavioral changes. The risk of these side effects becomes greater in people with long-term use or those who are using the medication at higher doses. Women and people over 65 are also more likely to experience long-term zolpidem side effects.
Complex Sleep Behaviors
Ambien and other similar drugs were originally considered much safer and less addictive than other types of sedative-hypnotics. However, in 2019, the FDA added a boxed warning to warn people about its potential to cause complex sleep behaviors.  These complex behaviors may include sleep-cooking, sleepwalking, sleep-driving, and engaging in other activities in wakefulness. Doing so can put any person at risk of getting a potentially fatal injury, not only to themselves but to others too.
The FDA also advises avoiding zolpidem by people who have experienced complex sleep behaviors in the past. Remember that these behaviors are likely to occur even in people taking zolpidem in therapeutic doses, either with or without alcohol or other nervous system depressants.
The FDA has lowered its recommended dose because of the potential of zolpidem to cause next-day drowsiness and impairment. Additionally, it does not suggest the extended-release version of this drug for people who frequently drive or participate in activities requiring complete alertness and focus. This is because the impairing effects of zolpidem extended-release medication may persist even after a person has slept well during the night.
Depression and Suicide Risk
Research has indicated that zolpidem use can worsen pre-existing depression and suicidal thoughts in such people. Hence, the FDA warns such people about using this drug with caution; if needed, they must keep it at the lowest dose possible to avoid an intentional overdose. For such people, behavioral therapy should remain the mainstay of treatment for insomnia, whereas pharmacological interventions must only be used when needed.
Overdosing on zolpidem is possible, regardless of whether a person is using it alone or in combination with other drugs. The possibility is higher in people who use it in higher doses or combined with opioids or other depressants of the nervous system, like alcohol or benzodiazepines. Some common symptoms of zolpidem overdose to watch out for include extreme sedation, severe respiratory depression, and impaired consciousness.
Zolpidem Interactions and Side Effects
Zolpidem oral tablets can interact with various other medications in different ways, leading to different effects. For example, some medications may affect the way zolpidem works, while others may increase its side effects.
Mentioned below is a list of medications that can interact with zolpidem. Remember that the list is not comprehensive and expandable. Be sure to let your doctor or pharmacist know if you are on any of these medications and are about to start zolpidem, as they can make necessary adjustments to minimize the potential side effects.
Increased Side Effects of Both Drugs
Using zolpidem with certain medications can increase the risk of overall side effects. This is mostly true in cases when both medications possess the same side effects profile, and their combination leads to an increase in their severity. Some examples include drugs that decrease the level of alertness, such as chlorpromazine and imipramine, and taking these drugs with zolpidem leads to enhanced drowsiness.
Increased Zolpidem Adverse Effects
Using certain medications with zolpidem can raise the risk of the side effects caused by the latter. This is because these medications increase the levels of zolpidem in the blood. Some examples include antibiotics (such as erythromycin and clarithromycin), drugs for managing fungal infections (ketoconazole, voriconazole, and itraconazole, and other drugs like atazanavir and ritonavir.
Lesser Efficacy of Zolpidem
When used with zolpidem, some drugs can mess with its working and make it less effective by reducing its amount in the body. Some of these drugs include antibiotics (such as rifapentine, rifabutin, and rifampin), supplements like St. John’s wort, and anticonvulsants (like phenobarbital, phenytoin, and carbamazepine).
Zolpidem Warnings to Remember
Zolpidem is available in oral tablets and comes with different warnings to remember. These warnings include the following:
Decreased reaction time and awareness warning
If you have been taking zolpidem but fail to get a full night’s sleep, you may experience slower reaction time or decreased awareness the following day. These effects can make it dangerous for you to be involved in certain activities, such as driving or operating heavy machinery. In case you are using a generic version, do not engage in any focus-demanding activities unless you have gotten at least 4 hours of sleep after taking zolpidem.
Abnormal behaviors warning
Zolpidem may cause changes in behavior, such as higher agitation. Some people may become totally different than they usually are, such as they may become more outgoing. Others may start seeing or hearing things that aren’t real or feel like they are watching themselves outside their physical body. Sleep driving is another common behavior that can occur in people with zolpidem. Many people also engage in activities that they can hardly remember once they are over the effects of zolpidem.
Withdrawal effects warning
Experts strictly advise not stopping zolpidem use without taking it to a professional. People who have been taking this drug for some time stop suddenly; they may experience a withdrawal.  Some common zolpidem withdrawal symptoms include emotional changes, sweating, vomiting, flushing, and muscle cramps. Some people may also experience panic attacks, uncontrollable crying, and nervousness.
Some people may be sensitive to zolpidem and experience a severe allergic reaction. The common symptoms of an allergic reaction may include swelling of the throat or tongue and breathing difficulties. If you suspect to be suffering from an allergic reaction, call for emergency help at once, as it may prove life-threatening.
Food interaction warning
Having zolpidem with food can slow down its mechanism of action. Hence, experts recommend taking on an empty stomach for best results.
Alcohol interaction warning
Drinking alcohol with zolpidem can make a person drowsier and more sedated than from using the drug alone. Hence, avoid mixing them, as the combination may sometimes lead to respiratory depression. Talk to a doctor if they have started you on zolpidem, but you drink alcohol.
How should I use zolpidem to avoid side effects?
The best tip to follow for avoiding zolpidem side effects is to follow the dosage instructions provided by the doctor closely. Remember that each person’s dosage may vary depending on the following factors:
- Age and sex
- The type of insomnia being treated
- The form of zolpidem a person is taking
- Other co-existing medical conditions, such as liver issues
In general, a doctor starts most people on a low dose and keeps adjusting it over time until the right one is achieved. The key is to use the smallest dose that delivers the desired effects.
Why are older adults at a higher risk of experiencing zolpidem adverse effects?
The liver of an older individual does not work as efficiently as it used to, making the body slow at processing zolpidem. Consequently, the drug persists in the blood for a much longer time, raising the risk of side effects. Hence, such people typically use a lower dose of this medication to avoid side effects.
Does regular zolpidem use require any clinical monitoring?
A doctor may advise regular clinical monitoring during zolpidem treatment to ensure that you remain safe while taking the medication. This clinical monitoring includes screening for mental health and behavioral problems with any unusual mood shifts. Moreover, liver functions are another aspect to measure, as the medication dosage may need to be adjusted depending on how well the liver is working.
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