From the Guidelines
Xanax (alprazolam) and Ambien (zolpidem) have significant side effects, including drowsiness, dizziness, and memory problems, and can cause serious adverse effects such as complex sleep behaviors, respiratory depression, and physical dependence, as reported in recent studies 1.
Side Effects of Xanax and Ambien
The side effects of Xanax and Ambien can be categorized into common and serious side effects. Common side effects of Xanax include:
- Drowsiness
- Dizziness
- Lightheadedness
- Decreased coordination
- Memory problems
- Slurred speech
- Changes in mood More serious side effects can include:
- Confusion
- Hallucinations
- Thoughts of suicide
- Physical dependence with withdrawal symptoms when stopping Ambien commonly causes:
- Daytime drowsiness
- Dizziness
- Headache
- Nausea
- Coordination problems More concerning side effects include:
- Complex sleep behaviors (like sleep-walking, sleep-driving, or eating while asleep)
- Memory loss
- Hallucinations
- Next-day impairment
Mechanism of Action and Risks
Both medications work by enhancing the effect of GABA, an inhibitory neurotransmitter in the brain, which explains their sedative effects and many of their side effects 1. The risk of adverse events, including serious injuries caused by sleep behaviors, is a concern with nonbenzodiazepine BZRAs like zolpidem, as noted in a recent safety announcement by the U.S. Food and Drug Administration 1.
Recommendations
To minimize the incidence of adverse events, Xanax and Ambien should be administered at the lowest effective dose and for the shortest possible duration, and all patients offered these agents should be counseled on the potential risks 1. Neither medication should be stopped abruptly after regular use, as withdrawal symptoms can occur. Always take these medications exactly as prescribed and discuss any concerns about side effects with your healthcare provider.
From the FDA Drug Label
- Adverse Reactions The following serious adverse reactions are discussed in greater detail in other sections of the labeling: Complex Sleep Behaviors [see WARNINGS AND PRECAUTIONS (5.1)] CNS-Depressant Effects and Next-Day Impairment [see WARNINGS AND PRECAUTIONS (5.2)] Serious Anaphylactic and Anaphylactoid Reactions [see WARNINGS AND PRECAUTIONS (5. 4)] Abnormal Thinking and Behavior Changes [see WARNINGS AND PRECAUTIONS (5.5)] Withdrawal effects [see WARNINGS AND PRECAUTIONS (5.9)] Zolpidem may cause serious side effects, including: complex sleep behaviors that have caused serious injury and death. After taking zolpidem, you may get up out of bed while not being fully awake and do an activity that you do not know you are doing (complex sleep behaviors).
The side effects of zolpidem (Ambien) include:
- Complex sleep behaviors
- CNS-depressant effects
- Next-day impairment
- Serious anaphylactic and anaphylactoid reactions
- Abnormal thinking and behavior changes
- Withdrawal effects
- Drowsiness
- Dizziness
- Diarrhea
- Drugged feelings
- Lethargy
- Lightheadedness
- Depression
- Abnormal dreams
- Amnesia
- Sleep disorder
The FDA drug label does not provide information on the side effects of alprazolam (Xanax). 2 2 2
From the Research
Side Effects of Alprazolam (Xanax)
- Drowsiness and sedation are common adverse effects of alprazolam 3
- Alprazolam may impair performance in a variety of skills in healthy volunteers as well as in patients 3
- Withdrawal and rebound symptoms are common at discontinuation of alprazolam treatment, and discontinuation must be tapered 3
- Alprazolam has potential for addictive use, and its withdrawal syndrome may be more severe and may occur after a shorter period of use compared to diazepam 4
Side Effects of Zolpidem (Ambien)
- Zolpidem has been associated with an increased risk of falls in hospitalized patients, with an OR of 4.28 (P <0.001) 5
- The relative risk (RR) for hip fractures in patients taking zolpidem was described as 1.92 (95% CI 1.65-2.24; P<0.001) 5
- Zolpidem has been linked to central nervous system (CNS)-related adverse effects such as confusion, dizziness, and daytime sleepiness 5
- Zolpidem use has been associated with an increased risk of suicide attempts and completion, with an OR of 2.08 (95% CI 1.83-2.63) 5
- Rebound insomnia is a concern with zolpidem use, and sleep onset latency has been demonstrated to be significantly increased on the first night after stopping zolpidem 5