From the Guidelines
Zolpidem (Ambien) can cause several side effects, including amnesia, dizziness, sedation, headache, nausea, and taste perversion, as well as more concerning complex sleep behaviors and next-day impairment. The most common side effects of zolpidem, as reported in a meta-analysis, include:
- Amnesia, with a minimal difference from placebo (0.03 risk difference) 1
- Dizziness, with a small increase in risk (0.06 risk difference) 1
- Headache, with a mildly increased risk (0.07 risk difference) 1
- Nausea, with a minimal difference in risk (0.02 risk difference) 1
- Sedation, with a slightly higher risk (0.04) 1 More concerning side effects, such as complex sleep behaviors, including sleepwalking, sleep-driving, eating, or engaging in other activities while not fully awake, have been reported, although the exact risk is not well quantified in the provided evidence. Next-day impairment, affecting driving and activities requiring alertness, has also been observed, even when patients feel fully awake 1. To minimize the incidence of adverse events, zolpidem should be administered at the lowest effective dose and for the shortest possible duration, and all patients offered this agent should be counseled on the potential risks 1.
From the FDA Drug Label
Zolpidem tartrate may cause serious side effects, including: getting out of bed while not being fully awake and do an activity that you do not know you are doing. abnormal thoughts and behavior. Symptoms include more outgoing or aggressive behavior than normal, confusion, agitation, hallucinations, worsening of depression, and suicidal thoughts or actions. memory loss anxiety severe allergic reactions. Symptoms include swelling of the tongue or throat, and trouble breathing The most common side effects of zolpidem tartrate are: drowsiness dizziness diarrhea grogginess or feeling as if you have been drugged After you stop taking a sleep medicine, you may have symptoms for 1 to 2 days such as: trouble sleeping nausea flushing lightheadedness uncontrolled crying vomiting stomach cramps panic attack nervousness stomach area pain
The side effects of zolpidem (Ambien) include:
- Serious side effects: getting out of bed while not being fully awake, abnormal thoughts and behavior, memory loss, anxiety, and severe allergic reactions
- Common side effects: drowsiness, dizziness, diarrhea, and grogginess
- Withdrawal symptoms: trouble sleeping, nausea, flushing, lightheadedness, uncontrolled crying, vomiting, stomach cramps, panic attack, nervousness, and stomach area pain 2
From the Research
Side Effects of Zolpidem
The side effects of zolpidem, a nonbenzodiazepine hypnotic used for treating insomnia, have been reported in various studies. Some of the common side effects include:
- Hallucinations/sensory distortion
- Amnesia
- Sleepwalking/somnambulism
- Nocturnal eating
- Confusion
- Dizziness
- Daytime sleepiness
- Increased risk of falls, especially in hospitalized patients
- Hip fractures
- Rebound insomnia
- Sleep onset latency
Factors Influencing Side Effects
Several factors can influence the occurrence of side effects when taking zolpidem, including:
- Gender: Women have been found to have a significantly higher serum zolpidem concentration than men 3
- Zolpidem dose: The adverse reactions that develop are dose dependent 3
- Protein binding affinity: A high proportion of zolpidem is protein bound, and low serum albumin can result in a higher level of free zolpidem, leading to adverse psychiatric reactions 3
- Cytochrome P450 (CYP) isoenzyme inhibition: Concomitant administration of zolpidem and other drugs may cause interactions that lead to increased concentrations of zolpidem 3
Special Considerations
Zolpidem has been associated with an increased risk of complex behaviors, such as:
- Sleeping and driving
- Hallucinations
- Increased suicidality
- Sleep-related eating disorders, which can occur in about 1% of patients 4
- Seizures, especially after withdrawal of zolpidem 5
Pharmacological Treatment
Zolpidem is considered a reasonable choice of therapy for insomnia, especially when used in conjunction with cognitive-behavioral therapy 5. However, the decision to prescribe zolpidem should be made on a case-by-case basis, considering both the physical and psychiatric risks posed to the patient 5. The FDA has classified zolpidem as a category C drug based on adverse outcomes seen in animal fetal development 5.