What are the effects of long-term Zolpidem (Ambien) use?

From the Guidelines

Chronic zolpidem use is not recommended beyond 2-4 weeks due to risks of dependence, tolerance, and adverse effects. If you've been taking zolpidem (commonly sold as Ambien) long-term, work with your healthcare provider to develop a tapering schedule rather than stopping abruptly. Typical tapering involves reducing the dose by 25-50% every 1-2 weeks, but this should be personalized to your situation 1. During tapering, implement good sleep hygiene practices including:

• Consistent sleep-wake times
• Avoiding screens before bed
• Creating a comfortable sleep environment
• Limiting caffeine and alcohol Cognitive behavioral therapy for insomnia (CBT-I) is more effective than medication for long-term insomnia management 1. Chronic zolpidem use can lead to:
• Memory problems
• Daytime drowsiness
• Increased fall risk
• Paradoxical reactions like sleepwalking The medication works by enhancing GABA, an inhibitory neurotransmitter in the brain, but with prolonged use, the brain adapts, requiring higher doses for the same effect and potentially worsening insomnia when discontinued 1. Observational studies have shown that hypnotic drugs, including zolpidem, may be associated with infrequent but serious adverse effects, such as dementia, serious injury, and fractures 1. The FDA suggests dosages lower than those used in many studies, especially for older adults 1.

From the FDA Drug Label

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)] During longer-term treatment (28 to 35 nights) with zolpidem at doses up to 10 mg, the most commonly observed adverse reactions associated with the use of zolpidem and seen at statistically significant differences from placebo-treated patients were dizziness (5%) and drugged feelings (3%)

The effects of long-term Zolpidem (Ambien) use include:

• Dizziness (5%)
• Drugged feelings (3%)
• Withdrawal effects
• Abnormal thinking and behavior changes
• CNS-depressant effects
• Next-day impairment 2

From the Research

Effects of Long-Term Zolpidem Use

• The long-term use of Zolpidem has been associated with various adverse effects, including an increased risk of falls, hip fractures, and cognitive impairment 3, 4.
• Zolpidem use has also been linked to complex behaviors, such as sleepwalking, hallucinations, and increased suicidality 3.
• Additionally, long-term use of Zolpidem can lead to dependence and withdrawal symptoms, including insomnia, tension, and palpitations 5, 6.
• A case report of a patient who developed generalized tonic-clonic seizures due to Zolpidem withdrawal highlights the potential risks of long-term use 6.

Cognitive Impairment and Zolpidem Use

• A study found that benzodiazepine exposure density was an independent risk factor for cognitive impairment in middle-aged and older patients with chronic insomnia, but no correlation was found between Zolpidem use and cognitive impairment 4.
• However, another study found that Zolpidem significantly impaired psychomotor and driving performance, as well as early memory recall, in healthy middle-aged and elderly volunteers 7.

Dependence and Withdrawal

• Zolpidem dependence and withdrawal have been reported in several cases, with symptoms including insomnia, tension, and palpitations 5, 6.
• A comprehensive approach, involving both pharmacological and psychological interventions, is essential for an effective detoxification strategy for Zolpidem addiction 5.

Special Considerations

• The FDA has classified Zolpidem as a category C drug due to adverse outcomes seen in animal fetal development, and its use during pregnancy has been associated with an increased incidence of low birth weight, preterm delivery, and small for gestational age babies 3.
• Zolpidem should be prescribed with caution in elderly patients, as they may be more susceptible to its adverse effects due to slower drug metabolism 3.