Can Ambien (zolpidem) cause constipation?

Does Ambien (Zolpidem) Cause Constipation?

Ambien (zolpidem) can cause constipation, but it is a relatively uncommon side effect occurring in approximately 2% of patients taking the medication at recommended doses. 1

Evidence from FDA Drug Label

The FDA drug label for zolpidem provides the most definitive evidence regarding constipation as a side effect:

• In longer-term treatment studies (28-35 nights) with zolpidem at doses up to 10 mg, constipation was reported in 2% of patients taking zolpidem compared to 1% of those taking placebo 1
• This places constipation among the documented but less common adverse effects of zolpidem 1
• Constipation is listed in the "Incidence of Treatment-Emergent Adverse Experiences in Placebo-Controlled Clinical Trials Lasting up to 35 Nights" section of the FDA label 1

Comparison to Other Medication Classes Known to Cause Constipation

Zolpidem's constipation risk is significantly lower than medications known to frequently cause constipation:

• Opioid medications cause constipation in 40-80% of patients taking chronic opioid therapy 2
• Calcium channel blockers like nifedipine and verapamil have been shown to inhibit sigmoid colon myoelectric response, leading to constipation as a common side effect 3
• Clozapine has such a high risk of causing severe constipation that prophylactic laxatives are recommended for all patients taking it 4

Management of Zolpidem-Associated Constipation

If constipation does occur while taking zolpidem, standard constipation management approaches can be used:

• Ensure adequate hydration and physical activity when appropriate 2
• Dietary interventions with adequate fiber intake may be helpful for patients with sufficient fluid intake 4
• For persistent constipation, consider:
  • Osmotic laxatives such as polyethylene glycol (PEG) 2
  • Stimulant laxatives such as bisacodyl or senna if needed 2

Clinical Considerations

• When prescribing zolpidem, constipation is not among the most common side effects to warn patients about, as drowsiness (2%), dizziness (1%), and diarrhea (1%) are more frequently reported in short-term use 1
• The most concerning adverse effects of zolpidem are typically CNS-related, including drowsiness, dizziness, lethargy, and drugged feelings 1
• Zolpidem misuse or overdose, especially when combined with other medications or alcohol, can lead to serious complications requiring intensive care 5

Conclusion

While constipation can occur with zolpidem use, it is a relatively uncommon side effect compared to the medication's CNS effects and compared to other medication classes known to frequently cause constipation. Patients experiencing constipation while taking zolpidem can be managed with standard constipation treatments if the symptom persists.