What is the relationship between sleep eating and the use of pramipexole, zolpidem (Ambien), and dextroamphetamine-amphetamine?

From the Guidelines

Sleep eating while taking pramipexole, Ambien (zolpidem), and amphetamine-dextroamphetamine is a serious concern that requires immediate medical attention, and discontinuing Ambien first may be the most appropriate course of action, as it is the most likely culprit, according to the most recent evidence from 2023 1. You should contact your healthcare provider right away to report this side effect. Sleep eating, or sleep-related eating disorder, is most commonly associated with Ambien, which can cause complex sleep behaviors including eating while not fully conscious. Pramipexole, a dopamine agonist used for Parkinson's disease and restless legs syndrome, can also cause sleep disturbances and potentially worsen this behavior. The combination with amphetamine-dextroamphetamine (used for ADHD or narcolepsy) creates a particularly problematic medication mix, as the stimulant might be masking daytime sleepiness caused by disrupted nighttime sleep. Your doctor may recommend adjusting the timing of your medications to prevent overlap of peak effects. Never stop these medications suddenly without medical supervision. In the meantime, secure your kitchen by removing easily accessible food items and consider having someone monitor your nighttime behavior until this issue is resolved. This combination of medications affects multiple neurotransmitter systems including GABA, dopamine, and norepinephrine, which collectively can disrupt normal sleep architecture and consciousness during sleep transitions. Some key points to consider include:

• The potential for sleep-related eating disorder is a known side effect of Ambien, as reported in the FDA warnings and guidelines from the American Academy of Sleep Medicine 1.
• Pramipexole can also contribute to sleep disturbances, although its role in sleep-related eating disorder is less clear 1.
• The combination of these medications with amphetamine-dextroamphetamine increases the risk of disrupted sleep and daytime sleepiness, which may be masked by the stimulant effects of the amphetamine-dextroamphetamine 1.
• Discontinuing Ambien or adjusting the medication regimen under medical supervision is crucial to addressing sleep eating and preventing potential harm 1.

From the FDA Drug Label

1. Warnings and Precautions 5. 1 Complex Sleep Behaviors Complex sleep behaviors, including sleep-walking, sleep-driving, and engaging in other activities while not fully awake, may occur following the first or any subsequent use of zolpidem tartrate. Patients can be seriously injured or injure others during complex sleep behaviors. Such injuries may result in a fatal outcome. Other complex sleep behaviors (e.g., preparing and eating food, making phone calls, or having sex) have also been reported. Instruct patients and their families that zolpidem tartrate may cause complex sleep behaviors, including sleep-walking, sleep-driving, preparing and eating food, making phone calls, or having sex while not being fully awake.

The combination of pramipexole, Ambien (zolpidem), and amphetamine-dextroamphetamine may increase the risk of complex sleep behaviors, including sleep eating. However, the FDA drug label for zolpidem does not directly address the interaction between these specific medications and sleep eating.

• Key points:
  • Zolpidem may cause complex sleep behaviors, including sleep eating.
  • The risk of complex sleep behaviors may be increased with the concomitant use of other CNS depressants or stimulants.
  • Patients should be warned against driving and other activities requiring complete mental alertness if zolpidem is taken in these circumstances.
  • The FDA drug label does not provide direct information on the interaction between pramipexole, Ambien, and amphetamine-dextroamphetamine regarding sleep eating 2 2.

From the Research

Sleep Eating with Pramipexole, Ambien, and Amphetamine-Dextroamphetamine

• Sleep-related eating disorder (SRED) is characterized by recurrent episodes of involuntary eating during sleep period and is often associated with restless legs syndrome (RLS) 3.
• Pramipexole, a dopamine D3-receptor agonist, has been studied as a potential treatment for SRED, with some studies showing promising results 4, 3.
• A pilot double-blind placebo-controlled trial found that pramipexole reduced night-time activity median and increased the number of nights of good sleep/week in patients with SRED 4.
• A case report found that the combination of clonazepam and pramipexole therapy reduced SRED episodes and RLS symptoms in a patient with a history of hypertension, diabetes mellitus, sleep apnea syndrome, and depression 3.
• However, there is limited research on the specific combination of pramipexole, Ambien, and amphetamine-dextroamphetamine in relation to sleep eating.
• Amphetamine-dextroamphetamine is a stimulant medication that can interfere with sleep, and Ambien is a sedative-hypnotic medication that can increase the risk of sleep-related eating disorders 5.
• Further studies are needed to fully understand the effects of this combination on sleep eating and to determine the safest and most effective treatment options.

Potential Side Effects and Interactions

• Pramipexole can cause side effects such as daytime sleepiness, sleep attacks, and impulse control disorders, particularly with long-term use 5.
• The combination of pramipexole with other medications, such as Ambien and amphetamine-dextroamphetamine, may increase the risk of adverse interactions and side effects 6, 7.
• Patients taking this combination of medications should be closely monitored for signs of sleep-related eating disorders, as well as other potential side effects and interactions.