Ambien and Alcohol: The Danger of Mixing Ambien with Alcohol

Last Updated: February 3, 2021

Authored by Sharon Levy, MD, MPH

Reviewed by Michael Espelin APRN

Ambien is a prescription medication that is both abused recreationally and used for the treatment of insomnia. Mixing this with alcohol, whether intentional or not, can elicit a potentially life-threatening reaction.

Alcohol addiction can be devastating due to how accessible it is. Treatment is very accessible, and support groups are plentiful. However, the treatment of alcoholism can be made much more complex when the addict combines other drugs with it. Not only does this make it harder to treat, but it increases the chance of overdosing, which is a serious health risk.

Some abuse alcohol with other drugs for a high, while others do not know that using their medication with alcohol can cause reactions. This article will discuss common alcohol drug reactions.

Risks for Combining Ambien and Alcohol

Ambien, also known by its generic name of zolpidem, is prescribed mostly to treat insomnia. In this bid to sleep better, some people may use Ambien with alcohol. However, this does not yield many benefits, as it has been found that alcohol consumption reduces the quality of sleep. These individuals are more likely to experience rare side effects of zolpidem, such as sleepwalking and the like.

Many who abuse zolpidem are not aware that the drug does not immediately induce sleep. When it is taken, the user can sometimes experience a state between full sleep and wakefulness. When combined with alcohol, this state’s duration is extended, and the user finds themselves unable to fall into a deep sleep. Rapid eye movement, or REM, sleep, is the sleep section where healing processes can occur, which is shortened with alcohol.

The woman is suffering in her bed.

Mixing these drugs can cause a heavier sedative effect which can be dangerous in the wrong situations. Abusing these two drugs simultaneously also increases the risk of developing a dependence on either.

Consequences of Mixing Alcohol and Zolpidem

Zolpidem, by itself, poses many side effects to the users, even when taken as prescribed. When mixing Ambien and alcohol, the risks are aggravated. In most cases, the mild and moderate side effects become more intense, leading to severe or even lethal outcomes. There is a high risk of overdose on Ambien, alcohol, or both substances, too. It may happen even when a normal dose of Ambien is taken. The Ambien-alcohol interaction explains such a reaction.

According to the National Institute on Alcohol Abuse and Alcoholism, taking Ambien with alcohol will produce the following common side effects:

  • sleepiness
  • dizziness
  • loss of coordination
  • impaired motor functions
  • poor judgment
  • difficulty concentrating
  • slurring of speech
  • memory loss, including amnesia and blackouts
  • problems with breathing
  • unusual behavior
  • sharp mood swings

Severe Adverse Effects of Using Zolpidem with Alcohol

Both of these drugs are depressants of the central nervous system, so using them together tends to have an amplified effect in that regard. This combination is perilous and can even be fatal. The CNS depression that occurs can result in vital brain centers losing activity, such as breathing and consciousness.

A study monitoring visits to the emergency department found that admission to the intensive care unit was common in individuals who used alcohol and Ambien.

An overdose is likely when mixing these drugs, and some of the symptoms of an overdose include:

  • Extreme sedation
  • Slowed breathing
  • Slowed heart rate
  • Loss of coordination
  • Hypoxia
  • Difficulty waking up or staying awake
  • Hallucinations
  • Coma

Aside from overdose, abusing these two substances can result in multiple organ damage. Severe risks commonly associated with concurrent abuse of Ambien and alcohol include:

  • Cardio-vascular problems
  • Weakening lung function
  • Brain damage
  • Skin problems
  • Permanent liver damage, etc.

Chance of Fatality with Zolpidem and Alcohol

The mixture of alcohol and Ambien can easily prove fatal. In a study done in Australia, 91 cases of zolpidem-related fatalities were assessed, and nearly 40% of these had alcohol involved. This shows how this drug combination can be potentially fatal.

It arises from the depressant effects on the central nervous system, which translates to other systems. The respiratory depression they have can lead to hypoxia, which causes coma and organ failure, which can result in death.

When Is Zolpidem Safely Following Alcohol?

As long as alcohol is still active in the system, it can interact with medication. Alcohol needs to be given time to metabolize before medication like zolpidem is introduced. The time it takes for an alcoholic beverage to metabolize depends on the person’s size and the type of drink they’re having.

However, it can be estimated:

  • A shot of a spirit or heavily alcoholic beverage will take about an hour to metabolize.
  • A pint of beer, due to its volume, will take about 2 hours to metabolize fully.
  • A glass of wine is less voluminous than a pint, but it has more alcohol typically, so it can take around 3 hours to metabolize.

The more drinks one has, the more cautious one should be. It is best just to allow several hours or as many as possible if drinking was heavy.

Ambien Minor Drug Interactions

Mild drug interactions limit the effectiveness of the drug, but beyond that pose no large harm. There are few drugs. The following drugs have minor interactions with zolpidem, which can manifest as reduced efficacy or as a drug reaction:

Flumazenil

Flumazenil has been found to go against the effects of zolpidem, which means it works as an antagonist.

Caffeine

Caffeine causes a reduction in the efficacy of zolpidem. It reverses its effects partially, which is expected because it is a stimulant. Caffeine-containing drugs and foods such as cola, tea, guarana, and coffee, will reduce the effect of zolpidem.

Ritonavir

As a drug that inhibits cytochrome P450, an enzyme responsible for the breakdown of many drugs, ritonavir can slow down the metabolism of zolpidem. This means that its effect will last longer than it normally should and the person may find themselves drowsy for longer.

Ambien Moderate Drug Interactions

A moderate drug interaction is defined as one that can either cause a worsening of the patient’s condition or eventually result in some form of modification to the previous plan or therapy. Moderate drug interactions are not likely to be life-threatening, though they can impact the person’s quality of life.

It is also important to ensure that one’s doctor has all necessary medication information before prescribing.

The following are some of the drugs which can have moderate interactions with zolpidem:

Trazodone

Trazodone and Ambien should be taken carefully. Using them together, the central nervous system depressant’s additive symptoms may occur, including possible respiratory depression or hypotension. Also, there is a higher chance of developing sleep-related disorders, such as sleep-driving, when taking trazodone and zolpidem. Geriatric patients may be faced with impairment in thinking and motor coordination. It is recommended to decrease the dosages of both medications when used.

Benadryl

When taking Ambien and Benadryl together, one can experience CNS depression, such as sedating H1-blockers. There is a possibility of getting psychomotor impairment when full mental awareness is required, including operating machinery or driving a car. The prescribed doses of zolpidem and Benadryl need to be adjusted in case of necessity taking both drugs.

Klonopin

Klonopin and Ambien interaction may cause increased sedation or respiratory depression, especially in elderly or debilitated patients. Physicians may prescribe to start taking Klonopin, zolpidem, or both at lower dosages, and patients should inform about changes in their daily activities if any occur.

Ambien and Xanax

Before starting the treatment, it is obligatory to ask the doctor if one can take Ambien and Xanax together. The interaction between Xanax and zolpidem may lead to severe and prolonged CNS side effects. Ambulatory patients should avoid activities that require full mental concentration until they know how the drugs affect them.

Gabapentin

Gabapentin and Ambien interaction may invoke side effects, including drowsiness, dizziness, confusion, and difficulties with attention and concentration. Patients should avoid activities that require full mental alertness. Also, there is a report about the effectiveness of treatment zolpidem dependence with gabapentin that can be considered as a drug for detoxification.

Flexeril

Flexeril and Ambien interaction may cause different side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. A patient may feel difficulties in motor coordination and keeping balance. While taking zolpidem with cyclobenzaprine, a patient should avoid alcohol consumption.

Zoloft

The most common adverse reactions during treatment with Zoloft and Ambien are disorientation, delusions, or hallucinations. Hallucinations can continue from 30 minutes to 7 hours and should be reported to the doctor if such occurs. Despite Zoloft and zolpidem treating different illnesses, they might be taken at different times of the day or not even on the same day. Although these medications were both well-tolerated in healthy female volunteers during the study, they can lead to the rapid onset and stronger zolpidem effect.

Nyquil

Nyquil and Ambien interaction influences the CNS and acts like depressants causing a sedating effect. In some cases, respiratory depression may occur. A patient should not perform risky activities at the beginning of the treatment and start with the lowest possible dosage.

Valium

In prescribing Valium and Ambien, the patient should be aware of possible adverse reactions and inform the doctor if any occur to allow for adjusting the dosage or changing the treatment program. The most common side effects are increased sedation or respiratory depression. Alcohol intake with Valium should be avoided.

Lexapro

Lexapro and Ambien interaction can invoke disorientation, hallucinations, depression, and manic reactions. Some users report having occurring anxiety in the middle of the night. At the beginning of the treatment, cautious dosage titration of Lexapro may be necessary.

Ativan

Ativan and Ambien should not be taken together. Ativan and zolpidem are used to treat insomnia and make it easier to fall asleep. However, concomitant usage may lead to excessive sleepiness and sedation.

Seroquel

Seroquel and Ambien applying together may cause excessive drowsiness and breathing problems. Also, there is a higher chance of developing an addiction.

Ibuprofen

Ambien and ibuprofen should be watched out for possible side effects and taken cautiously only as prescribed.

Tizanidine

The interaction of tizanidine and Ambien sometimes increases the risk of symptomatic hypotension and orthostasis, particularly during initiation of therapy or dose escalation. There is also a high chance of other side effects related to CNS disorders.

Suboxone

It is recommended to decrease the dosages of Ambien and Suboxone when they are prescribed together. It is better to stay away from using zolpidem with other medications at bedtime or in the middle of the night. Sedation, coma, or respiratory depression may occur during co-administration. It is advised to take half of the injectable buprenorphine dose to the patients who receive other drugs with CNS depressant effects; for the buprenorphine transdermal patch, start with the 5 mcg/hour patch. Still, consult with a doctor first.

Lunesta

Ambien and Lunesta are both medications that deal with insomnia by decreasing brain activity and produce a feeling of calmness. Both drugs are intended to be used for a short period. Taking Lunesta with zolpidem, one can suffer from extreme sedation, which is why it is not recommended to take them at the same time.

Prozac

Prozac and Ambien interaction may induce disorientation, delusions, and impaired concentration. However, there were no severe reactions that appeared during the clinical trials. Zolpidem’s onset of action may be shortened in the presence of fluoxetine.

Every interaction should be discussed with the doctor, and the dosages should be adjusted according to the symptoms and the patient’s reactions. Multiple drug intoxication may lead to death.

Ambien Major Drug interactions

Major or severe drug interactions can be life-threatening and require medical attention to either save the individual’s life or avoid serious Ambien side effects. It is important to avoid major drug interactions at all costs.

Someone is in the hospital with a sensor on his hand.

Some of the most regular drugs can cause major drug interactions with zolpidem. It is essential to be vigilant and inform your physician of any new drugs you might take.

Medication that can cause major drug interactions to include the following:

Ambien and Melatonin

Patients should avoid taking Ambien and melatonin. During clinical studies, there were recorded transitory pharmacodynamics that occurred within one hour of co-dosing. The user can experience extreme sedation and impairment of memory when these two medications interact.

Percocet

Percocet and Ambien interaction should be avoided. These medications should be prescribed only in urgent cases. Possible worsening in general health conditions and respiratory depression may appear when using Percocet and zolpidem together.

Tramadol

Ambien and tramadol interaction can damage the CNS and invoke excessive sedation and somnolence. Zolpidem overdose or polysubstance overdose is more likely to occur. Patients should immediately inform their health provider in case any unusual sleep-related behaviors and activities occur.

Hydrocodone

Hydrocodone and Ambien can have a dangerous interaction. The medicines should be prescribed together only when alternative treatment is inadequate. Patients should monitor their symptoms and changes in behavior at the beginning of the treatment. In the case of prolonged therapy, stopping Ambien or hydrocodone should be executed gradually. Otherwise, severe Ambien withdrawal effects may occur.

Vicodin

Vicodin and Ambien interaction may cause major effects and invoke somnolence and complex sleep-related behaviors. Opioid cough and pain medications such as Vicodin should be avoided with zolpidem. If there are no alternatives, and the benefits from treatment are higher than potential risks, the starting doses should be decreased to the lowest effective one.

Oxycodone

Using oxycodone and Ambien may result in obtaining harsh side effects such as hypotension, profound sedation, coma, respiratory depression, or even death. Before starting concurrent use, one should assess the level of tolerance to CNS depression that has developed. It is also recommended to reduce both dosages and use an initial dose of oxycodone at 1/3 to 1/2 the usual dosage.

Codeine

Prescription of codeine and Ambien should be avoided unless it is the most effective treatment approach, and risks are lower than the expected benefits. Ambien or codeine’s side effects, such as excessive sedation and complex sleep-related behaviors (sleep-driving, sleep-talking, sleep-eating), may be intensified.

Ambien and Cannabis Interaction

Cannabis is known among users as a natural alternative to Ambien that helps to relax muscles and provide a calming effect. However, zolpidem and cannabis, when taken together, have a moderate interaction and may result in extreme sedation.

Apart from that, other side effects that this drug combination can cause include confusion, inattention, poor judgment, and impairment of motor coordination.

The girl lights up a joint.

Users who suffer from sleeping problems should not take zolpidem for a long time or increase the dosage because the drug is very potent, and there is a high chance of Ambien abuse. They should not use this drug combination ahead of any task that requires concentration and alertness.

Also, it is recommended to consult with a doctor and provide them with the appropriate information before changing the drug and/or switching to natural relaxants such as marijuana.

Importance of Monitoring Symptoms

Zolpidem is a prescription medication, and alcohol is a legal substance, which makes either of them relatively easy to obtain. Ambien and alcohol both have side effects on their own, but they can have serious consequences when used together.

It is important for people who use these drugs to look out for any unusual symptoms or changes in their behavior that might result from drug interaction with zolpidem. If there is anything noticed, the doctor should be informed right away.

Apart from alcohol, drugs like Xanax, Valium, Tramadol, and Gabapentin, can cause significant reactions with zolpidem. It is important to avoid using Ambien with alcohol or any other drug.


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Published on: June 30th, 2020

Updated on: February 3rd, 2021

About Author

Sharon Levy, MD, MPH

After successful graduation from Boston University, MA, Sharon gained a Master’s degree in Public Health. Since then, Sharon devoted herself entirely to the medical niche. Sharon Levy is also a certified addiction recovery coach.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.