Alarming Increase in Ambien Emergencies

Emergency department visits due to over-medication with zolpidem (commonly called Ambien) almost doubled between 2005-06 and 2009-10, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

The agency recently issued a report on 2005 to 2010 findings from the Drug Abuse Warning Network (DAWN). DAWN monitors drug-related morbidity and mortality through reports from a network of US hospitals. Those hospitals reported over-medication with Ambien (zolpidem) in 21,824 visits in 2005-06 and 42,274 visits in 2009-10. (For perspective, there were almost 5 million drug-related visits to US emergency departments in 2010.)

FDA-approved for short-term treatment of insomnia, zolpidem is the active ingredient in prescription medications sold under the brand names Ambien, Ambien CR, Edluar and Zolpimist. Millions of Americans have safely taken these medications. But in January 2013, the FDA responded to rising reports of adverse reactions to zolpidem by requiring manufacturers to reduce the recommended dose for women by half. The FDA also advised pharmaceutical companies to reduce the recommended dose for men.

The FDA is particularly concerned about the phenomenon known as “next-morning impairment”—that is, when zolpidem blood levels remain elevated for people who must perform tasks like driving that require a high level of alertness. It seems that women are more susceptible to next-morning impairment because zolpidem generally remains in their blood longer than it does for men. Reducing the dose may help improve alertness in the morning.

Side effects associated with zolpidem include dizziness, daytime drowsiness, sleep-walking, hallucinations, agitation and drowsiness while driving in the morning. SAMHSA also warned that combining zolpidem with other substances can significantly increase its sedative effects. The agency noted that common combinations include alcohol, narcotics or benzodiazepines. (Doctors prescribe benzodiazepines for anxiety, insomnia, agitation, seizures, muscle spasms or alcohol withdrawal and as a premedication for medical or dental procedures.)

SAMHSA Details More Ambien Concerns

Of even more concern in the current SAMHSA report: Emergency department visits for men due to over-medication with zolpidem increased 150 percent from 2005-06 to 2009-10, compared to a 69 percent increase for women during the same period.

Emergency department screenings revealed that 57 percent of patients with zolpidem over-medication also had additional prescription drugs in their systems. Benzodiazepines (26 percent) and narcotic pain relievers (25 percent) were the most common, followed by alcohol (14 percent). Close to 47 percent of emergency department visits related to zolpidem over-medication resulted in either a hospital admission or a transfer to another medical facility. Nearly a quarter of these patients went an intensive care unit.

Ultimately, while prescription sleep aids like Ambien, Ambien CR, Edluar and Zolpimist can help with short-term insomnia, they require cautious use. Patients should watch closely for side effects–especially the following day.

It’s very important for patients who take zolpidem to have a frank discussion with their doctors about possible adverse reactions and to address side effects if they arise. Anyone who needs to drive the morning after taking zolpidem should consider the risks of decreased alertness and reaction time. The elderly especially should use medications such as zolpidem with caution–if at all.

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