- Symptoms and Signs of Ambien Overdose
- What Causes Ambien Overdose?
- General Risk Factors for Overdose
- When to Get Medical Help
- How to Avoid an Overdose
- Ambien Overdose Treatment
- Recovering from Ambien Overdose
Ambien Overdose Symptoms and DangersAmbien (zolpidem) induces sedation and is prescribed for the short-term treatment of insomnia. Ambien overdose can occur when more than the prescribed amount is taken.
Overdose can be especially severe if Ambien is taken with other drugs or alcohol.
Symptoms and Signs of Ambien Overdose
Ambien overdose can result in symptoms, such as:
- Memory loss.
- Impaired ability with driving, cognition and work performance.
- Shallow breathing.
- Slowed heart rate.
The standard dosage of Ambien is 5-10 mgs.
At therapeutic dose levels, Ambien induces sedation, producing a pattern of sleep in the absence of the euphoric, anticonvulsant and muscle relaxant effects produced by benzodiazepines (e.g. Xanax, Valium, Klonopin) (Julien, 2011).
When used as directed, there are minimal next-day effects on memory or other activities such as driving and work performance.
Examples of memory loss include doing any of the following activities during sleep, with no ability to recall these events later:
- Making phone calls
- Sexual activity
Hallucinations lasting several hours have been reported by Poison Control Centers (Tsai et al., 2003).
Respiratory depression or shallow breathing may result with Ambien overdose, as with benzodiazepines. Increased heart rate above the normal resting heart rate (tachycardia) has also been reported (Forrester, 2009; Letsas et al., 2006).
Death resulting from Ambien overdose is extremely rare, and more likely to occur with concurrent use of alcohol, antidepressants or other drugs (polydrug use).
Reported overdoses up to 40 times the therapeutic dose have not been fatal (Julien, 2011).
What Causes Ambien Overdose?
Co-occurring Drug Abuse
Overall, Ambien has a mild toxicity similar to that of benzodiazepines.
However, respiratory depression and coma have been reported in the presence of alcohol
Some also take Ambien intravenously in an attempt to mitigate a "comedown or "crash in a post-cocaine use setting (Brunelle et al., 2005).
This is a method in which the user dissolves the crushed pills with a solution of water and injects the contents.
Co-occurring Mental Disorders
Cases of death from overdose, in which Ambien was used, have been reported in females with a history of major depressive disorder and paranoid disorder (Gock et al., 1999).
While Ambien overdose was reported as the cause of death, the subjects had also been treated with risperidone (Risperdal). Opioid/opiate use was also evident.
Health Issues in Older Populations
Insomnia is a frequent problem for older adults, potentially prompting the prolonged or excessive use of non-benzodiazepine hypnotics such as Ambien.
Additionally, even when taken as directed, hepatic impairment may cause problems with the drug metabolism of Ambien in an elderly population, resulting in toxic blood levels.
In the presence of memory impairment, elderly individuals have been reported to misuse prescription medications.
General Risk Factors for Overdose
Depressed women are more likely to use sedatives with pain medication compared to men.Depression and depressive symptoms are the primary risk factors associated with insomnia, with a higher rate among women compared with men (Buysse et al., 2008).
As many as two-thirds of reported cases of Ambien or other sedative overdose were females. Depressed women are more likely to use sedatives along with pain medication such as opioids/opiates compared with men.
Pain, the inability to cope, the absence of support systems, work and home-related stress, all contribute to insomnia.
While Ambien is considered to be a safe alternative to the benzodiazepines for treatment, the risk of overdose is compounded by the use of alcohol and other drugs, such as opioids prescribed for pain.
In these cases, the use of Ambien and similar sedatives is probably related to reports of high ratings of pain, which cause sleep-related disorders.
Depressed females being treated for pain with opioids are at high risk of a potentially dangerous combination of opioid/opiate and sedative medications (Saunders et al., 2012).
When to Get Medical Help
Ambien overdose, especially if used with alcohol or other drugs, constitutes a medical emergency.
It is essential to call 911, call your local emergency hotline, or get to the emergency room of your local hospital as soon as possible.
Signs of overdose include:
- Depressed breathing.
- Pinpoint pupils.
- Heart failure.
This is potentially a life-threatening situation that warrants immediate medical assistance.
How to Avoid an Overdose
- Take Ambien only as prescribed--the prescribed therapeutic dose is 5-10 mgs.
- Do not crush, chew or break the pill. Swallow it whole.
- Do not drink alcohol while taking Ambien, or take in conjunction with any other impairing substance.
- Be sure that your physician knows if there are any problems with liver (hepatic) function.
- Tell your physician about any over-the-counter (OTC) medications you take.
- Consider some counseling sessions to address any underlying issues you feel may be contributing to your insomnia.
- Talk to your doctor about any concerns you have about your use of alcohol or other drugs.
Ambien Overdose Treatment
If the Ambien has been ingested recently, gastric lavage (stomach pumping) may be induced. Alternative treatment may include flumazenil, which blocks the effects of the Ambien, reducing the sedative effects.
The primary cause of Ambien overdose is the use of this medication along with illicit drugs or illicit use of prescription drugs.
Vital signs will be monitored frequently. Cardiac and respiratory function will be evaluated and monitored.
A taper of the dosage over a period of 3-5 days, as with benzodiazepines, is an alternative, especially if there is risk of withdrawal seizures.
Psychosocial interventions include screening for alcohol or drug abuse, which are frequently abused along with Ambien.
- Motivation for substance abuse treatment.
To learn more about the SBIRT program, contact SAMHSA at 1-800-662-HELP.
Recovering from Ambien Overdose
If alcohol or other drugs have been a problem, help is available. Where depressive illness has been a contributing factor, treatment is effective with the use of SSRI antidepressants (e.g. Prozac) or other medications along with counseling.
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- Buysse, D.J., Angst, J., Gamma, A., et al. (2008). Prevalence, Course, and Comorbidity of Insomnia and Depression in Young Adults. Sleep 31(4): 473-480.
- Forrester, M.B. (2009). Immediate and Controlled-Release Zolpidem Ingestions Reported to Texas Poison Control Centers. Hum Exp Toxicol 28(8): 505-509.
- Gock, S.B., Wong, S.H., Nuwayhid, N., et al. (1999). Acute Zolpidem Overdose - Report of Two Cases. J Anal Toxicol 23(6): 559-62.
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- Tsai, M.J., Huang, Y.B., Wu, P.C. (2003). A Novel Clinical Pattern of Visual Hallucination after Zolpidem Use. J Toxicol Clin Toxicol 41: 869-72.