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New Concerns About Ambien

Aug 28, 2013
By Malcolm Thaler

Ambien (generic name: zolpidem) is the most widely prescribed sleeping aid in the US. Although there are many very effective non-pharmacologic methods to treat insomnia, many of us still rely on the occasional Ambien to get to sleep when all else fails. Although there is little data to suggest that the drug contributes to the overall length of sleep time, it has been shown to decrease sleep latency — that is, the time it takes to fall asleep — by about 20 minutes. But this benefit comes with a price.

Ambien Can Impact Next-Day Activities

Recent analysis has shown that Ambien can have a significant impact on your ability to perform activities requiring a high level of alertness the following morning. Investigators have found that high blood levels of Ambien associated with significant driving impairment are often present eight hours after taking the drug. Here are the important numbers:

  • Among people taking 10 mg of immediate-release Ambien, 15% of women and 3% of men have high blood levels of the drug 8 hours later.
  • Among people taking 12.5 mg of extended-release Ambien, 33% of women and 25% of men have high blood levels of the drug 8 hours later.

Why does Ambien affect women more than men in this way? Women metabolize the drug more slowly than men, and thus clear the drug more slowly from their system, maintaining higher blood levels for much longer periods.

These results clearly show the greater risk associated with the long-acting, extended-release forms of Ambien. But as you can see, there is a significant risk with the shorter-acting form as well.

A New, Stricter FDA Recommendation

The FDA recently lowered the dosing recommendations of Ambien from 10 mg to 5 mg for the immediate-release form and from 12.5 mg to 6.25 mg for the extended-release form. The group aimed these recommendations primarily at women, but strongly suggested that men follow them as well. Now, supported by data like that cited above, the FDA has announced a stricter recommendation that states that people taking the extended-release form at any dose should not drive or engage in any activity requiring full alertness the day after using the drug, even if they have slept for a full 8 hours.

The extended-release form of Ambien actually offers very little benefit in terms of sleep latency or length of sleep over the immediate-release form. Therefore, in light of the statistics above, it is reasonable to question the value of this particular preparation. We urge you to take a commonsense approach to using Ambien, and consider the following guidelines:

  • Only use Ambien on rare occasions when absolutely needed; see your health care provider for guidance on proper sleep hygiene and other non-prescription approaches to managing insomnia
  • If you must use Ambien, avoid the extended-release forms and use only the immediate-release forms in the lowest dose possible
  • If you have taken Ambien, follow the FDA guidelines and, the following day, avoid driving and any other activities requiring you to be at maximal alertness

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Malcolm Thaler

Malcolm enjoys being on the front lines of patient care, managing diagnostic and therapeutic challenges with a compassionate, integrative approach that stresses close doctor-patient collaboration. He is the author and chief editor of several best-selling medical textbooks and online resources, and has extensive expertise in managing a wide range of issues including the prevention and treatment of cardiovascular disease, diabetes, and sports injuries. Malcolm graduated magna cum laude from Amherst College, received his MD from Duke University, and completed his residency in Internal Medicine at Harvard's New England Deaconess Hospital and Temple University Hospital. He joined One Medical from his national award-winning Internal Medicine practice in Pennsylvania and was an attending physician at The Bryn Mawr Hospital since 1986. He is certified through the American Board of Internal Medicine. Malcolm is a One Medical Group provider and sees patients in our New York offices.

The One Medical blog is published by One Medical, a national, modern primary care practice pairing 24/7 virtual care services with inviting and convenient in-person care at over 100 locations across the U.S. One Medical is on a mission to transform health care for all through a human-centered, technology-powered approach to caring for people at every stage of life.

Any general advice posted on our blog, website, or app is for informational purposes only and is not intended to replace or substitute for any medical or other advice. 1Life Healthcare, Inc. and the One Medical entities make no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical services provider.