Dangers of Mixing Ambien and Alcohol: Precautions and Side Effects

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Ambien is classified as a sedative-hypnotic, a class of drugs prescribed to treat sleep disorders. Because they are both central nervous system (CNS) depressants, mixing Ambien and alcohol is dangerous and can lead to potentially life-threatening consequences.

What is Ambien?

As a sedative-hypnotic, Ambien helps you fall asleep and stay asleep throughout the night. Ambien’s mechanism of action increases gamma-aminobutyric acid (GABA) in the brain, thereby allowing the activity in the brain and central nervous system (CNS) to slow down, quickly initiating sleep.

Ambien is the brand name for zolpidem and comes in various forms. It can be prescribed as tablets (Ambien) or as extended-release, long-acting tablets (Ambien CR). Both of these forms are taken orally. Zolpidem can also be prescribed as an oral spray (Zolpimist) or as a tablet to place sublingually under the tongue (Edular, Intermezzo).^1,2

More than one-third of Americans have insomnia or other sleep disorders. Zolpidem is the most common prescription medication used to treat insomnia (difficulty falling or staying asleep) and other sleep disorders.^1,2

Side Effects of Mixing Ambien and Alcohol

Mixing Ambien and alcohol is dangerous because they are both central nervous system (CNS) depressants, meaning they slow your breathing and heart rate. Warning labels by the Food and Drug Administration (FDA) can be found on the packaging of Ambien, indicating the risks of drinking while taking it. The labels advise and warn against taking Ambien if you have consumed alcohol.^3,4

The reason for this is that the side effects of mixing the two can cause dangerous cognitive and physical impairment and potentially fatal overdose. Alcohol works on the same GABA receptors in the brain as Ambien does, which increases their effects when you combine the two. Both drugs suppress the CNS, which is the part of the nervous system responsible for controlling breathing, brain function, and heart rate.¹

When you mix alcohol and Ambien, their effects are heightened and intensified and can lead to the following side effects and health problems:^5,6

Drowsiness or sleepiness
Dizziness
Unusual behavior
Memory problems
Confusion
Disorientation
Hallucinations
Impaired motor control
Compromised and slowed breathing

Another consideration when mixing the two is that it takes the human body time to process and eliminate Ambien. The amount of time it takes the human body to do this varies based on your:⁷

Weight
Age
Overall functioning of kidney and liver
Pre-existing medical conditions
Co-occurring medical conditions and disorders
Other prescription medications
Use of other illicit substances (non-prescribed)

Research shows that the average time to eliminate 5 to 10 mg of Ambien from the system is about 14 to 17 hours.⁷ This is yet another reason for staying away from alcohol while taking Ambien. Because of the potential dangers of taking Ambien alone, plus the added risks of combining alcohol and Ambien, the Food and Drug Administration (FDA) mandated stronger boxed warnings. Regardless of your demographics and current level of health, it is important to heed these warnings.^3,4

Finally, you may experience the side effects of Ambien the morning after taking it. This may include daytime drowsiness or lowered alertness upon awakening and impaired driving. This could happen especially if you do not get a whole night of sleep, defined as 7-8 hours.

Combining alcohol and Ambien can also increase the risk of day-after or next-day side effects. Working with your doctor to find the proper dosing to limit day-after side effects is essential. If you consume alcohol while taking Ambien the night before, this behavior increases the likelihood you will experience day-after side effects. If you are still drowsy, have slow reflexes, or drowsy the next morning, stay away from driving and operating heavy machinery. Contact a medical provider or your treatment team if you think there is a medical emergency or a risk for one.⁴

Signs of an Ambien and Alcohol Overdose

While some of these side effects may seem like a minor inconvenience, combining Ambien and alcohol can lead to overdose. An overdose is defined as an excessive and dangerous dose of a drug that the body cannot process. It is when you take more than the recommended or standard amount of something (in this case, a drug or alcohol). An Ambien and alcohol overdose can result in harmful, severe symptoms that can be fatal.

Due to the fast-acting sedative qualities of Ambien and both Ambien’s and alcohol’s effects on the CNS, taking the two together can lead to unconsciousness and coma. Hence, mixing Ambien and alcohol increases the risk of overdose.⁴

Signs and symptoms of Ambien overdose are:⁴

Challenged breathing
Lowered levels of consciousness
Loss of consciousness
Slowed heartbeat
Pale/blue lips, skin, and/or fingernails
Difficulty walking
Comat

If you suspect an overdose, call 911 immediately.

Should an overdose occur, seek medical treatment immediately. If you have taken too much Ambien or combined it with alcohol, you may need your breathing and pulse monitored closely until it returns to normal. You may also need your stomach pumped and require treatment with intravenous fluids.³

Long-Term Consequences of Mixing Ambien and Alcohol

Since Ambien is prescribed for insomnia and other sleep disorders, it is intended for short-term use, typically no more than two weeks. The use of Ambien is not to replace a long-term cure or solution.³ It may be beneficial to look at lifestyle factors that are contributing to sleep challenges and insomnia, such as:³

Caffeine intake late at night
Sleep hygiene
Being around computer and technology screens in the evening
Melatonin production
Shift work (particularly second shift and rotating shifts)
Techniques to calm thoughts at night
Doing non-stimulating activities before bad
Napping during the day
Daytime activity (sedentary lifestyle)
Eating enough during the day so you aren’t eating the bulk of your calories at night

If you are drinking while taking Ambien, you may want to speak to a professional about it or seek treatment, such as working with a sleep therapist, sleep specialist, or entering a sleep study to rule out underlying sleep disorders or structural causes for insomnia.

Research suggests that there might be a link between taking Ambien on a long-term basis and an increased mortality rate.⁸ In rare cases, liver damage can be a side effect of Ambien since the liver primarily metabolizes it.⁹ The FDA recommends that the lowest recommended doses of Ambien should be prescribed if you have a hepatic (liver) impairment. If you have cirrhosis of the liver and renal disease, it is recommended to take lower dosages of Ambien.¹⁰

Sleep driving, sleepwalking, and sleep-related eating disorders have all been reported as side effects of Ambien. While this affects less than 1% of prescription Ambien users, the risk of these side effects increases when Ambien is taken with alcohol.¹¹ As such, it increases your risk of injury or catastrophic accidents should you be sleep-driving. Not being fully awake can result in serious injury and can be life-threatening.¹²

Driving on Ambien impairs your driving as much as if you had a blood alcohol content (BAC) of 0.05- 0.08%. This is why the FDA has placed warning labels on Ambien packages urging you not to mix alcohol and Ambien and to work with your medical professional to find the appropriate dosing to eliminate daytime drowsiness (the day after you take Ambien).¹³

Alcohol and Ambien Addiction

Another serious risk of mixing these substances is that of developing an addiction to Ambien and alcohol, also known as a polysubstance addiction. An addiction is characterized by compulsive alcohol and Ambien use regardless of negative consequences. This may involve problems at work, such as excessive absences or write-ups, issues with school, including late assignments or poor grades, or relationship problems, such as fighting or separation. Many people who have a polysubstance addiction will continue to use substances despite knowing that substance use is leading to or worsening medical or psychological conditions.

Although some people be able to overcome a mild addiction on their own, many people may need professional addiction treatment to recover from alcohol and Ambien addiction and live a substance-free life.

Treatment for Ambien and Alcohol Addiction

Treatment for misusing Ambien or combining Ambien and alcohol may include detox, also known as medically managed withdrawal. Receiving professional medical detox will allow you to be supervised in a medical setting while you are tapered off Ambien and receive medication, supportive treatment, and counseling.¹⁴

After you are successfully and safely detoxed, it is recommended to continue inpatient zolpidem rehab or outpatient treatment to address why you had trouble taking Ambien as prescribed and combined with alcohol.¹⁴

The level of treatment that you will be referred to would depend on your needs and current life circumstances. It is often decided through an assessment and discussion with a credentialed professional.^15,16 Regardless of what level of treatment you go to after detox, it would be beneficial to receive education about addiction, your triggers, and counseling.¹⁷

Each person has unique circumstances and needs. Treatment post-detox would be different based on those circumstances. It is best to be honest with your doctor, clinical team, and loved ones so you can receive the most appropriate level of care following detox. Treatment components could include relapse prevention education, behavioral help to address insomnia without using Ambien, alcohol, and other sleep-inducing drugs, self-care, social support, and self-help groups.^14,15,16,17

If you or a loved one is struggling with substance abuse or taking Ambien with alcohol, give us a call at 800-681-1058 (Who Answers?) to find the right rehab for you. One of our knowledgeable treatment support specialists is available 24/7 to assist you.

Resources

National Institute on Drug Abuse. (2020, June). Misuse of Prescription Drugs Research Report: What Classes of Prescription Drugs are Commonly Misused?
Bhaskar, S., Hemavathy, D., & Prasad, S. (2016). Prevalence of Chronic Insomnia in Adult Patients and its Correlation with Medical Comorbidities. Journal of Family Medicine and Primary Care, 5(4), 780-784
Center for Disease Control (n.d.) Sleep and Sleep Disorders.
National Library of Medicine. (n.d.) Ambien.
National Institute in Alcohol Abuse and Alcoholism. (n.d.) Harmful Interactions: Mixing Alcohol with Medicines.
Weathermon, R., & Crabb, D.W. (1999). Alcohol and Medication Interactions. Alcohol Res Health, 23(1), 40-54.
Gunja, N. (2013). The Clinical and Forensic Toxicology of Z-drugs. Journal of Medical Toxicology, 9(2), 155-162.
Silversten, B., Madsen, I.E., Salo, P., Tell, G.S., &Overland, S. (2015). Use of Sleep Medications and Mortality: The Hordaland Health Study. Drugs Real World Outcomes, 2(2), 123-128.
Liao, K.F., Lin, C.L., Lai, S.W., & Chen, W.C. (2015). Zolpidem Use Associated With Increased Risk of Pyogenic Liver Abscess. 94(32), e1302.
Langtry, H.D. & Benfield, Pl. (2012). Zolpidem: A Review of its Pharmacodynamic and Pharmacokinetic and Therapeutic Potential. Drugs, 40, 291-313.
Poceta, J. S. (2011). Zolpidem Ingestion, Automatisms, and Sleep Driving: A Clinical and Legal Case Series. Journal of Clinical Sleep Medicine, 7(6), 632-638.
Food and Drug Administration. (2019, April 30). FDA Requires Stronger Warnings About Rare But Serious Incidents Related to Certain Prescription Insomnia Medicines: Updated Warnings for Eszopiclone, Zaleplon and Zolpidem.
Gunja, N. (2013). In the Zzz Zone: The Effects of Z-Drugs on Human Performance and Driving. Journal of Medical Toxicology, 9(2), 163-171.
Center for Substance Abuse Treatment. (2015). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No 45.
Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Treatment Improvement Protocol (TIP) Series, No. 47. Center for Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2006.
Mee-Lee, David. (2016, November 3). How to Deal with Relapse, Continued Use and Continued Problems: Working Together to Promote Recovery.
U.S. Department of Veterans Affairs. (2014). Reducing Relapse Risk.

Dangers of Mixing Ambien and Alcohol