Ambien, also known by its generic name zolpidem, is a popular prescription sedative/hypnotic drug that is used to treat insomnia. Ambien is a “z-drug” that acts as a central nervous system (CNS) depressant, meaning that it reduces brain activity and causes drowsiness.
Z-drugs work by enhancing the signaling of a neurotransmitter called GABA. GABA inhibits brain activity, which has a sedating effect. Ambien and other z-drugs are associated with a risk for dependency and addiction and should only be used intermittently and at the lowest effective dose.
Ambien is similar to the benzodiazepine family of drugs — which are notoriously addictive and can be very dangerous to quit abruptly. Although Ambien is generally less risky than benzodiazepines, similar concerns for dependence and addiction exist. For people with severe Ambien dependence, quitting abruptly can be dangerous.
Symptoms of Ambien Tolerance
Regular use of Ambien, even as prescribed, can lead patients to develop tolerance and dependence. The hallmark symptom of tolerance is a reduced response to the normal dose. For example, someone who was taking 5 mg of Ambien to fall asleep might feel, in time, that this dose is no longer effective.
If someone is dependent upon a drug, they will experience physical and/or psychological withdrawal symptoms when they reduce their dosage or stop taking Ambien. Common withdrawal symptoms associated with Ambien dependence include:
Causes Of Ambien Tolerance
The development of tolerance to a drug involves complex molecular and cellular pathways that are not completely understood. In addition, behavioral factors influence tolerance development. Factors that may affect the development of Ambien tolerance include:
- Pharmacokinetics: Pharmacokinetic tolerance is caused by changes in the amount of the drug in the body. For example, repeated use of Ambien may cause the body to respond by increasing Ambien metabolism, which will result in the need for increased doses to achieve the same effect.
- Pharmacodynamics: Pharmacodynamic tolerance is when repeated Ambien use causes the body to adapt to the presence of the drug. For example, the first time someone uses Ambien, they will experience the biggest response. As the brain adapts to the drug, Ambien no longer causes the same degree of response.
- Behavioral: Behavioral tolerance is a complex topic and there are several forms. All types of behavioral tolerance are associated with psychological adaptations to the presence of a drug. An example that many people may be familiar with is alcohol-related behavioral tolerance: the first time someone drinks to excess they will be demonstrably intoxicated (stumbling, slurred speech). If they continue to drink the same amount every day for a month, they will be just as intoxicated but they will learn how to manage the signs of intoxication by the end of the month. The body may learn how to “manage” Ambien in the same way, which will reduce its efficacy.
Because Ambien metabolism happens in the liver and kidneys, drugs that impede liver and kidney function will increase the amount of time that Ambien is available for use by the body. Among the most potent Ambien potentiators is alcohol, but combining Ambien and alcohol can be incredibly dangerous and even lethal. Other potentiators include selective serotonin reuptake inhibitors (SSRIs), which have some of the same targets in the brain.
Potentiating Ambien is never a good idea. Ambien is a CNS depressant that, with potentiation, can cause respiratory depression (shallow, irregular breathing) than can lead to coma or death.
How To Prevent Ambien Tolerance
The most effective way to prevent Ambien tolerance is to take it at the lowest effective dose and as infrequently as possible. Prescribing guidelines for Ambien indicate that the drug is only to be used as a short-term insomnia treatment and that regular use is significantly associated with dependence.
Ambien dependence can be challenging to overcome and, for people with serious physical dependence, quitting suddenly can be dangerous.
Getting Help With Ambien Addiction
The regular use of Ambien is associated with a very real risk of dependence and addiction. For people with serious dependence concerns, Ambien addiction treatment can help patients to safely manage detox and acute withdrawal. The first step toward recovery is making an appointment with an addiction specialist who is experienced with Ambien dependence.
For some people, medical detox may be an important component of safely recovering from an Ambien use disorder. Medical detox involves 24/7 support from medical professionals who can intervene in the case of complications and, when appropriate, provide medications that can ease withdrawal symptoms. Behavioral therapies are often incredibly helpful for people who struggle with insomnia.
If you or someone you love is struggling to quit taking Ambien, The Recovery Village Ridgefield can help. We offer multidisciplinary teams of rehab professionals who can address the physical and psychological aspects of Ambien dependence and withdrawal. Call us today to learn how we can help you overcome Ambien dependence and regain control of your life.
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National Institute on Drug Abuse. “The Neurobiology of Drug Addiction.” Updated January 2007. Accessed September 28, 2019.
Gunja, Naren. “The Clinical and Forensic Toxicology of Z-drugs.” Journal of Medical Toxicology, June 2013. Accessed September 29, 2019.
Bespalov, Anton; Müller, Reinhold; Relo, Ana-Lucia; Hudzik, Thomas J. “Drug Tolerance: A Known Unknown in Translational Neuroscience.” Trends in Pharmacological Sciences, May 2016. Accessed September 29, 2019.
Chopra, Nitin; Rayapati, Abner; Patel, Aarti. “Potentiating the Adverse Effects of Zolpidem in a Patient with Alcohol Dependence and SSRI use.” Clinical Medical Reviews and Case Reports, July 2015. Accessed September 29, 2019.
FDA.gov. “Ambien (zolpidem tartrate) prescribing information.” Updated February 2008. Accessed September 29, 2019.
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