*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
Ambien and Ambien CR are prescription sleep aids used for the treatment of insomnia. Ambien, with the active ingredient zolpidem, is used to help individuals achieve and maintain restful sleep. It is FDA-approved for only short-term use as prolonged use of this drug may lead to dependence and unwanted side effects. Please adhere to exact healthcare provider instructions when taking this medication to help prevent potential associated risks.1, 2
Boxed Warning: Zolpidem (Ambien/Ambien CR)
Zolpidem, the active ingredient in Ambien, has a black box warning. These are the most serious types of warnings from the Food and Drug Administration (FDA). Zolpidem can cause dangerous sleep behaviors like sleep-walking and sleep-driving. These behaviors can lead to serious injury and possibly death. Talk with your doctor about any sleep behaviors you have had or that you have while taking zolpidem to determine if the medication is safe for you to take.
Ambien is a controlled substance, which means that it’s more likely to be misused or cause dependence. There are federal and state laws that limit the amount of medication that can be prescribed or dispensed within a certain period of time.
What Are Ambien & Ambien CR?
Ambien, with the active ingredient zolpidem, is FDA-approved to treat insomnia. It’s in a drug class with sedative/hypnotic medications. Ambien targets specific receptors in the brain that inhibit certain types of activity in the brain, which can induce and maintain sleep. FDA approval indicates that the medication has undergone rigorous testing to support its safety and efficacy for its intended population.1, 2 Ambien and Ambien CR are both available in generic form.
What’s the Difference Between Ambien & Ambien CR?
Ambien and Ambien CR have the same active ingredient, zolpidem. Ambien CR is an extended-release form that works differently to last longer in the body, which may help you stay asleep longer. If you happen to wake up, you should be able to fall back asleep more easily. Ambien is used to initiate sleep but does not work as well as Ambien CR to keep you asleep for longer.
Ambien CR will be prescribed in cases where longer effects are needed if symptoms involve waking up during the night. If you continue to wake up during the night while taking Ambien, this problem may be solved with the use of Ambien CR instead.1, 2, 3
How Does Ambien Work?
Ambien works by affecting specific receptors in the brain that diminish alertness. This may help you fall asleep faster and give you the ability to stay asleep longer. This makes Ambien beneficial for patients who experience insomnia or difficulties falling or staying asleep.
Ambien CR has a controlled-release formula, which means it releases medication over an extended length of time. This sustained effect helps patients who have trouble staying asleep throughout the night.1, 2, 3
What Is Ambien Used to Treat?
Ambien and Ambien CR are both FDA-approved for the short-term treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance. No off-label uses are noted for Ambien or Ambien CR.1, 2, 4
Common Side Effects of Ambien
Common side effects of Ambien include sleepiness, dizziness, and diarrhea. These effects may be temporary and are often manageable. If they continue to occur or are not manageable, speak with your provider. Grogginess and feelings of being disoriented may occur with long-term use.
Common side effects of Ambien include:1, 2
- Sleepiness
- Dizziness
- Diarrhea
- Grogginess
- Slowed thinking and motor skills
*All medications, including Ambien, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor or pharmacist about any questions you have and to understand the potential side effects and benefits of any medication.
Serious Side Effects of Ambien
Ambien can produce a variety of serious side effects. Complex sleep behaviors have been seen when Ambien is not taken as prescribed, such as sleep-walking. Unusual mental and behavior changes require immediate medical attention as Ambien can worsen depression and suicidal thinking. Any respiratory issues also need to be tended to immediately by a medical professional. Seek immediate help if you experience slowed breathing or anaphylactic reactions (trouble breathing, swelling of lips, tongue, or throat).
Serious side effects of Ambien include:1, 2
- Complex sleep behaviors
- Abnormal thinking and behavior changes
- Worsening of depression and suicidal thinking
- Respiratory depression
- Severe anaphylactic reactions (trouble breathing, swelling of lips, tongue, or throat)
- Impaired alertness and motor coordination
*All medications, including Ambien, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor or pharmacist about any questions you have and to understand the potential side effects and benefits of any medication.
What Are the Risks & Warnings for Ambien?
Risk of Dangerous Sleep Behaviors
Zolpidem can cause dangerous sleep behaviors like sleep-walking and sleep-driving. These behavoiors can lead to serious injury and possibly death. Talk with your doctor about any sleep behaviors you have had or that you have while taking zolpidem to determine if the medication is safe for you to take.
Risk of Depression & Thoughts of Suicide
Zolpidem may cause worsened depression, and may increase the risk of thoughts suicide or self-harm. Your doctor will prescribe the lowest effective dose and monitor your mood closely.
Risk of Abnormal Thinking & Behavioral Changes
Changes including loss of self-control, unusual behavior, agitation, and feeling unusually detached or disconnected (depersonalization) have been reported. Notify your doctor promptly if you notice any changes.
Risk of Severe Allergic Reactions
Serious allergic reactions have been reported among those who have taken Ambien. This includes swelling of the tongue, lips, and throat, as well as breathing problems. This is more likely to occur in patients with impaired breathing. Seek immediate medical attention if you experience any of these symptoms.
Risk of CNS-depressant Effects
Zolpidem can make you feel less awake, especially in the morning, especially if you mix it with alcohol or other drugs. Be cautious when performing tasks requiring focus.
Risk of Breathing Problems
If you have breathing problems, zolpidem may worsen them. Your doctor will recommend alternative treatments.
Risk of Hepatic (Livrer) Impairment
Individuals with severe liver problems should avoid zolpidem due to potential risks. Patients with mild to moderate liver damage may also be at risk. Your doctor will suggest alternative treatments.
Risk of Withdrawal Effects
Abruptly stopping zolpidem may lead to withdrawal symptoms such as stomach cramps or tremors. Your doctor will assist you in gradually reducing your dose.
There may be additional warnings or precautions with this Ambien. Talk with your healthcare provider about all the risks before you start taking this Ambien.
What to Avoid When Taking Ambien
Different drug interactions can lead to depression of the CNS or respiratory system. Other drugs can impair alertness or the effect of Ambien itself in the body.
Six substances you should avoid while taking Ambien include:1, 2
- CNS depressants, including alcohol: Taking Ambien with alcohol can lead to increased depression of the central nervous system. Impaired alertness and motor coordination can be experienced.
- Opioids: Using opioids with Ambien may increase risk of slowed breathing. Can have a worsened effect in patients with compromised respiratory function.
- Imipramine: Decreased alertness can be observed when taking imipramine with Ambien.
- Chlorpromazine: Impaired alertness and psychomotor performance has been observed when using chlorpromazine with Ambien.
- CYP3A4 inducers (Rifampin or St. John’s wort): Using these substances with Ambien use may decrease its effectiveness.
- Ketoconazole: Combining ketoconazole with Ambien may amplify the effects of Ambien, leading to increased drowsiness and other side effects.
This is not a comprehensive list of the possible interactions with zolpidem. You should talk with your healthcare provider and your pharmacist about all prescription and over-the-counter medications, herbs, and supplements you take before starting zolpidem.
Ambien Dosages for FDA-Approved Treatment
Ambien is typically prescribed at the lowest effective dose for the patient. Initial doses of Ambien are 5 mg for women and either 5 mg or 10 mg for men taken once per night immediately before bed. If the initial 5 mg dose is not effective, the dose can sometimes be increased to 10 mg by the prescriber.
For Ambien CR, the initial dose begins at 6.25 mg for women and can be either 6.25 or 12.5 mg for men taken once per night immediately before bed. If the 6.25 mg dose is not effective, the dose can then be increased to 12.5 mg if approved by the prescriber. The treatment with Ambien or Ambien CR should be as short as possible and avoid extended treatment.
Older adults may be especially sensitive to the effects of Ambien or Ambien CR. The recommended initial doses for this population is 5 mg of Ambien or 6.25 mg of Ambien CR taken immediately before bedtime. Patients with severe hepatic (kidney) impairment should avoid Ambien or Ambien CR use as it may contribute to encephalopathy (disturbance of brain function).1, 2
Ambien Forms & Strengths
Dosage forms of Ambien only include oral tablets. While there are multiple strengths, the lowest dose effective for the patient is recommended and must not exceed a total of 10 mg daily. The recommended initial dose varies. For women, a single dose of 5 mg is recommended, while for men a single dose of 5 or 10 mg is recommended. This dose is to be taken only once per night immediately before bedtime with at least 7-8 hours remaining before you must be active again.
If the starting 5 mg dose is not effective, the dose can then be increased to 10 mg with the approval from a physician. Ambien should be taken as a single dose and should not be readministered during the same night. For geriatric patients with hepatic impairment, the recommended dose is 5 mg for men and women.
Ambien CR is a controlled-release formula that is delivered slowly over time, producing a prolonged effect. Ambien CR dosage varies between adults as well. For women, a starting single dose of 6.25 mg is prescribed, while for men a starting single dose of 12.5 mg is prescribed. If the starting dose is producing the desired effects, the dose may be increased by the prescriber. 12.5 mg is the highest daily dose recommended to be taken of Ambien CR. A prescriber may consider the Ambien CR dosage form over Ambien if the patient continues to have trouble sleeping or staying asleep after trying Ambien.
Ambien’s effect begins quickly after administration which is why it should be taken immediately before trying to fall asleep. Patients should keep in mind that the effect of Ambien can be slowed if it is taken with or immediately after a meal. Therefore, it is recommended to be taken on an empty stomach as it can help you fall asleep faster.1, 2
Ambien is available in the following forms and strengths:1, 2
- Ambien: 5 milligrams (mg) oral tablet
- Ambien: 10 milligrams (mg) oral tablet
- Ambien CR: 6.25 milligrams (mg) oral tablet
- Ambien CR: 12.5 milligrams (mg) oral tablet
How Long Does it Take for Ambien to Start Working?
Patients who take Ambien will begin to feel effects very soon after taking it. Peak of the drug will occur 90-minutes post-dose. Ambien should be taken immediately before bedtime with at least 7-8 hours remaining before scheduled wake-up time.1, 2
How Should I Take Ambien?
Ambien should be taken immediately before bedtime with at least 7-8 hours remaining before the planned wake-up time. It should be taken in one single dose and not be readministered throughout the night, even if it is not working effectively. Taking Ambien on an empty stomach is recommended as it will be absorbed better into the body. Your prescriber will start you on the lowest dose possible, increasing dosage only if they believe it is necessary. Take Ambien as prescribed to reduce the risk of adverse effects and potential abuse issues.1, 2, 3
What Happens If I Miss a Dose of Ambien?
If a dose of Ambien is missed, it should be taken at the next scheduled bedtime.1
Can You Overdose on Ambien?
Any patient can overdose on Ambien if taken in excess. Overdose of Ambien alone or in conjunction with other CNS depressants can be life-threatening. Signs and symptoms of an overdose on Ambien include impairment of consciousness ranging from drowsiness to coma, cardiovascular compromise, and respiratory issues. Fatal outcomes have been reported in Ambien overdose cases.1
What Should You Do If You Take Too Much Ambien?
If you suspect that you or someone close to you has taken too much Ambien and are at risk of an Ambien overdose, call 911 and seek immediate medical care. Be prepared to provide information such as when Ambien was taken, how much was taken, and medical history.
How to Get a Prescription for Ambien
To get Ambien, begin with an evaluation of your sleep issues. A good place to start for an evaluation like this is with your primary healthcare provider. They will know your health history, sleep patterns, and current medications and may be able to evaluate your insomnia symptoms. Or, your provider may refer you to a specialist who can assess your insomnia symptoms and prescribe Ambien, if they believe it is appropriate for you.
To get prescribed Ambien online, you will also start by getting evaluated by an online provider. It is important to find an online platform that will do a virtual consultation and can prescribe controlled substances, such as Talkiatry and Circle Medical. Not all online providers offer this type of care and prescription options.
Frequently Asked Questions
Is Ambien a Controlled Substance?
Yes, Ambien is a controlled substance. It has a DEA classification of Schedule IV. This means Ambien has less abuse potential than a Schedule III drug, but still has limited physical and psychological dependence.1
Is it Safe to Take Ambien Every Night?
It is safe to take Ambien every night as a short-term therapy option. Ambien is not recommended for long-term treatment of insomnia. The risk of abuse and dependence increases with longer duration of treatment.1
Why Am I Unable to Sleep After Taking Ambien?
The main goal of Ambien is to promote sleep, but responses to the medication can vary between individual patients. Factors like tolerance, underlying health conditions, and inadequate dosing may be responsible. If you are unable to stay asleep while taking Ambien, talk to your prescriber.1
Does Ambien Cause Amnesia?
Ambien does have the potential to cause short-term amnesia typically seen the morning after taking a dose. Impaired alertness and amnesia risk increases with dose and Ambien usage with alcohol. This effect is more common if the dose is too high, the medication is not taken as directed, or if individuals engage in activities requiring alertness shortly after taking Ambien. Tell your prescriber if you experience persistent memory problems while taking Ambien.1
Is Ambien Habit-forming or Addictive?
Yes, Ambien can be habit-forming or addictive. The class of sedative-hypnotics that Ambien belongs to has the potential for misuse or dependence which is why Ambien is only approved for short-term use. Addiction risk can be increased if a tolerance to Ambien is developed over time and higher doses are needed to attain the same effects. Ambien should only be taken as prescribed by a healthcare provider to avoid the risk of dependence or addiction.1, 3
Can Ambien Be Used During Pregnancy?
With approval from your healthcare provider, Ambien may be taken during early stages of pregnancy. Use of Ambien late in the third trimester may cause slowed breathing and sedation in neonates. Patients should notify their healthcare provider if they become pregnant or intend to become pregnant while taking Ambien.1
Can Ambien Be Used While Breastfeeding?
Breastfeeding parents taking Ambien should monitor infants for increased sleepiness, breathing difficulties, or limpness and should seek immediate medical care if they see these signs. It may be beneficial to pump and discard breast milk during treatment for up to 23 hours after Ambien administration in order to minimize drug exposure to the breastfed infant.1
Who Should Not Take Ambien?
Individuals who have a known hypersensitivity to zolpidem, the active ingredient in Ambien, should not take this medication. Ambien use should be avoided in patients with a history of substance abuse or dependence and Ambien has the potential for misuse and addiction. Patients with a severe respiratory insufficiency or liver impairment may also be at increased risk of adverse effects. Discuss your medical history with your doctor before starting Ambien to see if it is safe for you.1
Questions to Ask Your Healthcare Provider About Ambien
If you want to consider taking Ambien, start by talking to your primary healthcare provider about an evaluation. They already understand your health history and may be able to evaluate your insomnia symptoms. Or, they may refer you to a sleep specialist to evaluate your sleep needs. Alternatively, if you do not have a primary provider, an online platform offering insomnia treatment services can be a good place to start, such as Talkiatry and Circle Medical.
Questions to ask your care team about Ambien include:
- How safe is Ambien?
- How long will it take for me to adjust to taking Ambien?
- Am I at risk for more serious symptoms with Ambien if I am already taking other medications?
- What is the best dosage of Ambien to ensure fewer side effects?
- How can Ambien affect my mental health?
- Is regular Ambien or Ambien CR better for my needs?
- How long is it safe for me to use Ambien?
- Are there any warning signs I should watch out for with Ambien that might indicate a potentially harmful reaction to Ambien?
- What should I do if I miss a dose or accidentally take too much Ambien?
- Are there any alternative treatments or lifestyle changes I should consider before taking Ambien?
- Will Ambien be covered by my insurance?
Prescriber’s Tips
Choosing Therapy strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.
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AMBIEN- zolpidem tartrate tablet, film coated. (February, 2022). AccessData.fda.gov. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/
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Highlights of Prescribing Information Ambien CR. (February, 2022). Products.Sanofi.us. Retrieved from https://products.sanofi.us/ambien_cr/ambien_CR.pdf
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Prefer the Brand? Learn How to Get Ambien or Ambien CR. (2023). Your Prescription. Ambien.com. Retrieved from https://www.ambien.com/your-prescription
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Development & Approval Process (Drugs). FDA. (2022). FDA.gov. Retrieved from https://www.fda.gov/drugs/development-approval-process-drugs
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