Based on a new study by the Substance Abuse and Mental Health Services Administration (SAMHSA), estimated emergency department (ED) visits involving zolpidem (commonly known as Ambien) overmedication almost doubled from 21,824 visits in 2005-2006 to 42,274 visits in 2009-2010.
The report, "Emergency Department Visits Attributed to Overmedication That Involved the Insomnia Medication Zolpidem", is based on findings from the 2005 to 2010 Drug Abuse Warning Network (DAWN) reports. DAWN is a public health surveillance system that monitors drug-related morbidity and mortality through reports from a network of hospitals across the nation.
Overall, in 2010, there were a total of 4,916,328 drug-related visits to emergency departments throughout the nation as reference point.
An FDA-approved medication used for the short-term treatment of insomnia, zolpidem is the active ingredient in the prescription medications known as Ambien®, Ambien CR®, Edluar®, and Zolpimist®.
Millions of Americans have taken these medications for safe and effective sleep. But, in January 2013, the FDA responded to escalating reports of adverse reactions to zolpidem by requiring manufacturers to reduce the recommended dose for females by half. The FDA also made a recommendation that manufacturers reduce the recommended dose for men as well.
Concerning side effects associated with the medication include dizziness, daytime drowsiness, sleep-walking, hallucinations, agitation, and drowsiness while driving in the morning. The report also warned that when zolpidem is combined with other substances—such as narcotics, alcohol or benzodiazepines--the sedative effects of the drug can be significantly increased.
The FDA is particularly concerned about the phenomenon known as “next morning impairment,” whereby drug levels could remain elevated for persons who must perform tasks such as driving which require a high level of alertness. It seems that women are more susceptible to this phenomenon as their blood levels generally tend to remain higher compared to men. Reducing the dose may help improve alertness for patients who use these these medications.
The SAMHSA Details
Even more concerning in the current SAMHSA report is the fact that emergency department visits for males due to overmedication with zolpidem increased 150 percent from 2005-2006 to 2009-2010 compared with an increase of 69 percent for females over the same time period.
In 57 percent of the emergency department visits associated with overmedication, additional prescription drugs were noted in toxicologic screens. Benzodiazepines (26 percent) and narcotic pain relievers (25 percent) were the most common drugs noted with alcohol with zolpidem seen in 14 percent of these ED visits.
Close to 47 percent of zolpidem overmedication-related ED visits resulted in either a hospital admission or a transfer to another medical facility. And, in nearly a quarter of these patients were admitted to an intensive care unit (ICU).
The bottom line is that while prescribed sleep aids can help patients for short-term insomnia, these medications must be used with caution and patients need to be closely monitored for side effects, especially the following day.
It is quite important that patients have a frank discussion with their medical providers to discuss potential adverse reactions associated with such medication as zolipidem, and address any potential side effects when they arise. Those persons who need to drive the next morning after taking zolpidem need to consider potential risks of decreased alertness and reaction time. Elderly patients especially should use these medicines with extreme caution, if at all.
