Ambien and Ambien CR interactions: Alcohol, medications, and other factors

Ambien and Ambien CR (zolpidem) are brand-name prescription drugs used for the short-term treatment of insomnia. As with other medications, Ambien and Ambien CR can interact with alcohol and certain other drugs. They can also interact with some supplements. An interaction occurs when one substance causes another substance to have a different effect than expected.

The “CR” in Ambien CR is short for “controlled release.” This means the drug is released slowly over time.

For details about the interactions of Ambien and Ambien CR, keep reading. For additional information about the two drugs, see this article.

In some cases, a factor or condition could prevent your doctor from prescribing Ambien or Ambien CR due to the risk of harm. This is known as a contraindication. The contraindications of Ambien and Ambien CR include:

Having unusual behaviors while sleeping

Ambien and Ambien CR can sometimes cause unusual behaviors while sleeping. In fact, the drugs have a boxed warning about this risk. This is a serious warning from the Food and Drug Administration (FDA). Due to the risk, doctors typically will not prescribe Ambien or Ambien CR if you’ve had unusual sleep behaviors after taking either drug in the past. To learn more, see “Boxed warning: Risk of unusual behaviors while sleeping” at the top of this article.

Having had an allergic reaction to Ambien, Ambien CR, or any of their ingredients

If you’ve had an allergic reaction to Ambien, Ambien CR, or any of their ingredients, your doctor will likely not prescribe Ambien and Ambien CR. This is because having had a past allergic reaction can increase your risk of experiencing another one with either drug.

Note: Before you start treatment with Ambien or Ambien CR, it’s important to tell your doctor if either of these contraindications applies to you. Your doctor can determine whether Ambien, Ambien CR, or a different drug is right for your needs.

You should not drink alcohol with Ambien or Ambien CR because of several risks.

Consuming alcohol with Ambien or Ambien CR can increase your risk of a serious side effect called central nervous system (CNS) depression. With CNS depression, activity in your brain and spinal cord slows down. This can cause:

• slow, shallow breathing
• slow heart rate
• muscle weakness
• confusion
• loss of consciousness
• seizure
• coma

In rare cases, CNS depression may also be fatal. In addition, drinking alcohol with Ambien or Ambien CR can increase your risk of unusual behaviors while sleeping. The drugs have a boxed warning about the risk of these behaviors. To learn more, see “Boxed warning: Risk of unusual behaviors while sleeping” at the top of this article.

Drinking alcohol with Ambien or Ambien CR can also increase your risk of side effects the day after taking the medication. The side effects may include drowsiness, reduced alertness, and blurry or double vision. They can also include slowed reaction times and dizziness. The side effects may affect your ability to drive or do other activities.

If you’re concerned about avoiding alcohol while taking Ambien or Ambien CR, talk with your doctor.

Before you start treatment with Ambien or Ambien CR, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. They can advise you on what you should not mix with Ambien and Ambien CR.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a chart of drugs that can interact with Ambien and Ambien CR. Keep in mind that this chart does not include all drugs that may interact with Ambien and Ambien CR. Some of these interactions are described in detail just below in “Drug interactions in depth.”

Here’s a closer look at certain drug interactions of Ambien and Ambien CR.

CNS depressants

Central nervous system (CNS) depressants are drugs that slow down nerve activity in your central nervous system (brain and spinal cord). These drugs typically cause drowsiness. Ambien and Ambien CR are CNS depressants.

Interaction result. Increased risk of the following side effects:

• drowsiness
• reduced alertness
• increased risk of falls
• CNS depression,* which can cause symptoms such as:
  • slow, shallow breathing
  • slow heart rate
  • muscle weakness
  • confusion
  • loss of consciousness
  • seizure
  • coma
• unusual behaviors while sleeping†
• side effects the day after taking these drugs, such as:
  • drowsiness
  • reduced alertness
  • blurry or double vision
  • slowed reaction times
  • dizziness

* In some cases, CNS depression may be fatal.
† Ambien and Ambien CR have a boxed warning about the risk of these behaviors. See “Boxed warning: Risk of unusual behaviors while sleeping” at the top of this article for more information.

Interaction explained. Ambien and Ambien CR are CNS depressants. Taking either drug with another CNS depressant may increase the risk of the side effects mentioned above.

Examples of CNS depressant drugs. Here are some CNS depressant drugs:

• benzodiazepines used for anxiety or insomnia, such as Klonopin (clonazepam) or Valium (diazepam)
• other sleeping pills, such as Sonata (zaleplon)
• opioids, such as Hysingla ER (hydrocodone)
• tricyclic antidepressants, such as amitriptyline
• the antidepressant trazodone
• the seizure and nerve pain medication Neurontin (gabapentin)
• antipsychotics, such as chlorpromazine

Steps you or your doctor may take. Due to this interaction, doctors typically will not prescribe Ambien and Ambien CR with benzodiazepines or other sleeping pills.

If your doctor does prescribe Ambien or Ambien CR with other CNS depressants:

• They’ll likely decrease the dosage of Ambien or Ambien CR.
• You should not drive or perform other potentially dangerous activities, such as operating machinery. If you develop side effects the day after taking these drugs together, it’s important to avoid potentially dangerous activities until you have fully recovered.

Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant. These drugs can cause changes in sleep. Doctors sometimes prescribe Ambien or Ambien CR to treat sleep problems in people taking an SSRI for depression.

Interaction result. Increased risk of side effects of Ambien or Ambien CR.

Interaction explained. SSRIs may reduce how well your body breaks down Ambien and Ambien CR. This could raise the level of these drugs in your body, which may increase the risk of side effects from them.

Also, in rare cases, Ambien, Ambien CR, and SSRIs can all cause changes in thinking or behavior. This means that if you take Ambien or Ambien CR with an SSRI antidepressant, your risk of side effects can increase further.

Side effects that have been rarely reported in people taking Ambien or Ambien CR with SSRIs include delusions and hallucinations. The side effects also include disorientation (not knowing who or where you are or the date).

Examples of SSRIs. Here are some SSRIs:

• Lexapro (escitalopram)
• Prozac (fluoxetine)
• Luvox (fluvoxamine)
• Zoloft (sertraline)

Steps you or your doctor may take. If you takeAmbien or Ambien CR with an SSRI antidepressant, tell your doctor if you experience any changes in your thinking or behavior. Your doctor may lower your dose of Ambien or Ambien CR. Or they may recommend that you stop taking it altogether.

CYP3A4 inhibitors

CYP3A4 inhibitors are drugs that reduce the action of an enzyme in your liver called CYP3A4. An enzyme is a protein that helps chemical reactions occur. CYP stands for cytochrome P450. CYP3A4 helps break down certain drugs and remove them from your body.

Interaction result. Increased risk of side effects of Ambien and Ambien CR.

Interaction explained. CYP3A4 usually breaks down Ambien and Ambien CR in your body. CYP3A4 inhibitors reduce how well your system breaks down Ambien and Ambien CR. This can raise the level of the drug in your body, which may increase the risk of side effects from it.

Examples of CYP3A4 inhibitor drugs. Here are some CYP3A4 inhibitors:

• certain antibiotics, such as clarithromycin and Cipro (ciprofloxacin)
• certain antifungals, such as ketoconazole
• certain HIV drugs, such as ritonavir

Steps you or your doctor may take. If you take a CYP3A4 inhibitor, your doctor will typically prescribe a dosage of Ambien or Ambien CR that’s lower than usual.

Ambien and Ambien CR may have other interactions, such as with supplements. You’ll find details below.

Ambien and Ambien CR interactions with supplements

Before you start treatment with Ambien or Ambien CR, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Ambien and Ambien CR interactions with herbs

Taking the herb St. John’s wort with Ambien or Ambien CR can make Ambien or Ambien CR less effective than usual.

St. John’s wort is an inducer (activator) of an enzyme in your liver called cytochrome P450 (CYP) 3A4. An enzyme is a protein that helps chemical reactions occur. CYP3A4 helps break down Ambien and Ambien CR in your body.

CYP3A4 inducers such as St. John’s wort increase the activity of CYP3A4. This increases the breakdown of Ambien or Ambien CR in your system, which could reduce the drug’s effectiveness. Your doctor will likely recommend that you do not take St. John’s wort with Ambien or Ambien CR.

Ambien and Ambien CR and vitamins

There were no specific reports of vitamins interacting with Ambien and Ambien CR. However, it’s still important to check with your doctor or pharmacist before taking any of these products during treatment with Ambien or Ambien CR.

Ambien and Ambien CR and food

Food interactions with Ambien and Ambien CR have not been reported. If you’d like to learn more about eating certain foods during treatment with either drug, talk with your doctor.

Ambien and Ambien CR and vaccines

Vaccines have not been reported to interact with Ambien or Ambien CR. For more information about getting certain vaccines during treatment with either medication, talk with your doctor.

Ambien and Ambien CR and lab tests

There were no reports of lab test interactions with Ambien and Ambien CR. If you’d like details about having certain lab tests during treatment with either drug, talk with your doctor.

Ambien and Ambien CR interaction with cannabis or CBD

Cannabis (marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Ambien and Ambien CR. These products may increase or decrease the activity of an enzyme in your liver called CYP3A4. This enzyme helps Ambien and Ambien CR break down in your body.

If cannabis products increase the activity of CYP3A4, it may lower the level of Ambien or Ambien CR in your system. This could make these drugs less effective than usual.

If cannabis products decrease the activity of CYP3A4, it may raise the level of Ambien or Ambien CR in your body. This could increase the risk of side effects from Ambien or Ambien CR.

In addition, Ambien, Ambien CR, and cannabis can cause drowsiness and dizziness. If you take the drugs together, you may have an increased risk of these side effects.

Before you start treatment with Ambien or Ambien CR, tell your doctor and pharmacist if you take cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Ambien and Ambien CR. Before you take either medication, be sure to talk with your doctor about your health history. Ambien or Ambien CR may not be the right treatment option for you if you have certain medical conditions or other factors affecting your health. These include:

• Unusual behaviors while sleeping. Ambien and Ambien CR can sometimes cause unusual behaviors while sleeping. In fact, the drugs have a boxed warning about this risk. This is a serious warning from the Food and Drug Administration (FDA). Due to this risk, doctors typically will not prescribe Ambien or Ambien CR if you’ve had unusual sleep behaviors after taking either drug in the past. To learn more, see “Boxed warning: Risk of unusual behaviors while sleeping” at the top of this article.
• Older age. Ambien and Ambien CR cause drowsiness and reduced alertness. As a result, they can increase the risk of falls, especially in older people. If you’re age 65 years or older, your doctor may prescribe a dosage of Ambien or Ambien CR that’s lower than usual.
• Breathing problems. Ambien and Ambien CR can sometimes cause slow, shallow breathing. If you have a breathing problem, such as sleep apnea or chronic obstructive pulmonary disease (COPD), these drugs could worsen your symptoms. Talk with your doctor about whether Ambien, Ambien CR, or a different treatment is right for you.
• Liver problems. If you have liver problems, you may have an increased risk of side effects with Ambien and Ambien CR. Your doctor may prescribe a dosage of either drug that’s lower than usual. However, if you have a severe liver problem, your doctor will likely not prescribe these medications.
• History of drug or alcohol misuse or dependence. Ambien and Ambien CR are controlled substances that carry a risk of misuse (also called abuse) and dependence. If you’ve misused or been dependent on drugs or alcohol in the past, you may have an increased risk of experiencing this with Ambien and Ambien CR. If you’re taking either medication, your doctor will monitor you for any symptoms of misuse or dependence.
• Pregnancy. It’s not known if Ambien and Ambien CR are safe to take during pregnancy. If you’re pregnant, talk with your doctor about whether Ambien, Ambien CR, or a different drug is right for you.
• Breastfeeding. Ambien and Ambien CR can pass into breast milk and cause side effects in a child who is breastfed. If you’re breastfeeding, talk with your doctor about whether Ambien, Ambien CR, or a different medication is right for you.
• Allergic reaction. If you’ve had an allergic reaction to Ambien, Ambien CR, or any of their ingredients, your doctor will likely not prescribe either drug. To learn more, see “When to avoid Ambien and Ambien CR” above.
• Mental health conditions, such as depression. Ambien and Ambien CR can sometimes cause changes in thinking or behavior and worsen symptoms of mental health conditions. The drugs may also worsen depression and increase the risk of suicidal thoughts or actions. If you have a mental health condition, talk with your doctor about whether Ambien or Ambien CR are right for you.

Here are some frequently asked questions about Ambien and Ambien CR and possible interactions.

Can Ambien and melatonin be taken together?

No, that’s not usually recommended. Melatonin supplements are used to help with sleep. They’re not known to interact with Ambien or Ambien CR. However, doctors usually advise not taking other sleep supplements or sleep medications with Ambien or Ambien CR.

Ambien and Ambien CR are prescribed for insomnia. Treating sleep problems with both supplements and medication could make you extremely tired. This could be dangerous in some situations, such as when driving.

If you’re taking melatonin and are interested in learning more about Ambien and Ambien CR, talk with your doctor or pharmacist.

Does Ambien interact with blood pressure medications?

Ambien and Ambien CR are not known to interact with blood pressure medications. However, Ambien, Ambien CR, and blood pressure drugs can all cause dizziness. So you may be more likely than usual to have dizziness if you take Ambien or Ambien CR with blood pressure medication. And dizziness could increase your risk of falls, especially if you’re an older adult.

If you take a blood pressure drug and are considering treatment with Ambien or Ambien CR, talk with your doctor.

Can I take Ambien with prednisone?

Maybe. Ambien and Ambien CR are not known to interact with prednisone. It’s generally safe to take these medications together if your doctor prescribes them. Prednisone is a drug that’s used to reduce inflammation.

If you have additional questions about taking Ambien or Ambien CR with prednisone, talk with your doctor or pharmacist.

You can take certain steps to help prevent interactions with Ambien and Ambien CR. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or take cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the label and any other paperwork that comes with Ambien or Ambien CR. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the prescribing information, may contain details about interactions. If this information is difficult to understand, ask your doctor or pharmacist to help explain it.

You can also help prevent interactions with Ambien or Ambien CR by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Ambien and Ambien CR. These resources might help:

• Overview of Ambien and Ambien CR. For a general overview of Ambien and Ambien CR, see this article.
• Drug comparison. Find information abouthow Ambien and Ambien CR compare with Lunesta.
• Facts about insomnia. To learn more about insomnia, see our science of sleep hub and list of sleep-related articles.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.