When should I not take an Ambien?

October 11, 2025 •

4 min read

According to the FDA, Ambien (zolpidem) carries a boxed warning due to the risk of serious and potentially fatal complex sleep behaviors like sleep-walking or sleep-driving. Therefore, knowing when you should not take an Ambien is critical for your safety and well-being, as certain conditions and interactions can significantly increase these dangers.

Quick Summary

Numerous situations warrant avoiding Ambien, including concurrent use with alcohol or other central nervous system depressants. Contraindications also include severe liver or respiratory disease, a history of complex sleep behaviors, and not having a full 7-8 hours for sleep.

Key Points

Alcohol and Other CNS Depressants: Never combine Ambien with alcohol, opioids, or benzodiazepines, as this significantly increases the risk of severe central nervous system depression and fatal overdose.
Complex Sleep Behaviors: Stop taking Ambien immediately if you experience behaviors like sleep-driving or sleep-walking, which can lead to serious injury or death.
Pre-existing Medical Conditions: Individuals with severe liver disease, respiratory problems like sleep apnea, or certain mental health conditions should avoid Ambien or use it with extreme caution under medical supervision.
Insufficient Sleep Time: Avoid taking Ambien unless you have at least 7 to 8 hours available for uninterrupted sleep to prevent next-day impairment and grogginess.
Pregnancy and Breastfeeding: Ambien is not recommended for pregnant or breastfeeding individuals due to potential risks to the unborn baby or infant.
Older Adults: Be aware that individuals over 65 are more sensitive to Ambien's effects and have an increased risk of side effects like dizziness, confusion, and falls.

Critical Risks and Contraindications

Understanding the potential dangers and contraindications for Ambien is crucial for patient safety. The medication, which contains the active ingredient zolpidem, can have severe and sometimes fatal consequences when used improperly or in individuals with certain health conditions. Before taking Ambien, a thorough evaluation by a healthcare provider is necessary to ensure its appropriateness and safety.

History of Complex Sleep Behaviors

One of the most serious warnings for Ambien is the risk of complex sleep behaviors, which can occur with the first dose or at any time during treatment.

Sleep-walking
Sleep-driving
Preparing and eating food
Making phone calls
Engaging in sexual activity

These actions are often performed while not fully awake and patients typically have no memory of them the next day. The FDA requires a boxed warning on these products, and anyone who has experienced such an event should immediately stop taking the medication and discuss alternative treatments with their doctor.

Severe Liver Impairment

The liver is responsible for clearing zolpidem from the body. For individuals with severe hepatic (liver) impairment, the drug is not cleared as quickly, which can lead to higher-than-normal levels of the medication in the bloodstream. This increased concentration heightens the risk of adverse effects and may even contribute to hepatic encephalopathy, a dangerous form of brain damage. As a result, Ambien should be avoided entirely by those with severe liver disease.

Pre-existing Respiratory Problems

As a central nervous system (CNS) depressant, zolpidem can slow down breathing. Patients with compromised respiratory function are at a higher risk of experiencing respiratory depression, a serious condition where breathing becomes dangerously slow or shallow. Therefore, individuals with conditions such as:

Chronic Obstructive Pulmonary Disease (COPD)
Sleep apnea
Myasthenia gravis

should be cautious, and in some cases, avoid Ambien altogether. The risk is also heightened when Ambien is combined with opioids or other CNS depressants.

Drug and Alcohol Interactions

Combining Ambien with other substances is highly dangerous due to the potential for additive CNS depressant effects. A wide range of drugs and other substances interact negatively with zolpidem:

Alcohol: Consumption of alcohol before or while taking Ambien is strictly prohibited. It can intensify drowsiness, impair motor skills, and increase the risk of serious side effects, including complex sleep behaviors.
Opioids and Benzodiazepines: The co-administration of Ambien with opioids (e.g., oxycodone, morphine) or benzodiazepines (e.g., Ativan, Xanax) can lead to severe CNS depression, respiratory depression, and potentially fatal overdose.
Other Sleep Medications: Taking Ambien with other sedative-hypnotics, such as eszopiclone (Lunesta) or zaleplon (Sonata), is not recommended.
Herbal Supplements: Certain herbal supplements, like St. John's Wort and valerian root, can also have interactions. St. John's Wort can decrease Ambien's effectiveness, while valerian can increase drowsiness.

Situational and Population-Based Restrictions

Insufficient Time for Sleep

Ambien should only be taken when you can dedicate a full 7 to 8 hours to sleep. If awakened before the effects of the medication have worn off, you risk experiencing impaired mental and physical abilities the next day. This includes impaired driving, memory problems, and a feeling of grogginess. It is also not advisable to take Ambien during air travel or other situations where you might be woken up unexpectedly.

Pregnancy and Breastfeeding

Use of Ambien during pregnancy, especially in the third trimester, may cause sedation and breathing problems in newborns. The medication also passes into breast milk, potentially harming the breastfed infant. Therefore, Ambien is generally not recommended for those who are pregnant or breastfeeding, and risks should be carefully discussed with a healthcare provider.

Allergic Reaction to Zolpidem

Anyone with a known hypersensitivity or history of allergic reaction to zolpidem should not take Ambien. Severe allergic reactions, including anaphylaxis and angioedema (swelling of the tongue or throat that can obstruct breathing), have been reported. If such a reaction occurs after taking the medication, it should be discontinued immediately, and emergency medical help should be sought.

Comparison Table: Factors That Influence Ambien Safety


Factor	Risk Level	Reason for Risk	Action Required	Source
Alcohol Consumption	High	Additive CNS depression and risk of severe side effects.	Avoid alcohol completely.
Severe Liver Disease	High	Slowed drug clearance leads to high blood levels and increased side effects.	Avoid Ambien; risk of hepatic encephalopathy.
History of Complex Sleep Behaviors	High	Potentially serious injury or death from unconscious activities.	Discontinue immediately and seek alternatives.
Compromised Respiratory Function	High	Risk of respiratory depression, especially with COPD or sleep apnea.	Prescribe with caution; avoid if severe.
Taking Opioids or Benzodiazepines	High	Additive CNS depression, increased risk of respiratory depression.	Avoid concurrent use if possible; adjust doses carefully if necessary.
Not Having 7-8 Hours to Sleep	Moderate	Increased risk of next-day impairment, drowsiness, and memory issues.	Ensure a full night's sleep is possible.
Older Age (over 65)	Moderate	Higher risk of dizziness, falls, and cognitive side effects.	Lower dose is typically recommended.

Conclusion

Ambien is a powerful sedative-hypnotic that should be used with extreme caution and only under a doctor's guidance for short-term insomnia treatment. Key risks and contraindications include combining it with alcohol or other depressants, having a history of complex sleep behaviors, and suffering from severe liver or respiratory conditions. Always disclose your full medical history and all other medications and supplements to your healthcare provider to prevent dangerous interactions. Your provider will be the best source to determine if Ambien is safe and appropriate for your specific health profile. If any concerning side effects arise, immediate medical attention is essential.

Frequently Asked Questions

No, you should never drink alcohol when taking Ambien. Both are central nervous system depressants, and combining them can cause dangerously high levels of sedation, impaired motor skills, memory loss, and breathing difficulties, increasing the risk of fatal overdose.

You should not take Ambien if you do not have a full 7 to 8 hours to sleep. Taking it with less sleep time can lead to next-day drowsiness, dizziness, impaired memory, and slowed reaction times, which can be hazardous if you need to drive or perform other tasks requiring alertness.

Yes, several medical conditions are contraindications for Ambien use. These include severe liver disease, sleep apnea, chronic obstructive pulmonary disease (COPD), myasthenia gravis, and a history of complex sleep behaviors while using sedative-hypnotics.

Yes, Ambien should be used with caution if you have a history of depression. The medication can worsen symptoms of depression and has been associated with suicidal thoughts and actions in some individuals. Your doctor will weigh the risks and monitor you closely.

Complex sleep behaviors include activities like sleep-driving, sleep-walking, or eating while not fully awake. If you or someone you live with notices these behaviors, you must stop taking Ambien immediately and contact your doctor, as these events can lead to serious injury or death.

Older adults, especially those over 65, are more sensitive to Ambien's effects and have a heightened risk of dizziness, confusion, falls, and memory problems. Doctors typically prescribe a lower dose or recommend alternative treatments for this population.

Yes, Ambien has significant drug interactions. It can interact with opioids, benzodiazepines, certain antidepressants (SSRIs), some antibiotics, and herbal supplements like St. John's Wort. Always provide a complete list of your medications and supplements to your doctor or pharmacist.