Ambien is the brand name for zolpidem, a sedative medication that is FDA-approved for the short-term management of insomnia. [1] It works similarly to benzodiazepines, and subsequently, there is potential for misuse. [1] Possessing or using Ambien without a prescription can have significant consequences.
- Ambien is a sedating medication that can be used for short-term treatment of insomnia.
- Ambien carries risks of dependence and misuse. It should therefore only be used for the short term and requires careful monitoring.
- Ambien is a Schedule IV controlled substance, which means there are limitations on its prescribing and use.
Is zolpidem (Ambien) a controlled substance?
Ambien is a Schedule IV controlled substance under the Drug Enforcement Administration (DEA). [2] The scheduling system for controlled drugs ranks them from Schedule I (highest abuse potential) to Schedule V (lowest abuse potential). [3] As a Schedule IV controlled substance, Ambien falls into the same regulatory category as benzodiazepines like Xanax and Valium, alongside other prescribed medications like tramadol and carisoprodol. [3]
Although Schedule IV is lower in the scheduling system, it acknowledges that Ambien carries a risk of misuse and dependency. This classification means that Ambien prescriptions are subject to specific legal and prescribing requirements. As a result, possessing or using Ambien without a valid prescription is illegal under federal law and can result in criminal charges, including fines and potential imprisonment. Healthcare providers must also follow rigorous prescribing protocols and could face disciplinary action if prescribing Ambien inappropriately.
Why is Ambien a controlled substance?
Ambien is a controlled substance because it carries a risk of abuse and dependence. Ambien causes depression of the central nervous system, leading to sedation and drowsiness. [4] These effects can result in people taking Ambien without a valid medical reason, for example, to help with an undiagnosed sleep issue, which can lead to dependence.
Ambien works by enhancing GABA activity in the brain, and with regular use, tolerance can develop, meaning larger doses are needed to achieve the desired effect. Being in Schedule IV acknowledges the risk of abuse with Ambien while also recognizing the potential medical uses.
Implications: Prescription and monitoring
Ambien’s Schedule IV classification means there are stricter prescribing and monitoring protocols that healthcare professionals must follow. For example, Ambien prescriptions cannot be filled more than six months after the prescription date, and they also can’t be refilled more than five times in six months. [5] This means patients taking Ambien are regularly monitored, and the prescription is reviewed to ensure it’s still necessary.
Prior to providing an Ambien prescription, healthcare professionals will complete a thorough assessment to ensure Ambien is the right drug to use. This includes an evaluation of current symptoms, medications, and medical history. Medical professionals should monitor for side effects and adjust the treatment if necessary, using the lowest dose possible to give the desired effect.
Ambien vs. Other benzodiazepines
Ambien shares its Schedule IV status with all benzodiazepines, including Xanax (alprazolam) and Valium (diazepam). [3][6] This means they are considered to have a similar risk of misuse and dependence. The only exception to this is flunitrazepam (Rohypnol), which is treated as a Schedule I drug when issuing penalties for possession and distribution. [7]
While both Ambien and benzodiazepines are Schedule IV substances, there are important distinctions in how they work and their effects. Ambien is specifically designed for sleep, with a shorter duration of action compared to most benzodiazepines. [8] On the other hand, benzodiazepines can be used for a wider range of issues in addition to sedation, including anxiety, seizure control, and muscle relaxation. As benzodiazepines tend to stay in the system for longer, there is an increased risk of next-day drowsiness.
Alternatives to Ambien
Although Ambien can be effective at treating insomnia, it’s generally not considered the first choice due to the risk of misuse. [1] Individuals struggling with sleep should first try non-medical options. [1] Sleep hygiene should be optimized in the first instance, with some examples of how this can be done below: [9]
- Aim for 7-9 hours of sleep per night, going to bed and waking up at the same time each day.
- Having a regular bedtime routine.
- Avoid caffeine, alcohol, and heavy meals before bed.
- Avoid looking at screens immediately before going to bed.
- Do regular exercise, but not right before bed.
Cognitive behavioral therapy (CBT) can also be an effective non-medical treatment for insomnia. [1] If medications are required, drugs like melatonin (a hormone produced by the brain which can also be taken as a supplement) and doxepin (a tricyclic antidepressant) could be used instead of Ambien. [1][10] Although trazodone is not considered a preferred first-line treatment for insomnia, it is commonly prescribed off-label for sleep due to its sedating effects, particularly in individuals with co-occurring mood or anxiety disorders. [10]
Using Ambien safely
To maximize safety while taking Ambien, it should only be taken at the time and dose prescribed. Do not take Ambien with other drugs that cause sedation, or with alcohol. If you are taking other prescribed medications or supplements, check with your healthcare provider to ensure there are no interactions with Ambien.
Ambien shouldn’t be shared with anyone, even if they have similar symptoms, and should be stored securely, out of the reach of children. Caution should be taken if driving or operating machinery while taking Ambien due to its sedating effects.
Stopping Ambien abruptly after regular use can lead to withdrawal symptoms, including sleep issues, anxiety, tremors, and sweating. [1][11] To avoid this, it’s recommended to slowly taper off Ambien over several weeks under the guidance of a medical professional. [11] Withdrawal strategies include gradual dose reduction, taking it on alternate days, and improving sleep with non-pharmacological aids. However, the exact details will be tailored to your needs by your medical professional.
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