Weed and Ambien: Interactions and Risks

Ambien is a popular prescription drug used to treat various sleep disorders. Sleep issues are prevalent among U.S. adults. The American Academy of Sleep Medicine reports that 30% to 35% of adults experience brief insomnia symptoms. Between 15% and 30% of American adults have short-term insomnia disorder, lasting up to three months and 10% of U.S. adults suffer from long-term insomnia, or chronic insomnia disorder. 

According to a 2020 survey, 8.4% of the adults took sleep medications for their symptoms in the 30 days before being surveyed. And Ambien is among the most commonly prescribed sleep medications.

Cannabis is also frequently used by consumers as a sleep aid. Certain strains–typically indicas–are even marketed to help with sleep. It shouldn’t come as a surprise, then, that many people who are struggling to fall or stay asleep at night are wondering if they can use Ambien and cannabis together to enhance a restful night’s sleep.

Neither cannabis nor Ambien is without its risks, and combining them has the potential for severe side effects. If you’re having difficulty sleeping, it’s important to understand the effects of both of these medications. There are factors to consider when taking them on their own as well as potential risks consumers should be aware of before using both at the same time.

What Is Ambien?

Ambien is a prescription drug commonly used to treat sleep problems–mainly insomnia. Ambien is the brand name for zolpidem, which belongs to a class of drugs known as nonbenzodiazepines. Nonbenzodiazepines work very similarly to benzodiazepines, like Xanax–even binding to the same sites in the brain–but their chemical structure is different, so they’re classified differently. 

Like benzodiazepines, zolpidem increases signals from GABA¹, a neurotransmitter that sends calming messages within the brain. The brain uses GABA to inhibit excited nerves, leading to sedative effects. Unlike benzodiazepines, Ambien doesn’t bind to all benzodiazepine receptors in the brain, instead only to the BZ1 receptors. This is why researchers believe it doesn’t trigger the full range of effects that benzodiazepines carry.

Ambien isn’t the only brand name that zolpidem goes by. Other common brand names for zolpidem include:

• Ambien CR
• Edluar
• Intermezzo
• Zolpimist

Ambien is only approved to treat insomnia in the short term. It is specifically targeted at people who have a hard time falling asleep. 

Possible Side Effects of Ambien

Ambien works within the body in a nearly identical way to benzodiazepines and, therefore, has nearly all the same risks and side effects. This includes a high risk for dependence and overdose.

Ambien doesn’t just help people fall asleep. It helps to keep them asleep for a full 8 hours. Because of this, it’s only recommended that people take Ambien if they plan on getting a full 8 hours of sleep. Waking up earlier will likely result in tiredness, grogginess, and an inability to focus.

The more common side effects associated with Ambien include:

• Drowsiness and feelings of being tired throughout the day
• Headaches
• Dizziness
• Lightheadedness
• Feelings of being ‘high’ or drugged
• Weakness or unsteadiness when walking
• Balance problems
• Nausea
• Constipation
• Diarrhea
• Gas
• Heartburn
• Abdominal or stomach pain
• Appetite changes
• Uncontrollable shaking in one or more body parts
• Burning, pain, numbness, or tingling in the extremities
• Strange dreams
• Burning, tingling, or redness of the tongue
• Dry mouth
• Pain or itching in the ears
• Ringing in the ears
• Redness in the eyes
• Cramps and muscle aches
• Back, joint, or neck pain
• Heavy menstrual bleeding

Side effects of Ambien which are more severe or may indicate a more severe underlying problem include:

• Itching
• Rash
• Hives
• Swelling in the eyes, tongue, throat, or lips
• Feeling like the throat is closing up
• Difficulty swallowing or breathing
• Hoarseness
• Shortness of breath
• Yellowing of the eyes or skin
• Unusually light-colored stool
• Nausea
• Vomiting
• Racing or pounding heartbeat
• Chest pain
• Vision problems

The two most serious risks associated with Ambien are overdose and dependency. Like benzodiazepines, Ambien carries a high risk for addiction. This is why Ambien is only recommended as a short-term treatment for insomnia. Ambien withdrawal can be severe and cause severe symptoms, like:

• Uncontrollable shakes
• Lightheadedness
• Cramping, especially in the stomach or abdomen
• Nausea
• Vomiting
• Sweating
• Redness or flushing of the skin
• Sleepiness or tiredness
• Unexplained and uncontrollable crying
• Anxiety, nervousness, and panic attacks
• Difficulty sleeping

In rare cases, Ambien withdrawal can cause seizures.²

Weed and Ambien Interactions and Risks

Research is sparse regarding potential interactions of cannabis and Ambien. That said, there are indications that combining the two could increase the risks associated with Ambien in two major ways.

The first problem with combining cannabis and Ambien is straightforward; they both cause drowsiness. This means that when someone uses both substances, the two chemicals are simultaneously acting on their body to induce sleep, which can be unpredictable and difficult to manage.

Not only can this make it difficult or impossible to stay awake, even if you try, but it can also cause drowsiness to continue when it isn’t safe, like driving to work the following morning. It also means that if you need to wake up earlier than expected, you may not be able to. This effect is also why experts warn against using CBD while taking Ambien.

At the same time, there’s evidence that cannabis alters how the body processes other medications, including Ambien. Cannabis has the potential to block the enzymes that typically break down Ambien, causing it to remain in the body longer than expected, increasing its effects and duration. 

According to a spreadsheet published by Penn State, both THC and CBD can affect how the body metabolizes zolpidem. This could mean that using cannabis and Ambien at the same time will increase the effects of Ambien. This concern is echoed by Washington D.C.’s Department of Health, which put out a document warning that CBD inhibits the CYP3A4 enzyme, the enzyme responsible for breaking down both Ambien and benzodiazepines. By inhibiting this enzyme, the use of CBD could lead to amplified effects from those medications.

This combination of medications and the increased, lasting drowsiness that it can cause has the strong potential to lead to accidents and injury. The intense effects make it a risky combination, not just because of the chemical effect on the body itself, but how the effect can inhibit your ability to perform basic functions.

While the use of Ambien and cannabis is typically viewed as risky behavior for most consumers, there is evidence that Ambien may help people with cannabis use disorder (CUD) transition away from cannabis by mitigating withdrawal symptoms.

A 2016 study investigated the use of nabilone, a synthetic cannabinoid, both independently and in conjunction with zolpidem to alleviate the symptoms of cannabis withdrawal. The researchers found that nabilone on its own was beneficial, but participants found greater relief when it was used with zolpidem.³

This further corroborates an earlier 2011 study that found that zolpidem can help relieve common sleep disturbances related to cannabis detox.⁴ It should be noted that both of these studies focused on the effects of zolpidem after the individuals stopped using cannabis, not using them at the same time.

Are Weed and Ambien Safe to Use Together?

The research into cannabis and Ambien is sparse, but there are a few clear conclusions that can be drawn.

First, experts warn against using either Ambien or benzodiazepines at the same time as cannabis because of their combined sedative effects. Both cannabis and Ambien cause drowsiness. Using them together can amplify those effects in unexpected ways, leading to potential accidents and medical complications.

At the same time, there’s evidence that cannabis inhibits the enzymes the body uses to break down medications like Ambien. The slowed breakdown can intensify and extend the effects of these medications. So, taking Ambien and cannabis simultaneously can cause the Ambien to have a more profound, longer lasting impact on the body.

It is not recommended to use Ambien and cannabis at the same time. The combination can be unpredictable and the exaggerated effects can be dangerous. If you are having difficulty sleeping, it’s best to speak to your doctor about which course of treatment–medical cannabis or Ambien–is best for you.

Precautions when Taking Ambien and Marijuana

The use of Ambien can result in potentially serious complications. Using cannabis along with Ambien only amplifies those risks, meaning anyone using both substances should use extreme caution.

Because both Ambien and cannabis cause drowsiness, it’s recommended that anyone using both should avoid driving, operating heavy machinery, or doing any activity that requires them to be alert or physically capable. 

Anyone using Ambien, with or without cannabis, should be aware of the medication’s high potential for dependence and the numerous withdrawal symptoms that come along with it. 

If you’re considering using cannabis and Ambien at the same time, consult with your physician. They can further inform you of the risks and provide potential alternatives.

What Drugs Interact with Ambien?

Ambien is known to have numerous drug interactions beyond cannabis, many of which can be serious. 

Alcohol is one of the most warned-against substances since it’s a central nervous system depressant that can cause similar combined effects to cannabis. Using alcohol and Ambien together is extremely dangerous and can have serious side effects, including altered breathing that can lead to more serious consequences.

Other drugs that can interact with Ambien include:

• Benzodiazepines, like Valium and Xanax
• Opioids, like oxycodone and hydrocodone
• Imipramine(Tofranil)
• Chlorpromazine
• Selective serotonin reuptake inhibitors (SSRI), like Zoloft and Prozac
• CYP3A4 inducers
• CYP3A4 inhibitors (including cannabis)
• Tricyclic Antidepressants (TCA)
• Sedative-hypnotic drugs, like Lunestra and Sonata
• Certain antihistamines, like Benadryl
• Trazodone
• Bupropion (Wellbutrin SR)
• Serotonin norepinephrine reuptake inhibitors (SNRI), like Cymbalta and Pristiq
• Atypical antipsychotics, like Abilify and Seroquel
• Gabapentin (Neuronin)
• Pregabalin (Lyrica)

If you’re taking any of these medications, speak to your doctor before taking Ambien.

Ambien or Weed: Which is Better for Sleep Disorders?

Both Ambien and cannabis are popular choices for treating insomnia symptoms. So, which is better?

The answer to that question will depend heavily on the individual. The potential benefits and the acceptable risks of each will depend on the consumer’s lifestyle and physiology.

Both treatments have been shown to be effective. Ambien is approved and prescribed exclusively for sleep. And there is mounting evidence that cannabis can help with sleep. The non-intoxicating cannabinoid CBD has also shown the ability to help people get better sleep. In studies specifically targeting insomnia, most patients reported improvements, though some did face difficulties with cannabis.

There are a few key factors to consider when choosing between cannabis or Ambien to treat sleep-related issues. The first, and probably most pressing, is how long the treatment needs to last. Ambien is only recommended for periods less than two weeks due to its high risk of dependence. So, if the sleep problems persist, it may be better to investigate cannabis as a long-term solution.

Next, it’s important to consider side effects. Generally, the side effects of cannabis are considered to be mild and easily tolerated. You can moderate these effects further by decreasing the dose or choosing a cultivar with a higher concentration of CBD.  

The common side effects of cannabis are:

• Felling ‘high’
• Drowsiness
• Increased hunger
• Giggling
• Anxiety or paranoia (particularly at higher doses)
• Altered perception of time

Ambien has a longer list of side effects, as seen above. Those side effects can be more severe and result from underlying complications.

There’s also a difference in the duration and severity of the drowsiness that these medications cause. Cannabis usually creates a calming, relaxing effect that helps people slow down and get some rest. The effects of inhaled cannabis typically last between 2 and 3 hours, while edibles can last between 6 and 12 hours, depending on the dose. 

Ambien is dosed to last through a typical 8-hour night. During that time, the sedation can be more pronounced, and waking up early will cause drowsiness and possibly impaired coordination. Ambien is also associated with sleepwalking. It’s recommended that people who use Ambien do so just before bed because the sedative effects are strong.

Ambien may provide a better night’s sleep with its stronger sedative effects, but it also carries a high risk of dependence and a wide range of side effects that can be serious. Cannabis has a very low risk of dependence and may help people get to sleep without the overpowering sedative effects, but it may also cause sleep disturbances in some consumers.

Before making any medical decisions, it’s best to consult your healthcare provider to determine which course of treatment is best for you. 

References

1. Bouchette, Daniel, and Judy Quick. “Zolpidem.” Nih.gov, StatPearls Publishing, 2019, www.ncbi.nlm.nih.gov/books/NBK442008/.

2.  Haji Seyed Javadi SA, Hajiali F, Nassiri Asl M. Zolpidem Dependency and Withdrawal Seizure: A Case Report Study. Iranian Red Crescent Medical Journal. 2014;16(11). doi:https://doi.org/10.5812/ircmj.19926

3.  A 2016 study investigated the use of nabilone, a synthetic cannabinoid, both independently and in conjunction with zolpidem to alleviate the symptoms of cannabis withdrawal. The researchers found that nabilone on its own was beneficial, but when used with zolpidem, participants found greater relief.

4.  Vandrey R, Smith MT, McCann UD, Budney AJ, Curran EM. Sleep disturbance and the effects of extended-release zolpidem during cannabis withdrawal. Drug and Alcohol Dependence. 2011;117(1):38-44. doi:https://doi.org/10.1016/j.drugalcdep.2011.01.003

The information in this article and any included images or charts are for educational purposes only. This information is neither a substitute for, nor does it replace, professional legal advice or medical advice, diagnosis, or treatment. If you have any concerns or questions about laws, regulations, or your health, you should always consult with an attorney, physician or other licensed professional.