WebMD Ask the Pharmacist

Tips for Good Sleep: Ask the Pharmacist

March 30, 2010. Pharmacist Heather Free, PharmD, answers questions about drug safety and drug interactions.

Question:

We use melatonin to help fall asleep. My wife uses the 1 mg. She recently purchased a 300 mcg. How does that relate? Should she take 3 of these to equal closer to 1 mg?

Answer:

Melatonin is a hormone that is normally found in our bodies that aids in sleep patterns. As in your case, we can also find melatonin supplements over the counter. A typical dose is between the range of 0.3 mg to 5 mg at bedtime.

Due to the large range of melatonin doses available, read the bottles carefully prior to purchasing in order to get the dose you need. Consult your health care provider or pharmacist to help find the right dose for you.

Question:

I’m in my second trimester of pregnancy and I’m having difficulty sleeping. What OTC can I use?

Answer:

Diphenhydramine, also known as Benadryl, is the most common OTC product used for sleep aid. It is an antihistamine medication with one side effect profile of drowsiness. It is found as the active ingredient by itself or in combination products with pain relief medications, such as acetaminophen or ibuprofen. If you are pregnant and have having trouble sleeping, I would first consult your ob-gyn before taking any medications. Diphenhydramine has a pregnancy risk category listed as B, which means studies have not been able to prove an increased risk of fetal abnormalities.

If you were to select an OTC product for aid with sleep, stay away from the combination products that contain pain aids, specifically ibuprofen or nonsteroidal anti-inflammatory (NSAIDs) medications.

More importantly, continue to keep your health care professionals in the loop about your OTC selections. While OTC medications are easily available for self-treatment, it doesn’t always mean it is safe and effective for your individual purpose. Read the bottles carefully and ask questions with your pharmacist.

Question:

My 16-year-old daughter is taking depression medication and another prescription so she can sleep at night. She is taking citalopram hydrobromide tab 20 mg and Seroquel tab 100 mg. Which is the sleeping pill and which is the depression pill?

Answer:

Both medications are depression medications and have side effects for drowsiness. Seroquel tends to cause more drowsiness, but both have the side effect. When used adjunctively, the side effect tendency increases. Neither of these medications will be prescribed for sleep aid alone. You should consult your daughter’s doctor for a better understanding as to why these medications were prescribed and use your pharmacist for a better understanding of how these medications work in the body.

Question:

Sometimes when I take an Ambien 10 (generic), I still can't fall asleep. I have chronic back pain and take Percocet sometimes, too. Is that OK that I take both of these pills together? I just want the pain to stop and to be able to go to sleep.

Answer:

There aren’t any drug interactions with taking Percocet (oxycodone and acetaminophen) and Ambien (zolpidem) together. However, oxycodone and zolpidem both work on the central nervous system and have an additive side effect of drowsiness and impairment of activities. One should be very cautious of taking both medications together. The additive products alone can be dangerous. Due to the side effects, the drowsiness and impairment can be covering up the symptoms and not aiding in treatment of the condition.

Work with your health care provider if both these medications are required on a regular basis. No matter the frequency, informing your provider/pharmacist about the self use of any medications is important in order to safely treat your condition(s) and to find the root cause of symptoms.

Question:

Can you combine 10 mg of Valium with 2 mg of Ativan? Should I discontinue Ambien while using these?

Answer:

Valium and Ativan are both in the same drug class, benzodiazepines. They are both intermediate acting benzos, meaning that the onset of action is immediate (within 15-30 minutes) and can last about eight hours in the body. Taking both medications would give an additive effect and not be very beneficial.

Consult your health care provider about additive use and the reasons behind this decision. Knowing more behind the use of the benzos in addition to the use of Ambien is important in recommending an answer. I would not recommend taking all these medications at one time, and you should consult your health care provider.

Question:

Can I take my Viagra along with Ambien oral?

Answer:

There are no known drug interactions reported between Viagra and Ambien at this time. However, this does not necessarily mean no interactions exist. Always consult your health care provider or pharmacist about any new findings. At present, you would be safe to use both products.

Question:

Hello, I would like to know if it is OK to take one Advil PM and have a glass of wine. I do not do this all the time, only once in a while. Thanks for the info.

Answer:

Advil PM contains ibuprofen (nonsteroidal anti-inflammatory medication for pain/fever relief) and diphenhydramine (antihistamine). While diphenhydramine can cause drowsiness, alcohol can intensify this side effect temporarily. Using medications while drinking is not really recommended and should not be done on a regular basis. Occasional use of Advil PM after having a glass of wine should be all right.

Further consultation with your health care provider is recommended in understanding why you need the Advil PM and to make sure it is safe for you to take.

Question:

I take a Benadryl every night to help me sleep. Could that cause any dangerous side effects?

Answer:

Benadryl or diphenhydramine is an antihistamine used to aid with sleep because it makes people drowsy. Taking Benadryl every night alone should be all right, depending on other medications that you may be taking. Keep in mind a few things. While Benadryl is over the counter for self-treatment it is for temporary relief. If sleep issues continue, you many want to look into life style modifications and consult your health care provider.

Be careful when taking Benadryl with other antihistamines, such as Claritin, Zyrtec, and other prescription medications. Additive side effects will occur, such as constipation; diarrhea; dizziness; drowsiness; dry mouth, nose, or throat; excitability (especially in children); headache; loss of appetite; nausea; nervousness; restlessness; trouble sleeping; vomiting.

Question:

Could I become dependent if I habitually take melatonin to sleep every night?

Answer:

Melatonin does not have an additive property. Melatonin is a hormone that is normally found in our bodies that aids in sleep patterns. As in your case, we can also find melatonin supplements over the counter. A typical dose is between the range of 0.3 mg to 5 mg at bedtime.

Understand that while melatonin is a naturally occurring substance in the body and is commonly found over the counter, it is not approved by the FDA. There are studies that indicate it is likely safe for use, and little information about doses, interactions, and efficacy. However, we do not know much about toxicity.

Consulting your health care provider is very important in this situation. It sounds like a more complicated sleep issue that needs to be addressed by your health care provider.

Question:

After taking a sleep aid for 2 years (one 25 mg), are withdrawal symptoms normal when stopped cold turkey?

Answer:

Depending on the sleep aid and dose of the medication, withdraw symptoms can be normal and uncomfortable. You should work with your health care provider, including your pharmacist, to help decrease the effects of withdrawal and possibly taper or decrease the sleep aid dose rather than just abruptly stop taking the sleep aid.

Question:

Our doctor had prescribed Ambien to my 20-year-old due to her sleeping disorder. In her previous script (6 months ago), the doctor prescribed 5 mg and told her that it was OK to occasionally take two. [The new prescription was for 10 mg pills.] Unfortunately my daughter did not look at the bottle and check the milligram and took two (totaling 20 mg). At what quantity does an individual be concerned of an overdose?

Answer:

The recommended maximum daily dose, per manufacturer and FDA, is Ambien 10 mg per day. The medication is rapidly absorbed in the body and eliminated over a 2.5 hr time period. This means that the body will not accumulate any of the medication. She would probably experience the side effects quicker than usual. If she has only done this for one dose, there are no issues to worry about at this time.

Common side effects include drowsiness, dizziness, diarrhea, and a "drugged feeling." More severe side effects that may be seen with increased high doses include abnormal behaviors or thoughts, getting out of bed and not being fully awake to do normal activities, memory loss, hallucinations, and anxiety.

More importantly, she should not continue to take more than 10 mg per day. She should consult her health care provider or pharmacist for further assistance in decreasing the Ambien dose and preventing toxic symptoms, possibly as severe as coma. It is important to take the medication just before bedtime.

It is important to take this medication according to the recommended guidelines, otherwise discontinue use. Again, the maximum daily dose should not exceed 10 mg per day for the regular Ambien medication.

Question:

What are your thoughts on taking multivitamins before bed?

Answer:

Taking a multivitamin at bedtime is fine and should not interfere with sleep patterns.

Question:

I've just been prescribed ropinirole for restless legs syndrome. Can this be taken with the occasional use of Cialis?

Answer:

There are no known drug interactions reported between ropinirole and Cialis at this time. However, this does not necessarily mean no interactions exist. Always consult your health care provider or pharmacist about any new findings. At present, you would be safe to use both products.

Question:

Is it OK to take Tylenol PM when you are taking Mobic for arthritis?

Answer:

Tylenol PM contains acetaminophen (pain aid) and diphenhydramine (antihistamine). Mobic belongs to the nonsteroidal anti-inflammatory (NSAIDs) drug class, which also has pain aid properties. If you are looking for a specific sleep aid, more questions for assessment need to be asked in order to appropriately answer this question. If you are just looking for a sleep aid only and for temporary relief, then consider taking diphenydramine alone, especially if Mobic is controlling the pain associated with arthritis. Determining the cause of a sleep issue and working with your health care provider is important in selecting an appropriate aid, dose, and frequency of use.


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