We are all encouraged to get a good night’s sleep. That’s because scientists find that restful sleep is important for brain function, cardiovascular health and diabetes management. Sleep is also important for weight control, reaction time, athletic performance, mental health and immunity. If we have trouble falling asleep or if we wake up and can’t get back to sleep, we might get anxious just thinking of all these potential health problems. But is a medication causing nightmares? That’s not a question that is normally asked. Beta blockers such a metoprolol are notorious for this kind of side effect (Journal of Psychopharmacology, Dec. 2021).
Nightmares Can Be Terrifying!
Some side effects seem so trivial to prescribers and pharmacists that they rarely, if ever, mention them. They can have a profound impact on patients, however. One such reaction is an increase in nightmares.
Be honest now. Has anyone ever warned you about drug-induced bad dreams? We didn’t think so.
Nothing interferes with restful sleep like a terrifying nightmare. When someone is chasing you or trying to do you severe harm in a dream, it can wake you up. Then it can be hard to get back to sleep.
Readers Share Stories About Medication Causing Nightmares:
A surprising number of medications can cause really bad dreams.
Atorvastatin (Lipitor):
“I’ve been having terrible nightmares. I’ve kicked my husband and pulled his hair. I’ve sworn in my sleep (I don’t when I’m awake). It feels like somebody is trying to harm me.
“I sat straight up in bed on my knees and hit the headboard so hard that I caused cuts to my knuckles and bad bruising. I’ve been hollering in my sleep. The night before last, I bit myself so hard on the arm that it left bad bruising. My family and I are getting very concerned. I just stopped taking atorvastatin, and I had a restful night for the first time in a long while. I’ll talk to my doctor about an alternative medicine.”
We were surprised to discover that there is not a lot of research linking statins to nightmares. We did locate a case report of a woman who experienced extreme nightmares after starting atorvastatin (BMJ, April 22, 2006). Her doctor discontinued the drug and the bad dreams disappeared. He then coaxed her into a rechallenge. When she started back on the statin, her nightmares returned.
Scary Dreams on Statin Drugs:
Joel also found that the medication causing nightmares was atorvastatin:
“I think I’m obligated to say that I also have bad dreams due to atorvastatin. They were bad enough that I wanted to quit (I did for a while) but my doctor warned me that I am at high risk by not taking it and basically implied that I would have to deal with the dreams. Not always nightmares – strange and sad lately. But yes, the med gives me bad dreams.”
Ernie adds that:
“I have been taking atorvastatin as part of my diabetes 2 treatment for a long time and have a lot of sleep disturbance, waking 2-3 times per night with persistent bad dreams.”
“Anonymous” has a tale of woe and intrigue due to medication causing nightmares:
“I was prescribed atorvastatin 8 years ago to lower hereditary high cholesterol. I began having night terrors every few weeks. The vivid dreams were always of someone attacking me in my bedroom. I would wake up screaming and a few times even struck my husband.
“After several years, the night terrors became more frequent and more vivid. Finally last year I was having them almost every night. I told my doctor and he attributed them to stress, even though I mentioned they started after I started taking the atorvastatin.
“While having an acupuncture treatment for low back pain, I mentioned the night terrors during my intake session. The acupuncturist, who was also an MD, noticed the atorvastatin in my chart and told me that nightmares and night terrors are a side effect of statin drugs.
“He advised me to try weaning off the statin. I did over several months and as soon as I started reducing the statin, the frequency of the night terrors decreased, and once I stopped the drug, they disappeared altogether. I would rather take my chance with heart disease then go through that experience again. They definitely did not mention this side effect in any of the drug literature.”
Another Statin = Medication Causing Nightmares:
Other people have described sleep problems with cholesterol-lowering drugs:
“My husband takes pravastatin. He has been having nightmares at least three to four times a week. It is getting so bad that I cannot sleep. He has kicked me and hit me in the head. He told me he was fighting a monster.”
There is nothing in the prescribing information for pravastatin (Pravachol) about nightmares, but atorvastatin (Lipitor), does carry such a warning.
Linda also reports pravastatin is a medication causing nightmares:
“Eight years ago I was prescribed Pravachol (in retrospect, I did not need statins). I had terrible nightmares the entire time I took it, over a year. When I told my doctor about the nightmares, he looked at his drug reaction reference guide (a published book, not an updated internet reference) and told me nightmares were not a side-effect.
“It occurred to me that there might be many patients in their doctors’ offices complaining of nightmares at that very moment, but because nightmares were not listed in the published book my complaints were dismissed. I suffered for a year and then couldn’t take it any longer so I took myself off the drug and the nightmares went away. That year of nightmares took its toll on me.”
A Double Whammy:
Atorvastatin and Metoprolol:
“I have been having nightmares that wake me up screaming, seeing hallucinations of someone standing over me. After Googling, I found that I am taking two medications that could cause this, atorvastatin and metoprolol. Believe me, these dreams are terrifying!”
Bad Dreams from Beta Blockers:
Metoprolol is known as a beta blocker. It is prescribed for heart problems and high blood pressure. Metoprolol (Toprol) and other beta blockers can cause nightmares.
This is not a side effect that is often mentioned when a prescription is written or filled, so it can be difficult to detect a medication causing nightmares. Nevertheless, this adverse drug reaction can cause a great deal of distress.
Why Don’t Doctors Believe Patients?
Q. I have been taking the beta blocker metoprolol for more than a decade to lower my blood pressure and protect my heart. It gives me bizarre dreams and I have trouble getting a good night’s sleep. When I asked my doctor if this drug could cause insomnia, he said no. Is there a BP medicine that won’t interfere with sleep?
A. Doctors don’t always take the time to follow up on lesser-known side effects of the drugs they prescribe, but insomnia and nightmares have been reported with beta-blockers such as metoprolol. In fact, this medication is more likely than others in its class to cause nightmares (Journal of Psychopharmacology, Dec. 2021).
Our eGuide to Getting a Good Night’s Sleep lists many common drugs that can trigger insomnia. Unfortunately, some popular blood pressure pills such as amlodipine and losartan are included.
Diuretics such as chlorthalidone or hydrochlorothiazide and certain ACE inhibitors, including lisinopril, might not cause sleeping problems. You may want to consult our eGuide to Blood Pressure Solutions to learn more about such options before speaking to your doctor about a change in medication. These online resources may be found under the Health eGuides tab.
Other side effects from beta blockers include:
• Fatigue, tiredness, depression
• Dizziness, lightheadedness
• Itchy skin rash
• Difficulty breathing, asthma
• Slow heart rate
• Cold hands or feet
• Sensitivity to sunlight, sunburn
• Heart block (a problem with the rhythm)
• Blood disorders
Other readers have also faced bad dreams from beta blockers:
JP says:
“Metoprolol for high blood pressure caused such nightmares, such vivid dreams and finally, sleepwalking! I talked to the doctor and I now take this same medication in the morning instead of at bedtime. That might help some people.”
This reader also describes a bad experience:
“Years ago I was started on propranolol to maintain a regular heartbeat. I have had vivid and unpleasant dreams since being on this drug, and occasional really bad nightmares.”
Kathy reports that her beta blocker created trauma:
“I started taking metoprolol six days ago. The crazy, vivid dreams/nightmares started the same night. The dreams are usually negative. Once or twice I woke up in the middle of the night with anxiety and heart pounding.
“Last night was the worst to date: in my dream I was being suffocated by my husband, and I was pushing, clawing and biting him in attempts to get him off me. I woke up to the sound of my scream and with shortness of breath, and I had really scratched my husband several times across his chest. I feel terrible about that. I’m not even a week on the meds! I’ll stick it out until my next doctor visit and hope they cease as my body becomes adjusted.”
Antibiotic Medication Causing Nightmares
One person related this story:
“I took levofloxacin (Levaquin) for a prostate infection. About two weeks after I started taking it I began to suffer from extreme anxiety and horrific nightmares. I thought I was losing my mind. It never occurred to me that the medication could have been the culprit; my doctor even said that it wasn’t the Levaquin. Searching the Internet proved I was not alone. My time in hell lasted for months.”
Others have reported bad nightmares with this class of antibiotics (quinolones like levofloxacin or ciprofloxacin).
“I have been on levofloxacin for about 6 days for a respiratory infection. I have just begun having vivid, bizarre dreams and that is why I googled this site. I’ve never had such a disturbing reaction to a drug.”
The official prescribing information warns about insomnia and nightmares. We wonder how many patients are told about this complication.
Stop-Smoking Drug Causing Nightmares:
The prescribing information for the stop-smoking drug varenicline (Chantix) mentions, “vivid, unusual, strange or abnormal dreams.”
Readers have shared stories like this:
“I started Chantix after many unsuccessful attempts to quit smoking. By night three, the vivid dreams had turned into nightmares from which I awoke angry and agitated. I awoke the morning of the fourth day after another nightmare. My partner was snoring, which agitated me to the point where I thought a bullet would certainly solve this problem. The shock of such a thought, which is so far removed from the way I normally feel, scared me.”
This reader also complains about Chantix:
“Second week. Worst nightmare ever two nights in a row. Come home to find my family massacred. Wanna quit smoking so bad but I don’t know if I can continue waking up at 4 am every morning in horror…”
Even antidepressants such as duloxetine (Cymbalta) and venlafaxine (Effexor) can cause nightmares.
Corticosteroids and Bad Dreams:
Corticosteroid medications can interfere with pleasant dreams.
A mother wrote:
“My daughter was on daily corticosteroids (for asthma) from age three to about sixteen. She has had nightmares for many of these years.”
Antihistamine Medication Causing Nightmares:
Another medication that may cause nightmares is diphenhydramine (Benadryl). Paradoxically, this old-fashioned antihistamine is found in most “PM” pain relievers. In other words, the medication that millions use to fall asleep may be triggering bad dreams.
One reader offered this:
“On really bad weeks, I take over-the-counter sleeping pills. I’ve been having terrible nightmares on those nights. In fact, I end up with no rest because I keep waking up over and over again from the nightmares. I’d guess at least ten times per night.
“This week, I had a particularly scary dream. I jumped out of bed in a defensive fighting stance with my heart racing and drenched in sweat. That’s it – no more sleeping pills. I’d rather go to work with no sleep than live through such bad nights!”
According to GoodRx.com:
“Drug-induced nightmares and vivid dreams are most commonly reported with first-generation antihistamines such as diphenhydramine (Benadryl) (which are often found in over-the-counter sleep and allergy medications).”
Final Words:
Nightmares are not a minor side effect. Getting a good night’s sleep is a foundation of health. That’s why prescribers and pharmacists should tell patients about the possibility of drug-induced nightmares. People may not realize that their bad dreams are brought on by a medicine unless they are warned in advance.
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