What Medications Can Cause Vivid Dreams and Nightmares

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Certain medications can affect your dreams - and not always in a good way. Vivid dreams and nightmares can be an unexpected side effect of several medications and supplements, such as melatonin, beta blockers, and antidepressants. And while they don't happen to everyone, it's helpful to be aware of some of the most common offenders. Here's a list of medications that are most likely to affect your dreams.

1. Metoprolol and other beta blockers

Beta blockers are some of the most common medications associated with disturbed dreaming. In fact, one study found that about one-third of people who had nightmares were taking a beta blocker.

Beta blockers treat high blood pressure and other heart-related conditions. But they may also block the release of melatonin, a chemical made by the body to help regulate sleep. Having less melatonin may contribute to sleeping problems, including insomnia and nightmares.

Some beta blockers may be more likely to cause nightmares than others. Examples include:

• Propranolol (Inderal LA, Innopran XL)

• Metoprolol (Lopressor, Toprol XL)

• Nebivolol (Bystolic)

• Carvedilol (Coreg, Coreg CR)

A melatonin supplement in the evening may help with nightmares caused by beta blockers. Keep in mind that melatonin has side effects and can interact with other medications. So it's best to check with your healthcare team before taking it to make sure it's safe for you.

Switching to a different beta blocker may also be an option. Your prescriber can help decide on the best course of action.

2. Prozac and other antidepressants

Selective serotonin reuptake inhibitors (SSRIs) are used for depression and other mental health conditions. But they can cause sleep changes for some people. Common SSRIs include:

• Paroxetine (Paxil)

• Fluoxetine (Prozac)

• Sertraline (Zoloft)

• Citalopram (Celexa)

SSRIs raise the levels of a chemical called serotonin in the brain. While this may improve mood, it can also affect your sleep and have a strong effect on dreams.

Some SSRIs, such as sertraline, can make dreams more intense. And fluoxetine increases the chance that you'll remember your nightmares. Certain SSRIs also suppress rapid eye movement (REM) sleep. This changes the body's normal sleep cycle, which may contribute to nightmares.

But SSRIs aren't the only antidepressants that may affect your dreams. Other examples include:

• Venlafaxine (Effexor, Effexor XR)

• Bupropion (Wellbutrin SR, Wellbutrin XL)

• Duloxetine (Cymbalta)

• Mirtazapine (Remeron, Remeron SolTab)

If dreams become bothersome while taking an antidepressant, talk to your prescriber. They may recommend the addition of another antidepressant - trazodone. It can help improve sleep quality when taken before bed. They may also decide to switch you to a different antidepressant altogether.

3. Antihistamines

Antihistamines are commonly used for allergies. First-generation antihistamines, such as diphenhydramine (Benadryl, ZzzQuil) and doxylamine (Unisom SleepTabs), can also make you sleepy. So they're also present in many over-the-counter (OTC) sleep medications.

But one first-generation antihistamine in particular - chlorpheniramine (Chlor-Trimeton, Aller-Chlor) - can cause nightmares. This may be part of the reason it's only found in OTC allergy medications and not typically used for sleep.

Medication-induced sleep terrors have also been reported with cetirizine (Zyrtec). Cetirizine is a second-generation antihistamine. These are less likely to affect your sleep, but cetirizine may cause more drowsiness than the other medications in this class.

If you experience troublesome dreams from an antihistamine, a different one may work better for you. Talk to your pharmacist or prescriber about an alternate option.

4. Sleep aids: Ambien, melatonin, and other Z-drugs

Some medications used to treat insomnia can also cause nightmares. While this side effect doesn't happen to everyone, it's good to know about.

Z-drugs

Z-drugs are common medications prescribed for sleep. Examples include:

• Lunesta (eszopiclone)

• Sonata (zaleplon)

• Ambien (zolpidem)

This class of medications - Ambien in particular - causes an increased risk of nightmares. Z-drugs may also cause hallucinations and sleep walking that you don't remember after you wake up.

Melatonin

Melatonin is an OTC supplement often used for insomnia or jet lag. Your body naturally produces melatonin to help you sleep. In theory, taking melatonin should help you fall asleep easier. But it can also cause nightmares.

Why does melatonin cause nightmares? We don't know for sure. But as described above, changes in melatonin levels in the body can affect your dreams. Studies have reported that taking melatonin can increase dreaming, specifically vivid dreams and nightmares.

Tips for how to stop melatonin nightmares may include lowering your dosage or discontinuing melatonin for a few days to see if your nightmares improve. But if your prescriber has recommended taking melatonin, be sure to check with them first. You can also try improving your sleep hygiene. Putting electronic screens away at least for an hour before bed, avoiding caffeine at least 6 hours before bedtime, and having a consistent bedtime may help.

Other OTC supplements

Other OTC supplements can also cause vivid dreams. For example, valerian and ashwagandha are both used for anxiety and insomnia and can affect your dreams. These herbal supplements also have other side effects and drug interactions you should know about before taking them.

A sleep medication that causes nightmares may not give you the restful night you're looking for. So if these symptoms occur, talk to your prescriber about an alternate option.

5. Ozempic, Wegovy, and Zepbound

Some people have reported vivid or abnormal dreams while taking semaglutide. This is the active ingredient in Ozempic and Rybelsus, medications for Type 2 diabetes. It's also the active ingredient in Wegovy, a form of semaglutide approved for weight loss.

Vivid dreams are also reported with tirzepatide, the active ingredient in Mounjaro and Zepbound.

It's not clear why this happens or if it's directly related to the medication. But it's still a good idea to let your prescriber know if dreams become bothersome.

6. Cipro and other antibiotics and antivirals

Certain medications that fight infections may cause nightmares as well. They can decrease proteins released by your body that help you sleep to better fight off an infection. This is thought to result in disturbed sleep and nightmares.

Some examples are:

• Ciprofloxacin (Cipro)

• Erythromycin (Ery-Tab, E.E.S.)

• Efavirenz (Sustiva)

• Mefloquine

In most cases, you'll only take antibiotics for a short period of time. So dream-related side effects should resolve once you've finished your treatment.

7. Donepezil and other Alzheimer's disease medications

Medications used to treat dementia may also affect sleep quality. Specifically, they can cause REM sleep behavior disorder (RBD). RBD can cause intense dreams - and sometimes the body acts out the dream while asleep. Examples of medications that cause RBD include:

• Donepezil (Aricept, Adlarity)

• Rivastigmine (Exelon)

• Galantamine (Razadyne)

It's recommended to take donepezil at night since it can make you dizzy. But a small study suggested that taking it in the morning may help with nightmares. Your prescriber may recommend this for you.

Keep in mind that dementia itself can also contribute to sleep troubles. So your prescriber may add another medication at night to help if nightmares become a problem.

8. Medications that affect dopamine

Several types of medications affect dopamine, a chemical in the brain. These types of medications can all cause vivid dreams or nightmares.

Parkinson's disease medications

Parkinson's disease is caused by decreased levels of dopamine in the brain. Medications that treat it increase dopamine levels, which can lead to nightmares. Examples include:

• Carbidopa / levodopa (Sinemet)

• Amantadine (Gocovri, Osmolex ER)

• Selegiline (Zelapar)

Antipsychotic medications

Medications that treat mental health conditions, like schizophrenia and bipolar disorder, also affect dopamine. Examples include:

• Clozapine (Clozaril)

• Olanzapine (Zyprexa)

• Risperidone (Risperdal)

Stimulants

Some ADHD (attention-deficit hyperactivity disorder) medications can also cause vivid dreams. This is likely because they increase dopamine levels. Examples include:

• Methylphenidate (Ritalin, Methylin)

• Mixed amphetamine salts (Adderall)

If any of these medications give you unpleasant dreams, your prescriber can help you manage them. They may change your dose or try a different medication in the same class. They could also suggest adding another medication at night to help you sleep easier.

9. Atorvastatin and other statins

Statins such as atorvastatin (Lipitor) are a first-choice treatment for high cholesterol. Nightmares and sleep disturbances have been reported in some people taking statins. But a review of the few available studies did not find a clear link between the two.

It seems that if statins do cause nightmares, it's a rare side effect. But if you notice a change in your dreams, speak to your healthcare team. They may have you try a different statin or switch to another medication to manage your cholesterol.

10. Chantix

Chantix (varenicline) is a first-choice medication for helping people quit smoking. It affects your brain in a similar way to nicotine, but it doesn't contain any nicotine.

Vivid or abnormal dreams are a common side effect of Chantix. They occur in up to 1 in 12 people who take it. It's also one of the most common reasons people stop taking Chantix.

You'll usually only take Chantix for a few months, so as long as the dreams aren't troubling you, they'll go away after you stop taking it. But if they're a problem, talk to your healthcare team about other options to quit smoking.

How do medications cause nightmares?

It's not completely understood how medications cause nightmares. Often, the medications that can cause nightmares are known to affect the brain. They may change the levels of chemicals like melatonin, serotonin, or dopamine. Or they may have a direct effect on your sleep cycle.

Medication-induced nightmares vary from person to person. Other factors, such as mental health conditions or another underlying health condition, may also influence your dreams. So medications may not always be to blame.

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