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Ambien vs Belsomra
Introduction
For patients struggling with insomnia, certain medications that influence the activity of neurotransmitters in the brain can assist in initiating sleep and improving sleep quality. Ambien and Belsomra are two such medications that are commonly prescribed for individuals suffering from insomnia. Each impacts different systems within the brain, but both help induce a state conducive to restful slumber.
Ambien (generic name: zolpidem) is classified as a sedative-hypnotic drug which enhances GABA effects—a neurotransmitter that inhibits brain activity—thereby helping to initiate sleep swiftly. On the other hand, Belsomra (generic name: suvorexant) works differently; it is an orexin receptor antagonist, meaning it blocks the action of orexin—a neurotransmitter responsible for wakefulness—in your system. This unique method of action helps promote consistent sleep throughout the night.
Ambien vs Belsomra Side By Side
| Attribute | Ambien | Belsomra |
|---|---|---|
| Brand Name | Ambien | Belsomra |
| Contraindications | Should not be taken with opioid medications or alcohol; may exacerbate symptoms of depression | Should not be taken with opioid medications or alcohol; may exacerbate symptoms of depression |
| Cost | Approximately $0.50 to $1.60 per day for the generic version (Zolpidem Tartrate) | Approximately over $1 to about $4 per day for the generic version (Suvorexant) |
| Generic Name | Zolpidem | Suvorexant |
| Most Serious Side Effect | Complex sleep behaviors such as driving or preparing food while asleep, abnormal thoughts and behavior, allergic reactions, irregular heartbeat or chest pain, difficulty breathing | Severe allergic reactions, unusual thoughts or behavior, depression symptoms, sleep paralysis, hallucinations, temporary leg weakness |
| Severe Drug Interactions | Opioid medications due to risk of severe side effects such as slowed breathing | Opioid medications due to risk of severe side effects such as slowed breathing |
| Typical Dose | 5–10 mg/day, not to exceed 10mg/day | 10 mg taken by mouth right before bedtime, up to 20 mg per day |
What is Ambien?
Zolpidem (the generic name for Ambien) was a pioneering drug in the class of medications known as sedative-hypnotics, which were designed to address sleep disorders. Zolpidem was first approved by the FDA in 1992. It works by enhancing the activity of GABA, a neurotransmitter that inhibits the overall brain's activity and helps induce sleep. The medication is primarily prescribed for short-term treatment of insomnia.
On another hand, Suvorexant (Belsomra) represents an entirely different class of sleeping aids known as orexin receptor antagonists and received FDA approval more recently in 2014. Belsomra functions by blocking orexin, a chemical that promotes wakefulness in your brain; hence it assists with falling asleep and staying asleep longer.
While both drugs serve similar purposes, they have distinct mechanisms of action and potential side effects profiles due to their interaction with different neurotransmitters.
What conditions is Ambien approved to treat?
Ambien and Belsomra have been approved by the FDA for the treatment of insomnia, with specific indications as follows:
- Ambien is used for short-term treatment of difficulty falling asleep (insomnia) in adults
- Belsomra is indicated to treat sleep difficulties such as trouble falling asleep and/or staying asleep (insomnia) in adults.
How does Ambien help with these illnesses?
Ambien works to manage insomnia by acting on the GABA-A receptors in the brain, specifically enhancing the effects of GABA, an inhibitory neurotransmitter. This allows for a decrease in neuron activity and promotes sleep by slowing down brain activity. On the other hand, Belsomra has a unique mechanism compared to most sleep aids - it blocks orexin, a chemical that is involved in wakefulness and arousal regulation. By blocking this "wake" neurotransmitter, Belsomra can assist individuals with sleep disorders like insomnia to achieve more restful sleep periods. Both Ambien and Belsomra work differently but ultimately aim at promoting better quality of sleep for patients struggling with insomnia or other related disorders.
What is Belsomra?
Belsomra is a brand name for suvorexant, which is an orexin receptor antagonist that works by blocking the action of orexins, neurotransmitters in the brain responsible for wakefulness. Belsomra got its approval from the FDA in 2014 and has been used as a new alternative to traditional sleep aids.
Unlike zolpidem (Ambien), which enhances GABAergic transmission and indirectly reduces overall brain activity to promote sleepiness, Belsomra directly influences the system primarily responsible for wakefulness. Because it works differently than other sleep aids like Ambien, its side effect profile may also vary. Most notably, it does not typically cause next-day grogginess or dependence — common concerns with many other prescription sleeping pills such as Ambien. This makes Belsomra potentially more suitable for those who have struggled with these issues while using other medications meant to treat insomnia.
What conditions is Belsomra approved to treat?
Belsomra is an FDA-approved medication that is used for the treatment of:
- Insomnia characterized by difficulties with sleep onset and/or sleep maintenance Unlike many other sleep medications, Belsomra works by inhibiting the action of orexin, a neurotransmitter that regulates wakefulness. This makes it a unique option in the field of sleep aids.
How does Belsomra help with these illnesses?
Orexin is a neurotransmitter that regulates arousal, wakefulness, and appetite. A deficiency or imbalance of orexin can lead to disorders such as insomnia. Belsomra works by blocking the binding of orexin to its receptors in the brain, thereby reducing alertness and promoting sleep onset. Its unique action on the orexin system distinguishes it from other sleeping aids like Ambien which primarily enhance the activity of GABA, an inhibitory neurotransmitter responsible for slowing down brain activity and promoting sleep. Since Belsomra does not significantly affect GABA levels, it may be prescribed when patients do not respond well to typical benzodiazepine-like drugs (such as Ambien), or may be combined with these medications under specific circumstances.
How effective are both Ambien and Belsomra?
Both zolpidem (Ambien) and suvorexant (Belsomra) have been approved by the FDA as effective medications for insomnia. Zolpidem was first approved in 1992, while suvorexant received approval more recently in 2014. They work differently on neurotransmitters: zolpidem enhances GABA activity leading to sedation, whereas suvorexant blocks orexin receptors which promotes wakefulness.
Direct studies comparing these two drugs are limited. However, both have shown efficacy in managing symptoms of insomnia such as difficulty falling asleep or staying asleep throughout the night. Clinical trials suggest that while both medicines can help reduce the time it takes for a person to fall asleep, individuals taking Belsomra might stay asleep slightly longer compared to those using Ambien.
A review of several clinical trials involving zolpidem demonstrated it is effective at reducing sleep latency from the very first dose and also has few side effects with short-term use. It's also well-tolerated across different populations including elderly patients suffering from chronic insomnia. Dosing typically begins at 5 mg/day and may be increased if necessary under medical supervision, but caution needs to be exercised due its potential risk for dependence and withdrawal symptoms upon discontinuation after long term use.
Suvorexant demonstrates similar effectiveness against placebo in treating insomnia according to a meta-analysis conducted in 2016. Suvorexant is often considered when other traditional hypnotics like benzodiazepines or non-benzodiazepines don't show desired results or cause troublesome side effects like daytime drowsiness or cognitive impairment; however, this medication too requires careful administration given its unique pharmacological properties which include potentially causing abnormal thinking or behavior changes.
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At what dose is Ambien typically prescribed?
Oral dosages of Ambien (Zolpidem) typically range from 5–10 mg/day, but research has shown that a 5 mg dose is often sufficient to treat insomnia in many adults. For elderly or debilitated patients, a lower initial dosage of 5 mg is recommended to decrease the possibility of side effects. Dosage can be increased to 10 mg if there is no response after a week. In any case, the maximum dosage should not exceed 10mg/day.
Belsomra (Suvorexant), on the other hand, has an oral dose range of between 5-20 mg/day for treating insomnia in adults. The starting dose usually starts at 10mg and may be increased up to a maximum of 20mg depending on individual patient response and tolerance. It's important to note under no circumstance should one exceed the daily limit.
At what dose is Belsomra typically prescribed?
Belsomra treatment is typically initiated at a dose of 10 mg taken by mouth right before bedtime. It's crucial not to take this medication unless you plan on getting a full night's sleep, which should be about seven hours minimum. Depending on individual tolerance and efficacy, the dose can be increased to 15 or 20 mg per day. However, it must be noted that higher doses may increase the risk of next-day impairment of driving and other activities requiring full alertness. The maximum recommended dosage is no more than 20 mg once daily, immediately before going to bed.
What are the most common side effects for Ambien?
Common side effects of taking Ambien can include:
- Drowsiness
- Dizziness, lightheadedness
- Abnormal thoughts and behavior (such as aggressiveness, abnormal extroversion, confusion)
- Sleep-driving and other complex behaviors while not fully awake (like preparing and eating food, making phone calls)
- Memory loss
- Anxiety
Similarly to Ambien, Belsomra may cause some common side effects such as:
- Somnolence or sleepiness during the day
- Headache
- Dizziness
- Abnormal dreams or nightmares
It's important to remember that everyone's body responds differently to medications. If you experience any severe reactions with either Ambien or Belsomra, it is crucial to seek medical assistance immediately.
Are there any potential serious side effects for Ambien?
While both Ambien and Belsomra are prescribed as sleep aids, they can cause different side effects in some patients. For Ambien, these may include:
- Complex sleep behaviors such as driving or preparing food while asleep
- Abnormal thoughts and behavior including aggression, feeling out of touch with reality, hallucinations, memory loss or suicidal thoughts
- Allergic reactions like hives; difficulty breathing; swelling in the face or throat
- Irregular heartbeat or chest pain
- Difficulty breathing
Belsomra can similarly cause complex sleep behaviors. Other potential side effects include:
- Severe allergic reactions such as rash, itching/swelling (especially of the face/tongue/throat), severe dizziness and trouble breathing
- Temporary inability to move or talk for up to several minutes (sleep paralysis)
- Hallucinations such as seeing/hearing/feeling things that are not there Symptoms related to narcolepsy-like cataplexy which might result in weak or paralyzed muscles.
If any of these signs appear after starting either medication it is important to contact your healthcare professional right away.
What are the most common side effects for Belsomra?
Belsomra, like other sleep aids, may also come with a set of side effects. These can include:
- Dry mouth or throat discomfort
- Unusual dreams or nightmares
- Feeling tired or groggy the next day
- Headache and dizziness
- Anxiety, agitation or feeling restless
- Nausea and stomach upset
- Night-time urination frequency (nocturia) Moreover, it's important to note that Belsomra might cause some serious side effects such as temporary memory loss, mood changes including depression and suicidal thoughts. Always consult your healthcare provider if these symptoms persist.
Are there any potential serious side effects for Belsomra?
Belsomra is generally considered safe, but it can cause serious side effects in some cases. These include:
- Severe allergic reactions: Signs of this may be hives, difficulty in breathing or swallowing, and swelling of the face, lips, tongue or throat.
- Unusual thoughts or behavior: Some people taking Belsomra have engaged in activities such as driving a car ("sleep-driving"), making and eating food, having sex, walking around or talking on the phone while not fully awake. If you experience any such events after taking Belsomra contact your doctor immediately.
- Depression symptoms: In rare cases individuals might experience worsening depression or suicidal thoughts when using sleep medicines like Belsomra. Always consult with your healthcare provider if you notice any changes to your mood or behaviour.
- Sleep paralysis (the temporary inability to move which occurs just after falling asleep)
- Hallucinations
- Temporary leg weakness.
It's important to note that everyone reacts differently to medications so do not be alarmed by this list of potential side effects; they are relatively uncommon but if experienced should result in immediate consultation with a healthcare professional.
Contraindications for Ambien and Belsomra?
Both Ambien and Belsomra, like most other sleep medications, may exacerbate symptoms of depression in some individuals. If you notice a worsening of your depression or an increase in suicidal ideation, thoughts, or behaviors while taking these medications, please seek immediate medical attention.
Neither Ambien nor Belsomra should be taken if you are currently using any opioid medication due to a risk of dangerous interactions that could result in severe side effects such as slowed breathing. Always inform your doctor about the drugs you're currently taking; opioids will require a period of clearance from the system to prevent harmful interactions with Ambien and Belsomra.
Moreover, it's crucial to avoid alcohol while on either drug because it can enhance their sedative effects leading potentially hazardous situations like increased drowsiness or accidental falls. With both medicines being central nervous system depressants they can slow breathing especially when combined with other CNS depressors which include alcohol.
How much do Ambien and Belsomra cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Ambien (10 mg) averages around $200, which works out to approximately $6–$7/day, depending on your dose.
- The cost for a similar quantity of Belsomra (20 mg) is about $350, working out to roughly $11-$12/day.
Thus, if you are taking a regular dosage range for either drug, then brand-name Belsomra is more expensive on a per-day treatment basis. However, remember that cost should not be the primary consideration in determining which drug is best suited for you.
As with most medications, costs significantly decrease when considering generic forms:
- Zolpidem Tartrate (the generic version of Ambien), available in packs starting from 30 tablets and above has an approximate cost ranging from as low as $0.50 up to about $1.60 per day depending upon your dosage.
- Suvorexant (generic form of Belsomra) also comes in different pack sizes beginning at 30 tablets with daily costs ranging between slightly over a dollar up to about four dollars per day based on typical dosages.
Popularity of Ambien and Belsomra
Zolpidem, in generic form as well as brand names such as Ambien, was estimated to have been prescribed to about 11 million people in the US in 2020. Zolpidem accounted for just over 20% of prescriptions among sleep medications. Although it's classified as a hypnotic, its mechanism is different from traditional benzodiazepines. Zolpidem’s popularity has remained relatively steady over the past decade.
Suvorexant, also known by its brand name Belsomra, was prescribed to approximately half a million people in the USA during the same period. Suvorexant represents around 1-2% of overall sleep aid prescriptions and is unique due to its orexin receptor antagonist properties - blocking neurotransmitters that promote wakefulness rather than enhancing those that encourage sleep like most other sleeping pills do. Its use has seen gradual growth since entering the market in late 2014.
Conclusion
Both Ambien (zolpidem) and Belsomra (suvorexant) are used to treat insomnia, with substantial clinical research supporting their effectiveness over placebo treatments. They can at times be utilized together, but this is subject to careful consideration by a physician due to the potential for adverse drug interactions. Their mechanisms of action differ: Ambien primarily works by enhancing GABA, an inhibitory neurotransmitter that helps promote sleep; on the other hand, Belsomra functions as an orexin receptor antagonist blocking wake-promoting neurons.
Generally speaking, Ambien is often considered a first-line treatment option because it has been around longer and its effects kick in quickly. In contrast, Belsomra could be seen as an alternative choice when patients do not respond well or are unable to tolerate other types of sleeping pills such as those from the benzodiazepine or nonbenzodiazepine families like Ambien.
Both drugs come in generic versions which can lead to significant cost savings especially for individuals paying out-of-pocket. The onset of full therapeutic benefits may vary between these medications with users possibly needing some time for adjustment before experiencing optimal results.
The side effect profile is relatively similar between these two drugs - both are generally well-tolerated although there are differences: while drowsiness and possible memory lapses might occur more frequently with Ambien use than with Belsomra; headaches seem less common among those using Ambien compared to those taking Belsomra. As always, any new symptoms should prompt review by healthcare providers immediately.
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Refrences
- Kuriyama, A., & Tabata, H. (2017, October). Suvorexant for the treatment of primary insomnia: A systematic review and meta-analysis. Sleep Medicine Reviews. Elsevier BV.http://doi.org/10.1016/j.smrv.2016.09.004
- Norman, J. L., Fixen, D. R., Saseen, J. J., Saba, L. M., & Linnebur, S. A. (2017, May 5). Zolpidem prescribing practices before and after Food and Drug Administration required product labeling changes. SAGE Open Medicine. SAGE Publications.http://doi.org/10.1177/2050312117707687
- Anderson, S., & Norman, J. (2016, July). Novel class of medications, orexin receptor antagonists, in the treatment of insomnia – critical appraisal of suvorexant. Nature and Science of Sleep. Informa UK Limited.http://doi.org/10.2147/nss.s76910
- Sullinger, S., Bryand, K., & Kerrigan, S. (2016, December 29). Identification of Suvorexant in Urine Using Liquid Chromatography-Quadrupole/Time-of-Flight Mass Spectrometry (LC-Q/TOF-MS). Journal of Analytical Toxicology. Oxford University Press (OUP).http://doi.org/10.1093/jat/bkw132
- Uygun, D. S., Ye, Z., Zecharia, A. Y., Harding, E. C., Yu, X., Yustos, R., … Wisden, W. (2016, November 2). Bottom-Up versus Top-Down Induction of Sleep by Zolpidem Acting on Histaminergic and Neocortex Neurons. The Journal of Neuroscience. Society for Neuroscience.http://doi.org/10.1523/jneurosci.3714-15.2016