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Lunesta vs Ativan
Introduction
For patients suffering from insomnia or anxiety, certain medications can help by altering the concentration of chemicals in the brain linked to stress and relaxation. Lunesta and Ativan are two such drugs that are often prescribed for these conditions. Each impacts different neurotransmitters in the brain but both aim to promote sleep and reduce anxiety.
Lunesta is classified as a non-benzodiazepine hypnotic agent which primarily works by interacting with GABA receptors in the brain, promoting sedation, reducing anxiety, and helping initiate and maintain sleep.
Ativan on the other hand is a benzodiazepine, affecting levels of GABA (gamma-aminobutyric acid), an inhibitory neurotransmitter known for its calming effect on the nervous system. Both medications have their own set of side effects so it's important to discuss these factors thoroughly with your healthcare provider before starting treatment.
Lunesta vs Ativan Side By Side
| Attribute | Lunesta | Ativan |
|---|---|---|
| Brand Name | Lunesta | Ativan |
| Contraindications | Should not be taken with opioids or by individuals with a history of drug dependency. May intensify feelings of depression. | Should not be used with opioids or by individuals with a history of drug dependency. May worsen symptoms of depression. |
| Cost | For the brand name, around $350 for 30 tablets (3 mg). Generic eszopiclone costs approximately $0.80 - $1 per pill. | For the brand name, about $220 for 60 tablets (2.5 mg). Generic lorazepam costs as low as ~$0.20/day when bought in larger quantities. |
| Generic Name | Eszopiclone | Lorazepam |
| Most Serious Side Effect | Allergic reactions, changes in behavior or mood including thoughts of suicide, hallucinations, aggression. | Severe allergic reactions, vision disturbances, unusual changes in mood or behavior, including confusion and hallucinations. |
| Severe Drug Interactions | Opioids, alcohol, and other central nervous system depressants. | Opioids, alcohol, and other central nervous system depressants. |
| Typical Dose | 1-3 mg/night, with a starting dose of 1 mg/night recommended for most people. | For anxiety, 0.5 mg to 1 mg twice daily. For insomnia due to anxiety or stress, a single daily dose of 2-4mg may be given at bedtime. |
What is Lunesta?
Eszopiclone (the generic name for Lunesta) is a nonbenzodiazepine hypnotic agent used in the treatment of insomnia. It was first approved by the FDA in 2004. Lunesta works by enhancing GABA receptors, leading to sedation. Unlike some other sleep aids, it's approved for long-term use and does not decrease its effectiveness over time.
On the other hand, Lorazepam (the generic name for Ativan) belongs to a class of drugs called benzodiazepines which were developed as an advancement on barbiturates—an older class of anti-anxiety medications and sedatives. Ativan also enhances GABA receptor activity but has a broader range of uses including anxiety disorders, seizure disorders, alcohol withdrawal symptoms as well as insomnia.
While both medicines are effective at promoting sleep, they do have different side effect profiles and uses due to their unique influences on neurotransmission in the brain: Lunesta primarily promotes sleep while Ativan can be used for a wider variety of conditions but may come with greater potential risks such as dependence.
What conditions is Lunesta approved to treat?
Lunesta is approved for the treatment of specific sleep disorders:
- Insomnia, characterized by difficulties with sleep onset and/or sleep maintenance Ativan, on the other hand, has a broader range of applications:
- Anxiety disorders
- Insomnia due to anxiety or stress
- Preoperative sedation and procedural anxiety relief
- Acute seizures as part of its off-label uses.
How does Lunesta help with these illnesses?
Lunesta helps to manage insomnia by increasing the amount of gamma-aminobutyric acid (GABA) available in the brain. It does this by enhancing its effects, which inhibits excess brain activity and promotes relaxation and sleep. GABA is a neurotransmitter, a chemical that acts as a messenger in the brain, playing an important role in mood regulation, stress relief, focus ability and sleep patterns among other things. People with insomnia often have lower levels of GABA. Therefore, by augmenting GABA's effects, Lunesta can alleviate insomnia symptoms helping patients achieve restful sleep.
On the other hand, Ativan also increases availability of GABA but it works more on anxiety symptoms associated with several psychiatric disorders or for short term relief from acute symptoms such as panic attacks due to its quick onset action compared to Lunesta which is mainly used for improving sleep disturbances.
What is Ativan?
Ativan is a brand name for lorazepam, which is a benzodiazepine. Benzodiazepines work by increasing the effects of GABA, an inhibitory neurotransmitter in the brain. This results in sedative, anxiety-reducing and muscle-relaxing effects. Lorazepam was first approved by the FDA in 1977.
As lorazepam is not a nonbenzodiazepine sleep aid (like Lunesta), it does more than just promote sleep; it also reduces anxiety and can be used to treat seizures because of its action on GABA receptors. Its broader effect profile means that its side-effects are different from those of nonbenzodiazepine sleep aids like Lunesta: while both drugs can cause drowsiness and confusion, Ativan might also cause dependence if used long-term or at high doses.
The impact on GABA can be beneficial for treating conditions such as insomnia, especially if patients do not respond well to typical nonbenzodiazepine treatments like Lunesta. It's important to note that Ativan should only be taken under medical supervision due to potential risks including tolerance, physical dependence, and withdrawal symptoms following discontinuation.
What conditions is Ativan approved to treat?
Ativan, also known by its generic name lorazepam, is an FDA-approved medication for the treatment of:
- Anxiety disorders
- Short-term relief of symptoms related to anxiety or acute stress that may be disruptive to your everyday life.
How does Ativan help with these illnesses?
Ativan is a medication known as a benzodiazepine which affects gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain. This, in turn, helps to slow down and calm nervous activity, providing relief from acute symptoms of anxiety or panic attacks. It's also often used for pre-procedural sedation and during seizure management due to its calming effects on the brain and body. Unlike Lunesta, which specifically targets sleep regulation by interacting with GABA receptors that are closely related to your sense of wakefulness or alertness, Ativan has a broader impact on the central nervous system. Therefore it may be more suitable for individuals who suffer from both insomnia and anxiety issues concurrently. However, because of its broad-acting nature compared with Lunesta (a non-benzodiazepine hypnotic agent), Ativan has a higher risk of dependence if used long-term and should be prescribed carefully after consideration.
How effective are both Lunesta and Ativan?
Both eszopiclone (Lunesta) and lorazepam (Ativan) have established histories of success in treating insomnia, with Ativan having been approved by the FDA a decade before Lunesta. They act on different neurotransmitters - specifically GABA receptors - but both enhance sleep-promoting effects.
The effectiveness of Lunesta and Ativan was directly studied in a double-blind clinical trial in 2006; both drugs exhibited similar efficacy at inducing sleep as well as maintaining it through the night, reflecting promising safety profiles. In this study, none of the different metrics used to measure sleep quality showed significant differences between patients receiving Lunesta or those given Ativan.
A review from 2014 demonstrated that Lunesta is effective at reducing latency to persistent sleep from the first dose onward, its side effect profile is comparable to other non-benzodiazepine hypnotics, and it is generally well-tolerated even in elderly populations. This same study reported that despite being relatively newer than many other hypnotic drugs like benzodiazepines, Lunesta has become one of the most commonly prescribed medications for insomnia due to its minimal risk for dependency compared to traditional benzodiazepines.
On the other hand, a meta-analysis conducted in 2012 indicated that while Ativan appears more potent than placebo at promoting sleep onset and maintenance among insomniac patients initially, chronic use may lead to tolerance thereby diminishing its potency over time. Nonetheless, due to its rapid onset action and strong sedative properties without significant hangover effects often seen with longer-acting benzodiazepines such as diazepam or flurazepam make it an optimal choice for acute bouts of severe insomnia where immediate relief is required.
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At what dose is Lunesta typically prescribed?
Oral dosages of Lunesta typically range from 1-3 mg/night, but studies have indicated that a 1 mg/night dosage is sufficient for treating insomnia in most people. Elderly or debilitated patients may need to start with a lower dosage. Dosage can be increased after a few nights if there is no response. The maximum recommended dose that should not be exceeded in any case is 3 mg/night.
For Ativan (Lorazepam), typical oral doses for anxiety are between 0.5-2mg taken two or three times per day, but doctors often prescribe it on an as-needed basis rather than on a fixed schedule. For the treatment of insomnia due to anxiety or transient situational stress, a single daily dose of 2-4mg may be given, usually at bedtime. In either population, dosage adjustments may be necessary depending upon the clinical situation and patient's response.
At what dose is Ativan typically prescribed?
Ativan treatment for anxiety is usually initiated with a dose of 0.5 mg to 1 mg twice daily. The dosage can be gradually increased with an interval of at least three days in between adjustments, based on the patient's response and tolerance to the medication. The maximum recommended dosage is up to 6 mg/day divided into two or three doses depending upon individual needs and responses; however, some patients may require higher doses under close medical supervision. If there is no significant improvement in symptoms after a few weeks at this maximum recommended dose, further evaluation might be necessary.
What are the most common side effects for Lunesta?
Common side effects of both Lunesta and Ativan include:
- Drowsiness during the day
- Dizziness or lightheadedness
- Memory problems
- Difficulty with coordination, which can make it dangerous to drive or operate machinery
- Unusual changes in behavior, such as aggression, confusion, hallucinations
- Nausea and vomiting
- Dry mouth or excessive salivation
- Changes in appetite (increased hunger)
More serious potential side effects that should prompt immediate medical attention are signs of an allergic reaction: rash; itching/swelling (especially of the face/tongue/throat); severe dizziness; trouble breathing.
These medications may cause dependency if taken for extended periods. Always consult your doctor before stopping these medications abruptly.
Are there any potential serious side effects for Lunesta?
While Lunesta and Ativan are both used to treat various sleep disorders, they do have different potential side effects. For instance, with Lunesta:
- Allergic reactions may occur in sensitive individuals: symptoms can include hives; difficulty breathing; swelling of your face, lips, tongue, or throat
- Changes in behavior or mood (including thoughts of suicide)
- Hallucinations
- Aggression
- Memory problems
- Anxiety or restlessness
On the other hand, Ativan might cause:
- Memory disturbances
- Addiction if used long-term
- Withdrawal symptoms upon discontinuation after prolonged use,
- Paradoxical reactions like agitation and anxiety.
In case any of these signs appear while taking either medication, it's essential to seek immediate medical attention. It is also worth noting that neither medication should be consumed without a proper prescription from a healthcare provider.
What are the most common side effects for Ativan?
Ativan, an anti-anxiety medication and sedative, can present the following side effects:
- Dry mouth or changes in appetite
- Fatigue or drowsiness
- Dizziness and lightheadedness
- Sleep disturbances such as insomnia
- Muscle weakness or lack of coordination
- Nausea, vomiting, constipation
- Sweating or feelings of warmth
- Headache
- Blurred vision -Tremors, especially if the drug is stopped suddenly after long-term use. It's important to remember that while these symptoms may occur they do not happen to everyone. Always consult with your healthcare provider if you experience any unusual symptoms.
Are there any potential serious side effects for Ativan?
Ativan can cause serious side effects, though they are typically rare. If you experience any of the following symptoms while taking Ativan, seek immediate medical attention:
- Signs of an allergic reaction: hives; difficulty breathing; swelling in your face or throat
- Severe skin reaction: high fever with a sore throat and burning eyes; skin pain accompanied by red or purple rash that spreads in the upper body causing blistering and peeling
- New onset seizures (convulsions)
- Unusual changes in mood or behavior, including confusion and hallucinations
- Vision disturbances such as blurred vision, eye pain/swelling, seeing halos around lights
- Rapid heart rate or irregular heartbeat
- Mental/mood changes such as hallucinations and suicidal thoughts.
Remember to consult with your healthcare provider before starting new medications to fully understand potential risks and benefits.
Contraindications for Lunesta and Ativan?
Both Lunesta and Ativan, along with most other sedative medications, can intensify feelings of depression in some individuals. If you notice your symptoms of depression worsening or an increase in suicidal ideation or behavior while taking either drug, please seek immediate medical attention.
Neither Lunesta nor Ativan should be taken if you are using, or have recently used drugs classified as opioids. Always inform your healthcare provider about all the medications you're currently taking; opioids will need a period to clear from your system to avoid dangerous interactions with Lunesta and Ativan.
These drugs may also produce physical dependency over time which could lead to withdrawal symptoms if stopped abruptly. Therefore, it's always recommended that these medicines be discontinued under the supervision of a physician who can help manage any potential withdrawal effects.
How much do Lunesta and Ativan cost?
For the brand name versions of these drugs:
- The price for 30 tablets of Lunesta (3 mg) averages around $350, which works out to approximately $11–12/day.
- In contrast, the cost for 60 tablets of Ativan (2.5 mg) is about $220, working out to roughly $3.66 per day.
Therefore, if you are in the higher dosage range for Lunesta or considering a long-term treatment plan, then branded Ativan might be less expensive on a daily basis. However, bear in mind that cost should not dictate your choice between these two medications as their efficacy and side effects may differ significantly.
Considering the generic versions of both drugs – eszopiclone (Lunesta) and lorazepam (Ativan), costs decrease considerably:
- Eszopiclone comes in packs of 15 up to 90 capsules with prices ranging from about $0.80 - $1 per pill depending on dosage strength and quantity purchased; thus daily costs can vary but are generally lower than branded Lunesta.
- Lorazepam has typical pack sizes ranging between 10 up to nearly 500 tablets resulting in an approximate daily cost as low as ~$0.20/day if you buy larger quantities upfront.
In summary, although individual circumstances may differ including insurance coverage or location-based pricing disparities; typically generic forms offer significant savings compared to their brand-name counterparts while providing equivalent therapeutic benefits.
Popularity of Lunesta and Ativan
Eszopiclone, available under the brand name Lunesta, was prescribed to approximately 2.6 million people in the US in 2020. Eszopiclone is a non-benzodiazepine sedative hypnotic used for treating insomnia and accounts for just over 20% of prescriptions within its class. It has been generally increasing in usage since it was approved by the FDA in 2004.
Lorazepam, on the other hand, including branded versions such as Ativan, was prescribed to about 14.8 million individuals in the US during that same year. In terms of overall benzodiazepine prescriptions given out for anxiety and panic disorders among others, lorazepam takes up around a quarter (~25%). The prevalence of Lorazepam use has been relatively steady over the past decade. Both drugs are primarily used for their calming effects but differ significantly when considering their specific indications.
Conclusion
Both Lunesta (eszopiclone) and Ativan (lorazepam) have proven effective in managing sleep disorders, with numerous clinical studies and meta-analyses indicating their efficacy over placebo treatments. In some instances, these medications may be used together under the careful supervision of a physician due to potential interactions between them. Their mechanisms of action differ - Lunesta is primarily used as a sleeping aid for insomnia while Ativan, besides its use for insomnia, is also employed in treating anxiety disorders because it acts on GABA receptors producing sedative, anxiolytic effects.
Lunesta is often considered as first-line therapy for insomnia due to its minimal disruption of normal sleep architecture while Ativan might be added or chosen instead if there's concurrent need for anxiety control or if patients didn't respond well initially to other sleep aids.
Both drugs are available generically which can provide significant cost savings especially for out-of-pocket payers. Both Lunesta and Ativan may require adjustment periods where initial benefits aren't immediately noticeable.
The side effect profiles are somewhat similar with both being generally well-tolerated but with slight distinctions - Lunesta could cause taste alterations whereas Ativan might lead to dependency when used long-term. As always, patients should closely monitor their responses when starting treatment and seek medical help promptly if they experience worsening symptoms or unusual distressing feelings.
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Refrences
- Wu, T., Yu, G., Li, Z., & Xin, G. (2021, June 25). Case report of acute liver injury caused by the eszopiclone in a patient with chronic liver disease. Medicine. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1097/md.0000000000026243