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Restoril vs Ambien
Introduction
For individuals dealing with insomnia or other sleep-related problems, certain medications that adjust the balance of compounds in the brain related to sleep regulation can assist in stabilizing irregular sleep patterns and managing symptoms. Restoril and Ambien are two such drugs often prescribed for these conditions. Each impacts different processes within the brain but both have effects on inducing relaxation and promoting sleep in patients with insomnia. Restoril, also known as Temazepam, is a benzodiazepine medication which increases the activity of GABA receptors, a neurotransmitter associated with inducing sleepiness. On the other hand, Ambien, clinically known as Zolpidem, belongs to a class of drugs called sedative-hypnotics which work by activating GABA receptors specifically designed towards slowing brain activity enabling better initiation of sleep.
Restoril vs Ambien Side By Side
| Attribute | Restoril | Ambien |
|---|---|---|
| Brand Name | Restoril | Ambien |
| Contraindications | Worsening of depression, suicidal ideation, use with MAOIs or SSRIs without a clearance period or careful monitoring. | Worsening of depression, suicidal ideation, use with MAOIs or SSRIs without a clearance period or careful monitoring. |
| Cost | For brand name: around $250 for 30 capsules (30 mg). For generic (temazepam): as low as $0.40/day to about $1.20/day. | For brand name: about $180 for 30 tablets (10 mg). For generic (zolpidem): from just under $.50/day to about $3/day. |
| Generic Name | Temazepam | Zolpidem |
| Most Serious Side Effect | Unusual thoughts and behavior, including suicidal ideation, signs of an allergic reaction, changes in vision, hallucinations or confusion, abnormal heartbeats, symptoms associated with low sodium levels, severe reactions affecting the nervous system. | Signs of an allergic reaction, changes in behavior or mood such as aggression, agitation, hallucinations, depression or suicidal thoughts, confusion and disorientation, visual changes, memory loss. |
| Severe Drug Interactions | MAOIs, SSRIs | MAOIs, SSRIs |
| Typical Dose | 7.5–30 mg/day, with 15 mg/day being sufficient for most adults. | 5 mg for women and 5 or 10 mg for men, taken orally once per night immediately before bedtime. Maximum of 10 mg. |
What is Restoril?
Temazepam (the generic name for Restoril) and zolpidem (the generic name for Ambien) are two prescription medications used to treat short-term insomnia. Both belong to a class of drugs known as hypnotics, which work by slowing activity in the brain to allow sleep. Temazepam was first approved by the FDA in 1981 and works primarily on GABA receptors, enhancing the effects of this neurotransmitter to induce sleepiness. It's generally prescribed for people who have difficulty falling asleep or staying asleep throughout the night.
On the other hand, Zolpidem was approved later by FDA in 1992 and it acts specifically on GABA-A receptors that bind with high affinity to alpha-1 subunits; these types of receptors have been associated with sedation. This selective action results in fewer side effects compared to non-selective hypnotics like temazepam making it quite popular among doctors when prescribing a medication for short-term treatment of insomnia.
What conditions is Restoril approved to treat?
Restoril is approved for the treatment of insomnia characterized by difficulty in falling asleep, staying asleep or early morning awakening:
- Short-term insomnia
- Long-term chronic insomnia (on a case-by-case basis)
- Insomnia due to generalized anxiety disorder (GAD)
- Sleep disturbances related to depressive disorders.
How does Restoril help with these illnesses?
Restoril helps manage insomnia by enhancing the effects of a neurotransmitter known as gamma-aminobutyric acid (GABA) in the brain. GABA inhibits activity in many of the nerve cells of the brain, and its increased presence due to Restoril can result in sedative, anti-anxiety, and muscle-relaxing effects. This is achieved by increasing GABA's affinity for its receptor sites on neurons — thus slowing down neuron firing rates — which can help individuals with sleep disorders fall asleep quicker and stay asleep longer. Like serotonin plays a key role in depression management; GABA modulation plays an important role in managing insomnia conditions. Therefore, by enhancing GABA activity, Restoril can limit negative effects of insomnia and aid patients manage their condition more effectively.
What is Ambien?
Ambien is the brand name for zolpidem, a sedative medication that works by slowing brain activity to allow sleep. It's part of a group of drugs known as hypnotics and is most commonly prescribed for insomnia. Ambien was first approved by the FDA in 1992.
Unlike Restoril, which belongs to a class of medications called benzodiazepines, Ambien falls under non-benzodiazepine hypnotics category. This difference essentially means it has fewer side effects and less potential for dependency compared to many traditional "benzo" medications like Restoril (Temazepam).
As a non-benzodiazepine hypnotic, Zolpidem doesn't interfere with sleep stages - REM or deep sleep - thus making your rest more recuperative. Common side effects may include drowsiness upon waking up; however, serious side effects like hallucinations or memory loss are relatively rare when taken properly. The effectiveness on inducing sleep quickly can be beneficial especially for those who have difficulty falling asleep.
What conditions is Ambien approved to treat?
Ambien is a commonly prescribed medication approved for the short-term treatment of:
- Insomnia, characterized by difficulties with sleep initiation
- Sleep disturbances or disorders where maintaining sleep is a problem.
It's important to note that Ambien should be used sparingly and only under doctors' supervision due to its potential for dependency and withdrawal symptoms upon discontinuation.
How does Ambien help with these illnesses?
Ambien, also known as zolpidem, is a sedative primarily used for the treatment of trouble sleeping. It operates by interacting with GABA receptors in the brain to slow down activity and induce sleep. This medication works on specific GABA-A receptor subtypes, helping to improve sleep quality and duration. Restoril (temazepam), on the other hand, also interacts with GABA receptors but doesn't have the same specificity that Ambien does. As such, while both medications are effective at inducing sleep, Ambien often results in fewer side effects like grogginess or drowsiness during daytime hours due to its more targeted action. Hence it's sometimes prescribed when patients do not respond well or get undesirable side effects from "typical" benzodiazepines such as Restoril.
How effective are both Restoril and Ambien?
Both temazepam (Restoril) and zolpidem (Ambien) have proven their effectiveness in treating insomnia. Temazepam was first approved by the FDA in 1981, while zolpidem received its approval over a decade later, in 1992. They work differently within the body; temazepam is a benzodiazepine that enhances GABA activity to produce sedation, whereas zolpidem is a non-benzodiazepine hypnotic of the imidazopyridine class which selectively binds to the alpha-1 subunit of the GABA-A receptor.
In terms of comparative studies between these two medications, few head-to-head trials exist. However, both have demonstrated efficacy in reducing sleep onset latency and increasing total sleep time with similar safety profiles. A 2008 study found that patients receiving Ambien reported slightly better quality of sleep than those receiving Restoril but observed no significant differences for other measures such as sleep duration or number of awakenings.
A review conducted on temazepam confirmed it can effectively reduce time taken to fall asleep beginning from early stages of treatment. Its side effect profile is generally considered favourable compared to older sedatives; however caution must be exercised due to potential risks associated with long-term use including dependency and withdrawal symptoms upon cessation.
Zolpidem has been extensively studied since its introduction into clinical practice appearing more effective than placebo at improving both subjective and objective measures related to insomnia according to a meta-analysis done in 2016. Despite being categorized as non-benzodiazepines Z-drugs like zolpidem may also carry risks related to dependence particularly when used over extended periods or at higher doses.
Generally speaking choice between either drug would depend on individual patient characteristics like age health status risk factors for dependence etc., along with timing and type of sleeping problem present whether trouble falling asleep staying asleep or waking too early.
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At what dose is Restoril typically prescribed?
Oral dosages of Restoril range from 7.5–30 mg/day, but studies have indicated that 15 mg/day is sufficient for treating insomnia in most adults. Elderly or debilitated patients may be started on 7.5 mg/day. In either population, dosage can be increased after a few weeks if there is no response. The maximum dosage that should not be exceeded in any case is 30 mg/day.
At what dose is Ambien typically prescribed?
Ambien therapy typically starts with a dose of 5 mg for women and either 5 or 10 mg for men, taken orally once per night immediately before bedtime with at least 7-8 hours set aside to sleep. The dose can be increased to a maximum of 10 mg only if the initial dosage is not effective. This higher dosage should be considered if there is no noticeable improvement in sleep after taking the lower dose, but patients must remember that the total Ambien dosage in any given night should not exceed 10 mg. It's important to note that doses are usually individualized according to patient response and tolerance; thus ensuring safety and efficacy.
What are the most common side effects for Restoril?
Common side effects of Restoril include:
- Dizziness
- Sleepiness/drowsiness (somnolence)
- Nausea
- Fatigue or general weakness (asthenia)
- Nervousness, anxiety
- Dry mouth
- Headache
While Ambien has similar common side effects such as:
- Drowsiness/sleepiness (somnolence)
- Lightheadedness
- Unusual dreams or nightmares
- Stuffy nose or dry throat -Diarrhea, nausea, vomiting
Both medications can cause more serious but rarer side effects like memory loss and behavioral changes. Always consult with a healthcare provider for any unusual symptoms after taking these medications.
Are there any potential serious side effects for Restoril?
In unusual cases, Restoril can cause severe side effects, which include:
- Unusual thoughts and behavior, including suicidal ideation
- Signs of an allergic reaction such as hives; difficulty breathing; swelling in your face or throat
- Changes in vision such as blurred or tunnel vision, eye pain or swelling
- Hallucinations or confusion
- Abnormal heartbeats--either faster than normal or uneven--fluttering sensation in the chest, shortness of breath that may be accompanied by dizziness (feeling like you might pass out)
- Symptoms associated with low sodium levels - headache, confusion, slurred speech, severe weakness,vomiting , loss of coordination and instability
- Severe reactions affecting the nervous system: rigid muscles; high fever; sweating ;confusion ;fast/irregular heartbeats ;tremors , feeling faint
If you are using Restoril and notice any symptoms resembling serotonin syndrome—characterized by restlessness/agitation/hallucinations/high body temperature/sweating/shivering/fast heartbeat/muscle stiffness/twitching/uncoordinated movements/nausea/vomiting/diarrhea—seek medical attention immediately. Serious side effects from this medication are rare but require immediate medical attention if they do occur.
What are the most common side effects for Ambien?
While both Restoril and Ambien are prescribed to help with insomnia, their side effects may differ. Here are some common side effects of Ambien:
- Drowsiness during the day
- Lightheadedness or dizziness
- Dry mouth or throat discomfort
- Unusual dreams, nightmares, or sleepwalking episodes
- Nausea, vomiting or upset stomach
- Headache
- Muscle weakness
- Loss of coordination/balance
In rare cases, users may experience a fast heartbeat. More serious symptoms like confusion, aggression and even hallucinations have been reported in infrequent instances. If you notice any of these severe symptoms after taking Ambien or any other unusual changes in your behavior or mood it is important to contact your doctor right away.
Are there any potential serious side effects for Ambien?
While Ambien is generally considered safe when taken as directed, it can cause serious side effects in rare cases. These might include:
- Signs of an allergic reaction: hives, difficulty breathing or swallowing, swelling of your face or throat
- Changes in behavior or mood such as aggression, agitation, hallucinations, depression or suicidal thoughts
- Confusion and disorientation
- Visual changes including blurred vision and seeing halos around lights
- Memory loss (amnesia) about activities done after taking the medication e.g., driving a car ("sleep-driving"), preparing and eating food, making phone calls etc.
If you experience any unusual sleep-related behaviors while using Ambien, stop taking the drug immediately and consult with your healthcare provider. It's important to be aware that stopping this medication abruptly can lead to withdrawal symptoms including insomnia rebound so always seek professional advice before changing your dosage.
Contraindications for Restoril and Ambien?
Both Restoril and Ambien, as with most other hypnotic medications, could potentially worsen symptoms of depression in some people. If you notice your depression worsening or an increase in suicidal ideation, thoughts, or behavior after starting these medications, it is crucial to seek immediate medical attention.
Neither Restoril nor Ambien should be taken if you are currently taking or have recently taken certain classes of psychiatric drugs such as monoamine oxidase inhibitors (MAOIs) or selective serotonin reuptake inhibitors (SSRIs). Always inform your physician about all the medications you're currently on; MAOIs will require a period of about two weeks to clear from the system before initiating treatment with either Restoril or Ambien to prevent dangerous interactions. SSRIs may also interact adversely with these hypnotics and need careful monitoring under medical supervision.
How much do Restoril and Ambien cost?
For the brand name versions of these drugs:
- The price for 30 capsules of Restoril (30 mg) averages around $250, which works out to approximately $8–16/day, depending on your dose.
- The price for 30 tablets of Ambien (10 mg) averages at about $180, working out to roughly $6/day.
Hence, if you are in the higher dosage range for Restoril (i.e., 60 mg/day or more), then brand-name Ambien is less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.
For the generic versions - temazepam (Restoril) and zolpidem (Ambien), costs are significantly lower:
- Temazepam comes in packs ranging from 15 up to 1000 capsules with prices starting as low as $0.40 /day if you buy larger quantities upfront and not exceeding about $1.20 per day.
- Zolpidem can be found in packs from 7 up to several hundred tablets with daily prices ranging from just under $.50/day to about $3/day depending on quantity purchased and the specific dosage required.
Popularity of Restoril and Ambien
Temazepam, available under the brand name Restoril, was prescribed to approximately 2.3 million people in the US in 2020. Although it is considered a minor tranquilizer, temazepam accounted for just over 11% of benzodiazepine prescriptions in the US last year. It has been on the market since the early 1980s and is primarily used for short-term treatment of insomnia.
Zolpidem, also known by its brand name Ambien, was prescribed to nearly 10 million Americans during that same time period. In fact, zolpidem accounts for almost half (48%) of all prescriptions written for sedative-hypnotics - drugs designed specifically to induce sleep or cause relaxation - making it one of the most commonly used medications in this category. Despite some concerns about potential side effects and dependence issues associated with long-term use, Zolpidem's popularity continues largely unimpeded due to its effectiveness at initiating sleep quickly.
Conclusion
Both Restoril (temazepam) and Ambien (zolpidem) have a long track record of being effective in managing short-term insomnia. Numerous clinical studies indicate that they are more effective than placebo treatments at inducing sleep and improving sleep quality. Both medications work by enhancing the effects of GABA, a neurotransmitter known to induce calmness and relaxation.
Due to their different pharmacokinetics, with Restoril having a longer half-life compared to Ambien, they tend to be prescribed under different circumstances: Restoril may be used when both falling asleep and staying asleep is problematic, while Ambien is typically recommended for those who have difficulties initiating sleep.
Restoril is considered an older medication with well-known safety profile whereas Ambien has been linked recently to unusual behaviors during sleep such as eating or driving without any memory of it.
Generic forms for both drugs are available which can represent significant cost savings especially for patients paying out-of-pocket. It's important to note that tolerance or dependence might develop after prolonged use of either drug; hence doses should not be increased without consulting a healthcare professional first.
The side effect profiles are similar between the two drugs: drowsiness, dizziness, headache among others but users must closely monitor their condition especially when starting treatment because serious side effects although rare like confusion or memory loss might happen.
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Refrences
- Sancar, F., Ericksen, S. S., Kucken, A. M., Teissére, J. A., & Czajkowski, C. (2006, September 29). Structural Determinants for High-Affinity Zolpidem Binding to GABA-A receptors. Molecular Pharmacology. American Society for Pharmacology & Experimental Therapeutics (ASPET).http://doi.org/10.1124/mol.106.029595
- Greenblatt, D. J., & Roth, T. (2012, March 19). Zolpidem for insomnia. Expert Opinion on Pharmacotherapy. Informa Healthcare.http://doi.org/10.1517/14656566.2012.667074
- 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
- 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