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Restoril vs Ativan
Introduction
For patients suffering from insomnia or anxiety disorders, certain drugs that alter the levels of neurotransmitters in the brain can aid in managing symptoms and inducing sleep. Restoril and Ativan are two such medications often prescribed for these conditions. These benzodiazepines work by enhancing the effect of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits activity in the brain, thus producing a calming effect.
Restoril, also known as temazepam, is typically used to treat short-term insomnia symptoms like trouble falling asleep or staying asleep. On the other hand, Ativan or lorazepam is not only utilized for treating sleep disturbances but also actively prescribed for anxiety disorders due to its potent anxiolytic effects. Both drugs have sedative properties; however, their usage should always be under medical supervision due to potential dependency risks.
Restoril vs Ativan Side By Side
| Attribute | Restoril | Ativan |
|---|---|---|
| Brand Name | Restoril | Ativan |
| Contraindications | Should not be taken with alcohol or opioids; may exacerbate symptoms of depression or cause suicidal ideation. | Should not be taken with alcohol or opioids; may exacerbate symptoms of depression or cause suicidal ideation. |
| Cost | $0.60/day for generic versions | $0.20/day for generic versions |
| Generic Name | Temazepam | Lorazepam |
| Most Serious Side Effect | Increased thoughts about self-harm or suicide, severe nervous system reactions | Signs of an allergic reaction, severe sedation, unusual changes in mood or behavior |
| Severe Drug Interactions | Alcohol, opioids | Alcohol, opioids |
| Typical Dose | 7.5–30 mg/day, with 15 mg/day being sufficient for most adults | 1–2 mg/day, up to 6 mg/day in divided doses |
What is Restoril?
Temazepam (the generic name for Restoril) is a medication belonging to the benzodiazepine class of drugs, which was a significant advancement in treating insomnia and acute stress reactions compared to older sedative-hypnotic medications. Temazepam was first approved by the FDA in 1981. It works by enhancing the effects of GABA, a natural chemical in the body that induces sleepiness, effectively increasing its presence and action within the brain. It's primarily prescribed for short-term treatment of insomnia.
On the other hand, Lorazepam (the generic name for Ativan), another drug from the same benzodiazepine class as Temazepam, has broader uses including treating anxiety disorders and providing sedation before surgery or medical procedures alongside managing insomnia. Although both Restoril and Ativan work on GABA neurotransmitters to produce calming effects, they differ slightly in their potency and duration of action with Ativan having stronger anxiolytic properties but shorter duration than Restoril which makes it more suited for inducing sleep over longer periods.
What conditions is Restoril approved to treat?
Restoril and Ativan are both approved for the treatment of different conditions:
- Restoril is primarily used to treat insomnia, especially where difficulty falling asleep is a major symptom.
- Ativan, on the other hand, is predominantly utilized in treating anxiety disorders. It's also often used in conjunction with other medications for preoperative sedation and status epilepticus (a life-threatening condition where seizures last too long or occur close together).
How does Restoril help with these illnesses?
Restoril aids in managing insomnia by increasing the amount of gamma-aminobutyric acid (GABA) available in the brain. It accomplishes this by enhancing its effects, which allows for increased inhibition within the central nervous system. GABA is a neurotransmitter that plays a crucial role in reducing neuronal excitability throughout the nervous system, thus promoting relaxation and sleep. Individuals suffering from insomnia often have disrupted or insufficient GABA activity. Therefore, by potentiating GABA's effect, Restoril can alleviate symptoms of insomnia and help patients achieve better sleep quality and duration.
Similarly to Restoril, Ativan also works by enhancing the effects of GABA in the brain. However, it's not only used for treating insomnia but also for anxiety disorders, seizure disorders and to manage withdrawal symptoms from alcohol dependence due to its potent sedative effects on CNS.
What is Ativan?
Ativan is the brand name for lorazepam, a benzodiazepine that increases the action 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. Unlike Restoril (temazepam), another benzodiazepine primarily used as a short-term treatment for insomnia, Ativan has broader uses including management of anxiety disorders and providing sedation before medical procedures or surgery. It does not increase dopamine levels like antidepressants such as Wellbutrin; instead it heightens GABA activity to produce its therapeutic effect.
The side-effect profile of Ativan varies from those of SSRIs - it can cause drowsiness, which is beneficial for patients with insomnia but may not be ideal for other individuals. It's also less likely to lead to weight gain and sexual dysfunction compared to SSRI antidepressants like Prozac.
It should be noted that while both Restoril and Ativan can help people with sleep issues due to their tranquilizing properties, they are typically only recommended for short-term use because long-term usage can lead to tolerance and dependence.
What conditions is Ativan approved to treat?
Ativan is an FDA-approved medication used for the following conditions:
- Anxiety disorders, including generalized anxiety disorder and panic disorder.
- Acute symptoms of anxiety associated with depressive symptoms
- Short-term relief from severe or disabling anxiety
- Preoperative sedation and anxiety relief before surgical procedures.
How does Ativan help with these illnesses?
Ativan, also known as lorazepam, is in a class of drugs called benzodiazepines which act on the brain and nerves (central nervous system) to produce a calming effect. This drug works by enhancing the effects of a certain natural chemical in the body (GABA). Ativan is particularly effective for short-term treatment of seizures, anxiety disorders, and insomnia. It has a rapid onset of action within 1-5 minutes after administration and its effects can last up to 24 hours. Compared with Restoril, another benzodiazepine primarily used as a sleep aid, Ativan's broader scope of application makes it more versatile in managing various conditions that require anxiolytic intervention or seizure control. Similar to other medications in this class, patients must be closely monitored due to risks associated with dependency and withdrawal symptoms upon discontinuation.
How effective are both Restoril and Ativan?
Both temazepam (Restoril) and lorazepam (Ativan) are benzodiazepines with established histories of effectively treating insomnia and anxiety. They were initially approved by the FDA a few years apart, Restoril in 1969 and Ativan in 1977. As they act on similar neurotransmitters systems, namely enhancing the effects of GABA to reduce overactivity in the brain, their prescription may be based on individual patient factors.
The effectiveness of Restoril and Ativan was directly studied in a double-blind clinical trial; both drugs exhibited similar efficacy at managing symptoms of insomnia as well as comparable safety profiles. However, there can be differences within individual patients regarding onset time, duration of action, or side effect profile that could make one medication preferable over another.
A review showed that temazepam is effective for helping individuals fall asleep faster from the first night it's taken. It also increases sleep duration without causing serious adverse effects like rebound insomnia when treatment is stopped. Its side effect profile shows that it causes less daytime fatigue compared to other sedative-hypnotic medications making it better tolerated among different populations including elderly ones.
Similarly, a meta-analysis indicated lorazepam has proven to be more effective than placebo at reducing anxiety symptoms demonstrating an efficacy consistent with other common benzodiazepines. Lorazepam though typically considered after non-benzodiazepine treatments due to its potential risk for dependence if used long term. Further research supports its use alongside antidepressants showing robust data confirming its efficacy as adjunctive therapy for acute anxiety episodes related to depressive disorders. Nonetheless due to unique pharmacokinetic properties between these two drugs such as half-life duration or metabolism pathway either one might provide optimal benefits depending upon specific patient needs such avoiding prolonged sedation or minimizing drug-drug interactions respectively.
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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 a dosage of 15 mg/day is usually sufficient for treating insomnia in most adults. Elderly or debilitated patients may be started on 7.5 mg/day to decrease the possibility of oversedation or impaired motor function. In either population, dosage can be adjusted after careful observation if there is no therapeutic response. The maximum dosage that should not be exceeded in any case is 30 mg/day.
At what dose is Ativan typically prescribed?
Ativan treatment typically begins at a dosage of 1–2 mg/day, given in two to three divided doses. The dose can then be increased to up to 6 mg/day, divided into several smaller doses throughout the day. Maximum daily dose is usually around 10 mg for severe acute anxiety disorders and preoperative sedation but it may vary based on individual patient needs and response. It's important not to exceed the prescribed daily maximum and any changes should only be made under medical supervision. If there is no response after a few weeks of treatment or if symptoms persist, your doctor may reevaluate your condition and consider other therapeutic options.
What are the most common side effects for Restoril?
Common side effects of Restoril and Ativan include:
- Drowsiness, fatigue or lethargy
- Dizziness, unsteadiness
- Confusion, disorientation
- Amnesia (memory problems)
- Depression
- Nausea, vomiting
- Changes in appetite
- Dry mouth
- Blurred vision
- Sleep disturbances or insomnia (difficulty falling asleep or staying asleep)
It should be noted that both Restoril and Ativan can cause physical dependence with long-term use. If you experience any of these symptoms or they worsen over time, it is crucial to seek professional medical help immediately.
Are there any potential serious side effects for Restoril?
Although Restoril and Ativan belong to the same class of medications - benzodiazepines - they may cause slightly different side effects. With both, it's important to monitor for:
- Increased thoughts about self-harm or suicide (though rare with these sedatives)
- Signs of an allergic reaction like hives, difficulty breathing, swelling in your face or throat
- Vision disturbances such as blurred vision or seeing halos around lights
- Fast heartbeats, chest fluttering, shortness of breath and sudden dizziness that might make you feel like passing out
- Low sodium levels in the body which could present with headache, confusion, slurred speech, severe weakness, vomiting and loss of coordination
- Severe nervous system reactions - stiff muscles leading to high fever; sweating; confusion; fast uneven heartbeats; tremors
Also note that while serotonin syndrome is not common with these drugs due to their mechanism of action if experienced symptoms can include agitation hallucinations fever sweating shivering fast heart rate muscle stiffness twitching loss of coordination nausea vomiting diarrhea. If any such signs occur contact a healthcare professional immediately.
What are the most common side effects for Ativan?
Ativan, a potent benzodiazepine, may lead to the following side effects:
- Dry mouth or feeling thirsty
- Nausea, vomiting and loss of appetite
- Constipation
- Drowsiness or dizziness
- Memory problems (amnesia)
- Feeling unsteady, lack of balance or coordination
- Muscle weakness
- Problems with vision
- Sleep disturbances such as insomnia -Agitation or feelings of anxiety.
It's important to note that Ativan should be used with caution due to its potential for physical dependence and withdrawal symptoms. Always consult your healthcare provider before starting any new medication regimen.
Are there any potential serious side effects for Ativan?
Ativan, though generally safe and effective in treating anxiety or sleep disorders, can sometimes cause serious side effects. These adverse reactions may include:
- Signs of an allergic reaction: hives, difficulty breathing; swelling of your face, lips, tongue or throat
- Severe sedation: feeling like you might pass out
- Unusual changes in mood or behavior: aggression, agitation, hostility
- Hallucinations and confusion
- Worsening Sleep problems
- Sudden restless feeling or excitement
- Muscle weakness; drooping eyelid
- Change in vision
- Dark urine and jaundice (yellowing of the skin or eyes) If you experience any such symptoms after taking Ativan, immediately consult with your healthcare provider.
Contraindications for Restoril and Ativan?
Both Restoril and Ativan, similar to other medications in the benzodiazepine family, may exacerbate symptoms of depression or cause suicidal ideation. If you notice your mood worsening or an increase in thoughts about self-harm or suicide while on these medications, it is crucial that you seek immediate medical attention.
Neither Restoril nor Ativan should be taken if you are currently consuming, or have recently consumed alcohol as both substances can depress the central nervous system causing severe drowsiness and potentially life-threatening respiratory distress. Always inform your physician about any substance use; abrupt cessation of alcohol when starting a new treatment regimen with Restoril or Ativan can lead to dangerous withdrawal symptoms.
Restoril and Ativan are also contraindicated for individuals taking opioids due to potential drug interactions leading to profound sedation, respiratory depression, coma and even death. It's significant that one must allow sufficient time for such drugs to clear from the system before initiating therapy with either Restoril or Ativan.
How much do Restoril and Ativan cost?
For the brand-name versions of these drugs:
- The price of 30 tablets of Restoril (temazepam, 15 mg) averages around $200-$250, which works out to approximately $6.67–$8.33/day.
- In comparison, the cost for Ativan (lorazepam, 1mg), is about $240 for a supply of 60 tablets, working out to approximately $4/day.
Thus if your dose requires only one tablet per day for either drug, then brand-name Ativan could be less expensive on a per-day treatment basis than Restoril. However, cost should not be the primary consideration in determining which medication may best suit your needs.
Regarding generic versions:
-
Generic temazepam comes in packs ranging from 10 up to 100 capsules and costs can start as low as $0.60/day depending on quantity bought upfront.
-
Lorazepam also comes in similar size packs with prices starting at roughly $0.20/day when buying larger quantities upfront.
Like their branded counterparts, generic lorazepam tends to be cheaper than generic temazepam but choosing between them should depend more on efficacy and tolerability rather than just cost considerations alone.
Popularity of Restoril and Ativan
Temazepam, in generic form as well as brand names such as Restoril, was estimated to have been prescribed to about 2.3 million people in the US in 2020. Temazepam accounted for just above 6% of benzodiazepine prescriptions in the US. It is primarily used for short-term treatment of insomnia and has maintained a fairly steady prevalence over the last decade.
Lorazepam, including brand versions such as Ativan, was prescribed to approximately 14.8 million people in the USA in 2020. In the US, lorazepam accounts for around 38% of benzodiazepine prescriptions and remains one of the most frequently prescribed medications within this class due to its utility beyond treating anxiety; it can also be used for insomnia and seizure disorders among others conditions. The usage rate of lorazepam has remained relatively stable over recent years.
Conclusion
Both Restoril (temazepam) and Ativan (lorazepam) have established histories of use in managing insomnia and anxiety, backed by clinical studies demonstrating their efficacy over placebo treatments. Occasionally, these drugs may be used together under the careful supervision of a physician due to possible interactions between them. Their mechanisms of action differ somewhat: while both are benzodiazepines that enhance the effect of GABA, a neurotransmitter associated with calming effects, Ativan is also prescribed for other conditions like seizures.
Restoril is primarily indicated for short-term treatment of sleep disturbances where falling asleep or nocturnal awakenings are prominent symptoms. On the other hand, Ativan might be more suitable if you're dealing with anxiety disorders or need prevention and treatment of alcohol withdrawal symptoms.
Both medications exist in generic form allowing significant cost savings for patients who must pay out-of-pocket expenses. Both Restoril and Ativan can take some time to show full effects as they require an adjustment period.
The side effect profiles between these two drugs are fairly similar; general side effects include drowsiness, fatigue and light-headedness though Restoril has been linked slightly more often with residual 'hangover' sedation into the next day than Ativan due to its longer half-life. Users should carefully monitor changes in their mood or behavior when taking either drug as severe depressive symptoms could occur which necessitate immediate medical intervention.
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Refrences
- Jackson, E. A., Cardoni, A. A., McElnay, J. C., Jones, M. E., & Alexander, B. (1982, September). Temazepam (Restoril, Sandoz Pharmaceuticals). Drug Intelligence & Clinical Pharmacy. SAGE Publications.http://doi.org/10.1177/106002808201600902
- Heel, R. C., Brogden, R. N., Speight, T. M., & Avery, G. S. (1981, May). Temazepam. Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00003495-198121050-00001