Big E asked
Ambien or lorazepam.... which is safer long term?
Answer
Although technically placed in separate drug classes, both Ambien (zolpidem) and benzodiazepine medications (such as lorazepam) work in a similar fashion. They affect GABA receptors in the body, but Ambien is more selective for the hypnotic effects. Benzodiazepines act as a hypnotic in addition to working as a muscle relaxant, anxiolytic and an anticonvulsant.
In regard to which is 'safer' for long term use, that's difficult to answer as both drugs have positives and negatives, like all prescription drugs. In terms of raw safety data, benzodiazepines certainly have more of a record of misuse and abuse. They can also be more difficult to discontinue. They typically need to be tapered over a long period of time to avoid withdrawal effects.
That isn't to say Ambien doesn't have it's share of problems as well. It is associated with an increase in the risk of falls, delirium, fractures and has additional rare but serious side effects such as amnesia. These side effects are especially concerning in older populations. It is a troublesome fact that over 70% of emergency room vists due to Ambien are in the population aged 40 and older and visits an have increased greatly over time.
It should be noted that it does take longer to develop a tolerance to drugs like Ambien in comparison to benzodiazpeines, and they typically don't have the severity of withdrawal symptoms that benzodiazepines have. If they do occur, they tend to be mild.
To conclude, benzodiazpines have a higher likelihood of tolerance, dependence, abuse and generally have worse withdrawal effects. Having said that, drugs like Ambien are associated with a range of side effects, many serious and the benefit vs. risk for use in insomnia can certainly be questioned.
In general, although this certainly varies by practitioner, it is recommend to use a non-benzodiazepine for insomnia before using a benzodiazepine but the side effects must be taken into consideration.
