Selena asked
How is Belsomra different than Ambien (Zolpidem)?
Answer
Both Belsomra and Ambien are prescription only medications used in the treatment of insomnia. However, they work via very different mechanisms and are associated with specific concerns.
To summarize:
- Data indicates that Ambien and Belsomra have similar efficacy. The both can help reduce the time it takes to fall asleep (i.e. sleep latency) and increase total sleep time.
- Ambien and Belsomra work via different mechanisms, as discussed below.
- Belsomra is associated with additional side effects and may have the potential for more drug interactions.
Belsomra
Belsomra (suvorexant) is a unique drug that alters the signaling of neurotransmitters called orexins. Orexins are responsible for regulating the sleep wake cycle and are thought to promote wakefulness. Belsomra acts to block orexins to help individuals fall asleep and sleep for longer periods of time.
Belsomra should be taken 30 minutes prior to going to bed on an empty stomach.
You should not take Belsomra if you have less than seven hours remaining before your desired wake time. You should take the lowest effective dose of Belsomra as taking higher than needed doses can result in an increased risk of side effects which include, but are not limited to:
- Abnormal dreams
- Headache
- Drowsiness
- Hallucinations
- Dizziness
- Amnesia
- Suicidal ideation
Data indicates that Belsomra has similar efficacy to Ambien but is associated with the rare side effect of transient leg weakness. In addition, Belsomra may have more potential for drug interactions due to how it affects the metabolizing enzyme CYP3A4.
Belsomra is classified as a schedule 4 controlled substance.
Ambien
Ambien (zolpidem) is a sedative hypnotic medication and is available as an immediate release tablet (Ambien) and as an extended release tablet (Ambien CR). Ambien acts on the GABA receptors which leads to the desired sedative effects in treating insomnia.
Ambien and Ambien CR should both be taken on an empty stomach right before bedtime as the average onset of action for both the immediate and extended release tablets is 30 minutes
The onset can vary between individuals and may be delayed if the medication is taken with food. You should take the lowest effective dose of Ambien as taking higher than needed doses can result in increased risks of side effects which include but are not limited to:
- Anxiety
- Drowsiness (outside of desired time)
- Headache
- Depression
- Unusual thoughts
- Grogginess
- Dry mouth
- Constipation
- Dementia
- Irregular heart rate
- Skin reactions
Like Belsomra, Ambien is classified as a schedule 4 controlled substance.
Summary
- Although both Ambien and Belsomra are both used to treat insomnia, they do so by different mechanisms of action.
- Belsomra and Ambien have similar efficacy but Belsomra may have more side effect and drug interaction concerns.
- Your personal medical history would dictate if either Ambien or Belsomra may be appropriate for treating insomnia related symptoms.
