Ambien vs Lunesta: drug comparison guide
This article compares Ambien and Lunesta, two non-benzodiazepine hypnotic drugs. Medical uses, dosage and intake methods, mechanism of action, side effects, pharmacokinetic properties and interactions of both drugs are compared.
Ambien is a prescription medication which is used for the treatment of different brain disorders and insomnia. It is a non-benzodiazepine hypnotic drug. It initiates the release of GABA, which is an inhibitory neurotransmitter and binds itself to the GABA receptors at the same location as benzodiazepines. This drug acts quickly within 10-15 minutes and has a half-life of about three hours.
This drug isn’t quite effective in maintaining sleep but is more effective in initiating sleep. The effect of this drug is similar to other benzodiazepine drugs but it is quite different from classical benzodiazepine group when we look deeper into the mode of action of this drug. The effects of ambien can be reversed by a benzodiazepine receptor antagonist named Flumazenil.
There are some antioxidant and anticonvulsant properties present in this drug but it hasn’t been approved for its use in preventing seizure and muscle relaxation. The reason is that the dose needed for preventing seizures is about 20 times the sedating dosage and the dose needed for muscle relaxation is about 10 times the sedating dosage. Higher doses of this drug can cause some serious side effects like amnesia and hallucinations. Recent researches have indicated that zolpidem has anticonvulsant properties. The side effects of this drug aren’t felt until the time the normal dosage range has been surpassed.
Thirteen versions of this drug were approved for use by the FDA on April 23, 2007. It is available in the UK from different generic manufacturers. Sandoz and TEVA are its leading manufacturers.
The Food and Drug Administration Authority mentioned on 10 January 2013 that it is needed to cut the recommended dosage of Ambien in women to half. This was done in the light of a recent research which showed that patients can become drowsy and at risk of motor vehicle collisions after using this drug. FDA has also recommended lessening the dosage in men. But the reasons behind the men and women metabolizing at different rates are still unknown. FDA approved the labeling changes in the new recommendations for ambien because of the concerns behind next-morning impairment.
Medical uses of ambien
There are a number of medical uses of ambien. It is effective against anxiety and brain disorders. Some major effects of using ambien have been mentioned below:
Ambien beneficial against anxiety
Some researches have proved that ambien is quite beneficial against anxiety. One of these studies was published in a paper published by Dr. Estibaliz and her colleagues in the University of San Diego. The researchers had the view that the anxiety reducing properties of ambien come from its ability to reduce the excitability of a special structure in the brain known as amygdala. The amygdala in the brain controls our fear related responses. People show risk taking behaviors when the amygdala excitability drops. So there is always a danger of showing impulsiveness by the intake of ambien. This information clearly points out that ambien has the ability to reduce anxiety.
Helpful against depression
Depression and anxiety are co-related. A person becomes depressed when he is affected by anxiety for a long period of time. So people looking to fight depression should also use ambien. Ambien is also helpful against insomnia. The sleep and depression are also related with each other. A major factor behind depression is that a person doesn’t get enough sleep. Ambien helps against insomnia, which in turn helps against depression.
Ambien and memory enhancement
New research has indicated that ambien may help in improving a person’s memory. The researchers from UC Riverside discovered that there are sleep spindles in the hippocampus and they showed that ambien helps in improvingthe process. The researchers believe that this research can lead to new sleep therapies which can be quite beneficial for inducing sleep. This makes ambien especially beneficial for people with Alzheimer’s, schizophrenia and dementia.
Earlier researches of this sort have found a correlation between sleep spindles (bursts of brain activity which occur for a second or less during stages of sleep) and the memories, which depend on hippocampus. Experts know that hippocampus is quite helpful in consolidating new memories whether they are short term or long term memories. The leader researcher Mendick said, “We have found quite an uncommon sleep drug for improving memory. This is the first study which shows that you can improve your sleep to increase your memory. This study clearly shows that sleep medications can be a helpful tool in improving memory.
49 men and women between the ages of 18 and 39 were given varying dosages of ambien. There was also a placebo group. The researchers monitored the sleep and moods after napping. The researchers also conducted several tests to evaluate memory. The researchers found out in the study that ambien increases the density of sleep spindles and improves the memory consolidation.
The researchers say that the next step in the study is to find which component is responsible for the physical response of ambien. Is it the amnesia related to the drug or something totally else. The researchers also said in the results of the study that they are looking forward to find out how to increase the memory of dementia patients and people with Alzheimer’s disease. So, this research clearly indicates that ambien improves memory.
Helpful against insomnia
It is a common practice that medical practitioners prescribe ambien to people for short term treatment of insomnia. Ambien is given to the patients for initiating sleep but it isn’t that much effective in maintaining sleep, other drugs are used for this purpose. Some researches have also shown that ambien effects a person psychologically. So the increased attention can be corresponded to the intervention of insomnia (1).
The main benefit of ambien is that it is double layered. The first layer induces sleep whereas the second layer is absorbed slowly and keeps the body in the restful state.
Dosage and intake methods
The ambien tablet comes in the form of an extended tablet which is taken through mouth. It also comes in the form of sublingual tablet which is placed under the tongue and in the form of an oral spray. The oral spray is sprayed in the mouth. No matter the route, you shouldn’t use this drug more than once daily. The sublingual tablets should also be consumed as indicated which is no more than one time per day. The time at which the tablet should be taken should be night time. The medication works faster if it isn’t taken immediately before or after a meal. Follow the directions as written on the prescription label. Feel free to ask the doctor anything you don’t understand. Use the drug exactly as directed by the doctor.
A person may become quite sleepy after taking the medication and will remain sleepy sometime after taking the medicine. You should go to the bed after taking the ambien tablets, the sublingual tablets or the oral spray. You should take these tablets only when you are already in bed and plan to remain in bed for at least four more hours. Don’t take the medication if you are unable to sleep for the required number of hours after the intake of medication. A person may suffer from memory problems if he wakes up early after taking ambien.
You should swallow extended tablets as whole. Don’t chew or split them. You should inform your doctor or pharmacist if you are having difficulty swallowing the tablet.
You shouldn’t open the pouch of the sublingual tablets unless you are ready to take the tablet. You should peel off the top layer and push the tablet through the foil in order to get the tablet out. Now just place the tablet under your tongue and wait for it to dissolve. Don’t try to swallow the pill or take it with water.
Using oral spray
Following steps should be follow when you are going to use the oral spray:
You should be careful if you haven’t used the spray bottle for more than 14 days or you are using the bottle for the first time.
Squeeze the cap at arrows and pull the cap and the base to separate them. Remove the protective cap.
Now you need to prime the pump. Hold the container tightly to do so. Now press on the pump with your forefinger and do it for 4 times. A fine spray will come out of the container.
Now hold the container spray upright and the black spray should point towards your mouth. Now press the pump to make sure that you get a full dose of ambien.
Now allow the pump to return to its initial position. Put the protective cap back on the pump if your doctor has prescribed for you one spray of ambien. Dose a second spray if your doctor has prescribed two sprays for you.
Now rotate the cap and base so they aren’t lined with each other. This is done in order to prevent a child from using the bottle.
Side effects of ambien
There are many side effects of using this drug. Some major side effects of using ambien have been mentioned below:
- Night eating syndrome
- Poor motor coordination or ataxia (2)
- Impaired judgement
- Increase in impulsivity
- Rebound insomnia can occur when stopped
Some users of this drug have also reported sleepwalking as a side effect of using this drug. Ambien users also report eating large quantities of food while sleeping and performing different other daily tasks while asleep. Researchers in Australia found that these side effects occur as soon as the first dose is taken or in the starting days of therapy. People have also reported to experience rare amount of parasomnia (a disorder in which there is unusual behavior in the nervous system) during sleep (3). The sleepwalkers sometimes, perform the tasks as normally as if they were awake.
Nervous system side effects
The nervous system side effects are mostly dizziness and visual disturbances. People have also reported to suffer from confusion, amnesia, lightheadedness, nightmares, nervousness, hallucinations, and agitation.
Damage to the immune system
Ambien can also damage the immune system of the body. Different infections are caused in the body which kill the white blood cells and lead to serious complications if not treated properly.
Tolerance and dependence
A recent medical publication found that the long term usage of ambien is related with drug dependence, drug tolerance, rebound insomnia and central nervous system related effects. It was reported that ambien should be used for short periods with lowest possible dose. It has been seen that ambien is effective in treating sleep insomnia when 10 mg of 3 to 5 ambien tablets are taken and no more than five pills are taken for 12 weeks. There isn’t any clinical advantage found when the 10 mg tablet was replaced with 15 mg tablet.
Non pharmacological treatments for insomnia have found an improvement in sleep quality. Some animal studies have shown that ambien has less tolerance potential than other benzodiazepines. The tolerance to the effects can occur within just a few weeks. Some severe effects of abrupt withdrawal from the tablet include seizures and delirium. This happens if the drug is used for longer durations of time and for high dosages.
The overdosing of the drug can result in excessive sedation. The respiratory functioning can also be affected which can lead to comma and death in most serious cases. Fatal overdoses can be caused when this drug is taken along with CNS depressants, opiates and alcohol. The over dosage of ambien can easily be treated with the help of antagonist flumazenil. This displaces the ambien from the binding site to benzodiazepine receptors. This automatically reverses the effect of over dosing.
The scientific name for this drug is Eszopiclone. It is a nonbenzodiazepine hypnotic which is quite effective against insomnia. The active isomer in lunesta is zopiclone and it is a part of the drugs known as cyclopyrrolones.
Lunesta and ambien are among the most commonly prescribed sedative hypnotics in the United States. A decision was made by the EMA in 2009 by the European Union which denied that lunesta is a new active substance. It was found that lunesta is too similar to zopiclone and can’t be considered as a new drug.
Lunesta is present in its generic form since May 2014. The initial starting dosage for lunesta was 2 mg. But a study found out that the patients couldn’t focus on their daily life activities with full alertness after taking 2mg lunesta the previous night. So, the dosage was lowered from 2 mg to 1 mg.
Health benefits of Lunesta
Now let us look at the medical uses and health benefits of lunesta. Lunesta is widely used for the treatment of insomnia. The FDA approved the use of lunesta in six trials in which people with chronic and transient insomnia were treated. A six months double blind study was done which enrolled 788 subjects. The data was collected from 24 clinical trials.
A double blind parallel group study took place in which 436 healthy adults were evaluated in insomnia laboratory while comparing two different doses of lunesta and the placebo. The results of the study proved that 3 mg lunesta drug was quite superior to the placebo group on the basis of maintenance of sleep and sleep latency. The parameters included the latents to persistent sleep and WASO.
Lunesta has also found to be quite beneficial against chronic insomnia. A total of five different studies were conducted which showed that lunesta is quite beneficial against chronic insomnia. The first three controlled studies were done on adult subjects and the two controlled studies were done in elder patients suffering from chronic insomnia.
308 adults were evaluated in the first study in a double blind, parallel group trial of about 6 weeks in which the 3 mg lunesta tablet was compared with the placebo. The endpoints were measured over a period of four weeks. The results showed that 3 mg lunesta is quite superior to the placebo.
The second study involved 788 adults who were evaluated in a double-blind, parallel group study in which the safety of lunesta 3 mg was compared with the placebo for 6 months. The results showed that lunesta is quite superior as compared to the placebo.
Effects on elderly people
The sedative hypnotic drugs are commonly administered to the older adults as compared to younger adults. The hypnotic drug should be chosen with great care and the drug therapy should be started at low doses to minimize the side effects as much as possible. There is a lot of literature which has shown that sedative hypnotic drugs are quite beneficial for elderly for treating insomnia. Lunesta and other nonbenzodiazepine sedatives have been found to be quite effective for adults and have shown certain tolerance in elderly patients.
A study was done to find the effectiveness of lunesta in elderly adults. The elderly subjects between the ages of 65 and 85 were evaluated in two double blind studies with two weeks duration. The effects of lunesta on the subject outcome measures were evaluated in one study whereas objective and subjective outcomes were measured in the other study. There was a comparison done between the 1mg and 2 mg of lunesta with placebo and the second study involved the comparison of 2 mg of lunesta with placebo. The results of the study showed that all the doses were superior to the placebo group. The studies showed that 2 mg of lunesta is superior as compared to 1 mg lunesta for maintaining sleep.
Dosage and intake methods
Lunesta can make a person sleepy. So never take this medicine during your waking hours. Only take this medicine if you plan on spending the next 8 hours in bed.
Some people have reported that they suffer from memory lapses as a result of taking lunesta. For example, they call another person and later have no memory of doing so. You should stop taking lunesta at once if this has happens to you.
You should inform your doctor beforehand if you have one of the following complications:
- Breathing disorder
- Liver disease
- History of alcohols or drug addiction
- History of depression and suicidal thoughts
It isn’t known what effect lunesta will have on the unborn baby. So, pregnant women should consult the doctor before taking this medicine. Also breast feeding women should inform a doctor.
These medications are usually prescribed to older adults. People who take lunesta might have accidental falls. So you should take the caution to avoid falling or having an accidental injury while taking this medicine.
The initial dose should be 1 mg before bedtime. The maintenance dose should be between 1 and 3 mg. You should inform the doctor if insomnia still exists ten days after taking the medicine.
You should take lunesta exactly as told by the doctor. You should read the prescription label carefully and follow all the instructions. Don’t use this medicine longer than recommended.
Taking lunesta can turn into a habit. So never share it with those people who have alcohol addiction or a history of drug abuse.
You should also avoid taking the medicine within one hour after eating a heavy meal because it will just become harder for the body to digest this medication.
Take this medication only when you are having troubles with sleeping. You should immediately inform the doctor if the sleeping issue isn’t resolved after 10 days of taking this medicine.
Store the drug at room temperature.
Never stop this drug immediately. You will suffer withdrawal symptoms if you stop it. Consult your doctor when you plan on leaving the medicine.
Always keep track of the medication count. Lunesta is a drug of abuse and you should make sure that no one other than you is using it.
Side effects of lunesta
The side effects of lunesta can vary from one person to another. These side effects are mostly for short term. There have been studies which have shown that the use of lunesta can lead to cancer and even death. Some major side effects of lunesta have been mentioned below:
Cancer or death
The side effects of long term use of lunesta has been the cause of concern for researchers in the recent times. A recent study was conducted which showed that the cancer and the death rate of sleeping pill patients were more than the same number of population which didn’t use sleeping pills.
This particular study was done in February 2012. The researchers of the study monitored the health of about 1500 patients who took either lunesta or any other sleeping pill brand. The health of patients who used sleeping pills was compared to two other individuals who didn’t use sleeping pills. The study showed that people who take sleeping pills were 3.5 times more likely to suffer from premature death than the patients who didn’t take sleeping pills. The study also found that people who take up to 132 sleeping pills per year are 5 times more likely to suffer premature death than those didn’t take sleeping pills. The results of these studies is a serious cause of concern for those people who are taking sleeping pills and they should always consult a doctor before taking addictive sleeping pills like lunesta.
An individual experiences a partial arousal in sleep walking. A person fails to come out of full sleep during sleep walking. People in sleepwalking can do certain complex tasks such as driving a car, having sex and eating food and don’t remember it. This side effect of lunesta is quite dangerous because it can lead to risky behavior.
Lunesta has been classified as schedule IV of controlled substances under substance controlled act. Use of drugs like lunesta can lead to physical dependence. The risk of abuse of drug increases with the passage of time. Patients with a history of drug addiction should be careful before taking this drug as it can turn into an addiction. Tolerance to the drug can also occur after repeated use of the drug for a few weeks. A study was done by Sepracor in which he found that there are no signs of tolerance of dependence in lunesta (4).
A recent study about the abuse of lunesta found that a dose 6 mg of lunesta can have the same effect as a drug with of 20 mg diazepam. These doses are about three times the recommended dosage of lunesta and can lead to various side effects like sedation, sleepiness, hallucinations and amnesia.
The overdosing of lunesta is quite a serious issue. The U.S. prescribing information states that people who have taken up to 90 times the original dosage of lunesta have fully recovered from it. The May 2014 edition stated that deaths occurred from the use of lunesta only in cases when it was combined with other drugs like alcohol (5).
Ambien vs lunesta
Both ambien and lunesta have the same structure. But they have different effects against insomnia. The main difference is between the half-life of the two drugs. Lunesta’s half-life is six hours whereas ambien’s half-life is 3 hours. People who consume sleep medications have said that Lunesta can lead to more restful sleep as compared to ambien. But there is a downside to it. The drowsiness of a person increases the next day. But it isn’t necessary because some people have reported to feel better the next day as compared to when they take ambien.
Lunesta also has lower side effects as compared to ambien. The main difference between the two medications is how long the medicine takes to have some effect. Ambien is quicker in making a person feel the effects especially when taken on an empty stomach. The effects of lunesta are a bit slower. The effects vanish when the drug is taken on an empty stomach.
Experts have recognized that Lunesta isn’t as much effective in treating insomnia as Ambien. Another reason is that lunesta has milder side effects. That’s why doctors mostly prefer lunesta over ambien when prescribing sleep medications for longer periods of time. A person shouldn’t take lunesta for more than 6 months. Lunesta isn’t as strong as Ambien. So there are less chances of developing addiction to the drug. But people with a history of drug abuse should be careful while taking this drug because research has proven that lunesta does have some potential of forming into a habit.
Comparison chartThe following chart will give you a better idea of the comparison between ambien and lunesta:
|Treatment||Used for insomnia treatment||Used for insomnia treatment|
|Available forms||5 or 10mg tablets 6.25mg and 12.25mg extended release tablets||1,2 and 3 mg tablets|
|Pregnancy||Not safe||Not safe|
|Half life||3 hours||6 hours|
|Allergic reactions||Itching, swelling, difficulty in breathing and swallowing, short breath||Itching, swallowing problems, nausea, vomiting, chest pain, rashes|
|Routes||Oral, spray form||Oral|
|Side effects||Loss of coordination, memory loss, change in behavior and attitude||Memory loss, sleep driving, vision problems and sleep behavior|
|Excretion||56% renal, 34% fecal||Renal|
This article has informed you about Ambien and Lunesta and the difference between the two. It compared medical uses, side effects and interactions of both drugs. While both Ambien and Lunesta are used for treatment of sleeping disorders, there are some differences between indications. The choice mainly depends on your preference and the stage of insomnia. You should choose ambien if you want to have the effects of the drug quicker. You should choose lunesta if you want slow effects. In any case you should always get a proper medical advice from your physician before taking any of these drugs. You should also consult a doctor whenever you want to switch between the two or stop using the drug suddenly as it may cause serious withdrawal symptoms.
|Written by:||Michal Vilímovský (EN)|
|Education:||Medical student, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic|
|Article resources:||See numbered references within the article|
|Published:||September 21, 2015 7:22 PM|
|Next scheduled update:||September 21, 2017 7:22 PM|