Belsomra and Ambien are two commonly used sleep medications that are used for insomnia treatment and other sleep problems. They’re typically prescribed for the same conditions but work differently and have different side effects and risks.
Find out more about the differences between Belsomra and Ambien and how to determine the best choice for your needs.
Key Points
- Belsomra (suvorexant) and Ambien (zolpidem) are prescription sleep medications used to treat insomnia.
- These two insomnia treatments can be effective, but they have different mechanisms of action, side effects, and effectiveness to consider.
- Though there’s limited research, it’s possible that Belsomra may have a lower addiction potential than Ambien and may be more appropriate for prolonged use.
What Is Belsomra (Suvorexant)?
Belsomra is a brand-name medication for suvorexant, an orexin receptor antagonist that acts on the central nervous system (CNS) to influence the activity of chemicals in the brain.[1] Orexin acts on orexin receptor 1 (OX1R) and orexin receptor 2 (OX2R) to regulate sleep, appetite, and responses to stress. Belsomra and similar drugs block orexin’s activity by attaching to the receptors directly, preventing wakefulness and promoting restful sleep.
Belsomra is FDA-approved for insomnia treatment marked by difficulty falling asleep or staying asleep. It’s effective for up to 8 hours and should be taken before bedtime. Belsomra is classified as a Schedule IV drug because of its legitimate medical uses, but risk of misuse and addiction.
What Is Ambien (Zolpidem)?
Ambien is a brand-name medication for zolpidem, a sedative-hypnotic medication that’s used for short-term insomnia treatment. It binds to the gamma-aminobutyric acid-A (GABA-A) receptor similarly to benzodiazepines, causing the receptor to attract more GABA and induce a sedative effect.[2]
Ambien is FDA-approved to treat short-term insomnia marked by difficulty falling asleep or staying asleep. It may also be used off-label to treat other conditions, such as neurological disorders. It’s part of the “Z drug” group, which is grouped because of their similar mechanism of action. Ambien is classified as a Schedule IV drug because it has legitimate medical uses but a risk of misuse and addiction.
Belsomra vs. Ambien: Benefits and Effectiveness
Both Belsomra and Ambien have similar benefits for treating sleep disorders, but they do differ. Belsomra can be effective for promoting restful sleep throughout the night with a lower risk of dependence relative to other commonly prescribed sleep medications.[3] Belsomra also works differently than Z-drugs like Ambien, which are traditionally used for sleep problems, and may be safe for prolonged use.
Ambien can also effectively treat insomnia, helping you fall asleep and stay asleep longer.[4] Compared to a newer drug like Belsomra, Ambien has more dosing options to suit different needs, including immediate-release and extended-release formulations, and more versatility in treatment options. However, Ambien is not indicated for long-term use.
Belsomra vs. Ambien: Side-Effect Comparison
Belsomra and Ambien have similar side effects, such as dizziness and headache. However, being in different drug classes with different mechanisms of action, they have unique side effects as well.
Belsomra side effects may include drowsiness, but there are risks of serious side effects like hallucinations, sleep paralysis, strange dreams, and significant next-day drowsiness that can impact your ability to drive or perform other activities safely.[5]
Ambien has common side effects like nausea and diarrhea, as well as serious side effects like behavioral changes, next-day drowsiness, and a “hangover effect,” memory problems, and complex sleep behaviors like sleep walking, sleep driving, and having sex while sleeping.[6] Ambien may have a higher risk of dependence and addiction than Belsomra.
Belsomra vs. Ambien Dosage
Belsomra and Ambien are taken as oral tablets in several dosages to suit different patient needs and responses.
Belsomra comes in 5 mg, 10 mg, 15 mg, and 20 mg dosages.[7] It’s usually started at 10 mg, taken just before bed—about 30 minutes before falling asleep—and at least 7 hours before waking up. The dose is then increased or decreased based on your response.
Ambien’s dosage is a little more complicated. It comes in an oral tablet in a 5 mg or 10 mg immediate-release formulation or a 6.25 mg or 12.5 mg extended-release formulation.[8] The dose is not adjusted as much as Belsomra’s, with the maximum dosages being at the high end of both immediate—and extended-release formulations.
Men and women have different dosages, with men starting at 5-10 mg and women at 5 mg. Like Belsomra, Ambien should be taken 30 minutes before bedtime and at least 7 hours before waking up.
Belsomra and Ambien are intended to be taken at the lowest possible dose that’s effective and only when needed. Both of these drugs have the potential for misuse and addiction, so it’s crucial to take the dose exactly as prescribed to avoid any adverse effects.
Belsomra and Ambien: Risks
Many sleep medications have risks and precautions, including Belsomra and Ambien.
The risks of Belsomra may include:[9]
- Daytime drowsiness can be dangerous
- Complex sleep behaviors like sleepwalking or sleep driving
- Suicidal thoughts or actions
- Severe CNS depression that can be life-threatening
- Sleep paralysis or intense hallucinations while transitioning from sleep to wakefulness
- Misuse, abuse, and addiction
The risks of Ambien may include:
- Complex sleep behaviors
- Suicidal thoughts or actions
- Significant behavioral changes
- Next-day impairment that can make activities dangerous
- Misuse, abuse, and addiction
- Hepatic encephalopathy, a potentially life-threatening liver condition
- Severe CNS depression that can be life-threatening
Ambien and Belsomra can have risky drug interactions as well because these and similar sleep medications depress the central nervous system, which can become dangerous if they’re mixed with other CNS depressants like alcohol, opioids, or benzodiazepines.
Both Belsomra and Ambien have known interactions with rifampin and ketoconazole. Ambien may also interact with sertraline, fluoxetine, and St. John’s Wort, while Belsomra may interact with certain antiviral medications and antibiotics.[11,12]
It’s important to tell your doctor or pharmacist about the other medications you’re taking, including over-the-counter medications or supplements, to ensure there are no dangerous interactions. Avoid taking Ambien or Belsomra with other depressants or sedatives, as this can cause dangerous levels of respiratory depression and possible death.
Belsomra vs. Ambien Misuse and Addiction
Belsomra and Ambien are both classified as Schedule IV medications by the Drug Enforcement Administration (DEA) because of their potential for misuse and addiction. Though both drugs are considered potentially addictive, limited research suggests that Belsomra may not be as addictive as Ambien.[13] However, people with a history of substance abuse may be at a higher risk of addiction to either drug.
Ambien and Belsomra build dependence with regular use, which means the body becomes accustomed to the presence of the drug and needs it to function. If you take either drug for long periods and stop suddenly, you may experience uncomfortable withdrawal symptoms like rebound insomnia, anxiety, and irritability. The risk of dependence and withdrawal is increased if you misuse the drug or combine it with other substances.
You should never stop taking Ambien or Belsomra on your own, especially if you’ve been on them for a long time. Talk to your doctor about how you can safely stop taking these medications, which may require a taper schedule that gradually reduces your dose to lessen withdrawal symptoms and prevent complications.
Choosing Between Belsomra and Ambien
Belsomra and Ambien can be effective for treating insomnia and other sleep problems, but they work differently and have different side effects and risks. Discuss your options with your doctor, including your specific sleep problems and any substance abuse history, to determine which drug is the right choice for your needs.