SUMAYYA
01 October 2022
Medically reviewed by
Freny Menezes
Pharm. D
belsomra-vs-ambien
Table of Contents

It may be challenging to stay asleep if you have insomnia or sleep disorders. Insomniacs frequently have insufficient sleep or sleep of low quality. According to recent research, some pharmacological treatments for insomnia seem to work better than others. Some medications are more effective for short-term treatment, while others can have significant side effects.

Two popular sleep aid drugs commonly used to treat insomnia are Belsomra and Ambien. The U.S. Food and Drug Administration has approved both Belsomra and Ambien (FDA). These drugs are Schedule IV controlled substances, as they pose the risk of abuse and dependence.

Belsomra is classified as an orexin receptor antagonist whereas Ambien is a sedative-hypnotic. Even though both pills are for treating insomnia, are they the same? Which is more effective?

What Is Ambien?

Ambien (zolpidem) is a non-benzodiazepine used in insomnia in adults. It improves sleep onset and duration of sleep by acting on GABA receptors.

In contrast to conventional benzodiazepines, zolpidem is a selective agonist of the ω1 receptor of the GABA-A receptor complex. The elimination half-life of zolpidem is 2.5 hours.

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Uses of Ambien

Indicated for insomnia, migraine headaches, and various neurologic conditions.

Mechanism of Ambien

As a sedative-hypnotic, Ambien works by causing the GABA neurotransmitters to become active, which slows down the brain and the Central Nervous System (CNS). As a result of the reduced brain activity, you fall asleep quickly.

What is Belsomra?

The first drug in the orexin inhibitor family, suvorexant (Belsomra), is an antagonist of both orexin receptors and provides a novel mechanism for treating insomnia. The medication enhances sleep by inhibiting the function of orexin. It has a 10-hour half-life.

Uses of Belsomra

Treatment of insomnia in adults – difficulty with sleep onset and maintenance

Mechanism of Belsomra

  • Belsomra is an orexin receptor antagonist. It promotes sleep by inhibiting the neuropeptides orexin A and orexin B, thereby promoting wakefulness.
  • The perifornical lateral hypothalamus contains 70,000 orexin neurons communicating with other brain and spinal cord parts.

Dose and Dosage Forms

Dosing is important for medications that can reduce severe morbidity or extend life. Patients may be given the wrong doses if the doses are administered incorrectly due to human error or loss after administration. Therefore, it is necessary to optimize the proper dose before a drug is approved for use in everyday medicine.

Ambien

  • Ambien comes in extended-release, immediate-release, sublingual tablets and oral sprays.
  • Ambien has 5 mg, and 10 mg tablets, while the extended-release is available in 6.25 mg and 12.5 mg pills.
  • Take Ambien before bedtime, and the patient should have 7-8 hours of sleep.
  • The initial dose for women is 5 mg, and 5 mg or 10 mg for men.
  • The maximum dose of Ambien is 10 mg once daily.

Belsomra

  • Belsomra comes in 5 mg, 10 mg, 15 mg, and 20 mg tablets.
  • It is recommended to take 10 mg daily by mouth 30 minutes before bedtime.
  • One should have at least 7 hours to sleep after taking suvorexant.
  • The maximum daily dose is 20mg. 

Side effects

Ambien

Belsomra

Daytime drowsiness

Drowsiness

Dizziness

Dizziness

Weakness

Sleepiness

Lightheadedness

Abnormal dreams

Tiredness

Headache

Stuffy nose, nasal irritation

Cough

Dry mouth, sore throat

Allergic reaction

Nausea

Sleep paralysis

Constipation, diarrhea

Diarrhea

Muscle pain, ataxia

Muscle weakness

Confusion, memory loss

Upper respiratory tract infection

Euphoria

Suicidal thoughts

Visual changes

Hallucination

Which Is More Effective?

Suvorexant considerably improves the quality and length of sleep when compared to zolpidem.
In addition to having better efficacy, suvorexant does not cause withdrawal symptoms when stopped compared to other available therapies for insomnia.

Suvorexant use may be superior to first-line therapy for some populations, including the elderly. In addition to contributing to falls, benzodiazepines frequently produce vertigo and loss of balance. Suvorexant's mechanism of action does not result in dizziness; as a result, there is a chance to reduce dangerous falls in older people.

Patients who are obese also frequently experience insomnia. Obese women experience slower clearance of suvorexant and greater peak levels than non-obese women. And this could have worse consequences for obese women.

Studies related to zolpidem and suvorexant in sleep-related disorders

A study by Michelson and his colleagues examined the Safety and effectiveness of suvorexant over one year, followed by a two-month cessation phase. They found that suvorexant significantly improved Total Sleep Time, TSO (total time from lying in bed to sleep initiation), and other sleep quality measures throughout therapy compared to placebo. 

In a randomized, double-blinded, placebo-controlled trial with adult male volunteers in a noise-simulated setting, Bettina and colleagues compared the effectiveness of suvorexant with zolpidem (a non-BZD). The total sleep time increased by 17 and 31 minutes with suvorexant 10 mg and 30 mg, respectively, compared to 11 minutes with zolpidem.

Additionally, zolpidem medication lowered REM sleep while suvorexant treatment boosted it. The trial demonstrated that adverse effects following suvorexant were more prevalent than side effects following zolpidem. It is due to differences in their pharmacological activity.

Precautions you should follow before taking Ambien and Belsomra

Precautions are necessary steps taken before administering a drug. This is done to prevent any undesirable effects that would occur after taking the drug.

Before you take Ambien:
-Take AMBIEN exactly as directed.
-Do not take AMBIEN earlier than right before bed.
-Refrain from consuming alcohol while taking Ambien.
-Go over your prescriptions with your doctor.
-Tell your doctor if you have depression, mental illness, lung or kidney problems, or drug dependence.
-Before taking AMBIEN, make sure you can spend 7-8 hours in bed without having to get up.
-If your insomnia worsens or does not get better within 7 to 10 days, call your doctor.
-Until you feel fully alert after taking AMBIEN, avoid driving or engaging in other risky activities.

Before you take Belsomra

-Never exceed the recommended dosage of BELSOMRA.
BELSOMRA should not be used if you are unable to spend the entire night in bed (at least 7 hours) before you need to resume your normal activities.
-BELSOMRA should be taken 30 minutes before bed.
-Avoid driving or engaging in hazardous activities after taking Belsomra.
-Inform your physician before beginning BELSOMRA if you have 

  • depression, a mental illness, or suicidal thoughts
  • a history of drug or alcohol addiction
  • muscle weakness in the past
  • narcolepsy or excessive daytime sleepiness
  • lung or liver issues

- BELSOMRA in pregnancy: Discuss the potential risks to your unborn child with your healthcare professional.
-If you are currently breastfeeding or intend to do so, let your doctor know.
-Before starting Belsomra, inform the doctor of your medications, including prescription, over-the-counter, or vitamin or herbal supplements.

Interactions of Ambien and Belsomra

Ambien and Belsomra should not be taken at the same time. It might raise the likelihood of unfavorable side effects.

Interactions of Ambien

  • When alcohol and other CNS depressants are also taken with zolpidem, the risk of CNS depression increases.
  • Concurrent use of opioids with zolpidem increases the risk of respiratory depression.
  • Imipramine and Ambien combined reduce alertness.
  • Combining zolpidem and chlorpromazine may cause a decrease in alertness and psychomotor performance.
  • Benzodiazepines increase the risk of central nervous system CNS side effects, such as slowed breathing or sleepiness.
  • Combining zolpidem and sertraline improves zolpidem exposure.
  • Rifampin or St. John's wort, Combining these drugs with Ambien may reduce their effects.

Interactions of Belsomra

  • Concurrent use of BELSOMRA and alcohol can cause additive psychomotor impairment.
  • It is not advised to take BELSOMRA with potent CYP3A inhibitors. E.g., telithromycin, conivaptan, itraconazole, posaconazole, ritonavir, or ketoconazole.
  • Use of BELSOMRA with digoxin increases digoxin levels due to inhibition of intestinal P-glycoprotein.
  • Avoid drinking alcohol while taking BELSOMRA as it could have additive effects.
  • The risk of CNS depression increases when other CNS depressants, such as benzodiazepines, opioids, tricyclic antidepressants, and alcohol, are co-administered.

Bottom Line From Practical Anxiety Solutions

People with insomnia experience significant negative effects on their quality of life. Getting proper treatment can contribute to a happier and healthier lifestyle. Both Belsomra and Ambien are used to treat insomnia. Although both drugs are quite effective in treating sleep disorders, they both carry the risk of addiction and abuse.

It may be difficult to treat insomnia with difficulties falling and staying asleep. Unlike zolpidem, suvorexant does not affect GABA, and its mode of action is different from that of zolpidem. It decreases wakefulness rather than promoting sleep.

Evidence suggests that this medicine benefits patients with symptoms of chronic insomnia over the long term. Taking into account a patient's medical condition, history, and current medications, a healthcare provider can determine the most effective medication for that patient. 

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  • Bennett T, Bray D, Neville MW. Suvorexant, a dual orexin receptor antagonist for the management of insomnia. P T. 2014 Apr;39(4):264-6. PMID: 24757363; PMCID: PMC3989084. Obtain On 01/10/2022
  • Michelson D, Snyder E, Paradis E, Chengan-Liu M, Snavely DB, Hutzelmann J, Walsh JK, Krystal AD, Benca RM, Cohn M, Lines C, Roth T, Herring WJ. Safety and efficacy of suvorexant during 1-year treatment of insomnia with subsequent abrupt treatment discontinuation: a phase 3 randomised, double-blind, placebo-controlled trial. Lancet Neurol. 2014 May;13(5):461-71. doi: 10.1016/S1474-4422(14)70053-5. Epub 2014 Mar 27. PMID: 24680372. Obtain On 01/10/2022
  • Bettica P, Squassante L, Groeger JA, Gennery B, Winsky-Sommerer R, Dijk DJ. Differential effects of a dual orexin receptor antagonist (SB-649868) and zolpidem on sleep initiation and consolidation, SWS, REM sleep, and EEG power spectra in a model of situational insomnia. Neuropsychopharmacology. 2012 Apr;37(5):1224-33. doi: 10.1038/npp.2011.310. Epub 2012 Jan 11. PMID: 22237311; PMCID: PMC3306884. Obtain On 01/10/2022
  • Farrokhpour, Hossein, Fatemeh Bamdad, and Mahmud Ashrafizaadeh. "Interaction between the Human OX2 Orexin Receptor and Suvorexant and Some of Its Analogues: SAPT (DFT) Interaction Energy Decomposition Analysis." The Journal of Physical Chemistry B (2022). From https://doi.org/10.1021/acs.jpcb.2c02537 Obtain on 01/10/2022
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