SUMAYYA
06 October 2022
Medically reviewed by
Kajal Jain
M. Pharm
trazodone-vs-ambien-1
Table of Contents

For many, a restless night in bed is a rarity. But, for many people, Insomnia is a consistent struggle, with about 1 in 3 U.S. adults reporting they don't get enough sleep. Often, implementing better sleep hygiene habits can help improve your sleep. But if they don't work, some people may turn to medications. Zolpidem (Ambien) and Trazadone are two medicines that are FDA approved for the short-term treatment of Insomnia. It can help you fall asleep more quickly by activating areas in the brain called gamma-aminobutyric acid (GABA) receptors. Activating GABA receptors enables you to feel sleepy. 

Although both medications can be effective for Insomnia, they don't come without risks. As a controlled substance, they increase the risk of dependence with long-term use. Additionally, they have several drug interactions to keep in mind. But which ones are more serious? Let's study more about these medications.

What Is Zolpidem?

Zolpidem effectively treats Insomnia in adults by improving sleep induction, maintenance, and duration. Zolpidem is a rapidly acting agent which provides effective facilitation of sleep onset. 


It has a short half-life (2.2 hours), attaining peak plasma concentration in 1.5 to 2.5 hours. Zolpidem is a controlled substance, meaning you always need a prescription to buy Zolpidem online from an online pharmacy or the local drug store. 

Uses

  • Used to treat Insomnia in adults
  • Standard Immediate-Release formulations of zolpidem 5 and 10 mg help in the short-term treatment of sleep-onset Insomnia.
  • The formulations shorten sleep latency and improve next-day functioning.
  • Controlled-release preparations are approved for sleep onset and sleep maintenance insomnia.
  • Zolpidem finds use in neurologic conditions, Anxiety, stress, and migraine headaches.
  • Zolpidem may improve aphasia for a short duration in patients with stroke and disorders of consciousness, such as minimally conscious state, aphasia, gait disorders, and kinetic mutism.

What Is Trazadone(Desyrel)? 

Trazodone is a triazolopyridine used as an antidepressant. It also has some anxiolytic and hypnotic activity.
Trazodone inhibits serotonin reuptake, and studies have also revealed that it has antagonistic effects on 5-HT 1a, five5-HT 1c, and five5-HT2 receptor subtypes. 

Uses

  • In clinical practice, Trazodone helps to treat depression and, more recently, as a hypnotic for Insomnia caused by psychotropics.
  • Other uses include dementia, obsessive-compulsive disorder, chronic pain, migraines, esophageal symptoms, benzodiazepines, and others.

How Does Ambien (Zolpidem) Work?

Zolpidem is an imidazopyridine that increases the affinity of GABA to GABAA receptors and results in inhibition through the opening of the chloride channel, which increases cell membrane potential. Zolpidem, at hypnotic doses, binds selectively to thea1 subunit of the GABA-A complex, thereby inducing sleep. 

How Does Trazadone Work?

Trazodone is a 5-hydroxytryptamine (5-HT) selective serotonin reuptake inhibitor.

  • The two main biological effects of Trazodone are Serotonin uptake inhibition and blockage of alpha-adrenergic receptors, particularly presynaptic alpha-2 receptors.
  • The primary pharmacological effect of Trazodone is the blockage of the serotonin 5-HT2A receptor- (1mg of Trazodone roughly blocked half of brain 5-HT2A receptors). Increasing the dose (50mg) causes antagonistic effects on histamine H1 and α1-adrenergic receptors.
  • The hypnotic action of low doses is due to the inhibition of 5-HT2A, histamine H1, and alpha receptors (25–100mg). The short half-life of Trazodone helps to initiate and maintain sleep at these low doses without developing daytime sleepiness or tolerance (3–6 hours).
  • Simultaneous 5-HT2A and SERT blocking are necessary for the medication's antidepressant effects; this happens at larger doses (150–600mg).
Zolpidem and Trazodone help sleep disorders such as insomnia. Trazodone is primarily used to treat depression. Ambien is a sedative/hypnotic, while Trazodone is an antidepressant.
Zolpidem (Ambien) show an average rate of 6.9 out of 10 from a total of 935 ratings and Trazodone shows an average rate of 6.3 out of 10 from a total of 1,343 for the treatment of insomnia. Users found Zolpidem to be more effective than trazodone.
Zolpidem has been placed in pregnancy category C by FDA. It is not considered a choice of drug to treat insomnia during pregnancy, as it can cause withdrawal symptoms in your baby after birth.
Trazodone is classified as a pregnancy category C medication. Due to a lack of significant research on human subjects, these cannot be deemed entirely safe for use during pregnancy.

Possible Side Effects: Zolpidem And Trazodone

Along with the beneficial effects, the medicine may cause some undesirable effects, especially for older people. Some side effects may occur that might not require any medical attention. Also, not all of these side effects may occur, but if they do, they may need medical attention.

Side effects of Zolpidem

Side effects of Trazodone

Headache Panic attack
Drowsiness Blurred vision
Dizziness Dizziness
Dry mouth Stuffy nose
Diarrhea Diarrhea, vomiting
Hallucination Hallucination
Lightheadedness Agitation
Muscle pain Weight loss
Chest pain Increased heart rate
Poor concentration Thoughts of suicide, worsening depression
Memory loss Memory problem
Swelling of the tongue or face Swelling
Abnormal thoughts and behavior Trouble thinking, confusion

Zolpidem And Trazodone: Which Is More Effective?

It's also important to emphasize the rising use of Trazodone as a hypnotic. According to a preliminary study, low-dose Trazodone may benefit persons who experience Insomnia caused by MAOIs, psychiatric medications, or in patients for whom benzodiazepines are contraindicated.

  • Trazodone may be less effective as a sleep aid than Ambien, although not everyone benefits from Ambien's sleep-aid properties. Trazodone works well to prolong sleep duration and slow down sleep latency.
  • Studies with active treatment periods ranging from 6 to 12 weeks revealed a notable improvement in sleep quality. Trazodone has a minimal risk of habit formation and addiction.
  • Studies show that Trazodone is quite successful in treating Insomnia in patients with Alzheimer's disease, pregnant women with depression, and individuals who experience sleeplessness in addition to other psychiatric conditions.
  • In a few notable instances, Trazodone causes few adverse responses.
    Trazodone has a more remarkable ability to enhance self-reported sleep quality, but there are no changes in sleep-onset latency, overall sleep duration, or wakefulness after sleep onset.

Studies Related To Zolpidem And Trazadone Use In Insomnia

  • A survey by Roth T investigating the effects of IR 7.5 mg and 10 mg demonstrated a significant improvement in a model of transient Insomnia that used circadian misalignment to cause Insomnia by extending the patient's bedtime forward by 4 hours from their regular schedule.
  • A study by Walsh and colleagues conducted a placebo-controlled, randomized clinical trial in which 306 participants were randomly assigned to receive Trazodone 50 mg, Zolpidem 10 mg, or a placebo once a day for 14 days.
  • Subjective sleep questionnaires were used to evaluate sleep measures. During the first week, Trazodone considerably reduced sleep latency compared to the placebo, while Zolpidem significantly reduced sleep latency compared to both Trazodone and placebo. Trazodone's effects on sleep latency contrasted with placebo during the second week, and zolpidem-treated patients' sleep latency was lower.
  • In a randomized, double-blind, placebo-controlled crossover study with 16 people, a study by Roth and colleagues investigated the hypnotic effectiveness and daytime effects of Trazodone. 
    They discovered that 50 mg of Trazodone taken 30 minutes before bedtime was helpful for sleep maintenance but might cause cognitive and motor deficits. 

Bottom Line From Practical Anxiety Solutions

The above comparative study concludes that Zopiclone and Zolpidem effectively treat Insomnia. Trazodone is a relatively safe medication effective in treating Insomnia, especially in patients with concomitant depression. It is one of the most popular off-label options for treating Insomnia, even though it is not currently a medicine recommended for the condition. Trazodone can help prolong sleep, while Zolpidem helps with initial Insomnia. 

Whether you choose to try Trazodone or Zolpidem will depend on your medical history, other medications you are presently on, and your health objectives. As there is effectiveness to the medicine, some flaws might negatively affect you and eventually return to normal. You can get the treatment after the prescription from the doctor.

  • Stoianovici R, Brunetti L, Adams CD. Comparison of Melatonin and Zolpidem for Sleep in an Academic Community Hospital: An Analysis of Patient Perception and Inpatient Outcomes. J Pharm Pract. 2021 Feb;34(1):44-50. From https://doi.org/10.1177/0897190019851888  Obtain on 19/09/2022
  • Hardeland, Rüdiger, S. R. Pandi-Perumal, and Daniel P. Cardinali. "Melatonin." The international journal of biochemistry & cell biology 38.3 (2006): 313-316. From https://doi/10.1056/NEJM199701163360306 Obtain on 19/09/2022
  • Delgado, D., Canham, L., Cotterill, N. et al. Protocol for a randomized, double blind, placebo controlled, crossover trial of Melatonin for treatment of Nocturia in adults with Multiple Sclerosis (MeNiMS). BMC Neurol 17, 63 (2017). From https://doi.org/10.1186/s12883-017-0845-y Obtain on 19/09/2022
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