Belsomra (suvorexant) and Ambien (zolpidem) are both medications for treating insomnia or sleep problems and medicines called sedative-hypnotics. While they treat the same conditions, they have different mechanisms of action and may benefit certain people more than others.

Both medications can be effective, but they have side effects and significant risks you should be aware of before choosing the right one. Learn more about Belsomra vs. Ambien with this drug comparison.

What Is Belsomra (Suvorexant)?

Belsomra is the brand name medication for Suvorexant, a prescription drug approved by the Food and Drug Administration (FDA) for the short-term treatment of insomnia that involves difficulty falling or staying asleep. It’s controlled as a Schedule IV drug because while it has medical uses, it has a risk of dependence and misuse.

Suvorexant is an orexin receptor antagonist and reworks in the central nervous system (CNS) to affect the activity of orexin, a chemical in the brain that attaches to the orexin receptor 1 (OX1R) or orexin receptor 2 (OX2R).[1] These receptors regulate sleep and wakefulness, appetite, and stress responses.

Drugs like Belsomra attach to receptors and block the activity of these neurotransmitters, blocking the neurotransmitters that cause wakefulness. Belsomra can help you fall asleep and stay asleep. It works for up to 8 hours and is taken just before bed.

What Is Ambien (Zolpidem)?

Ambien is the brand name for zolpidem, a prescription medication approved by the FDA to treat short-term insomnia with difficulty falling asleep. At the discretion of a doctor or prescriber, Ambien may be used off-label to treat neurological disorders besides insomnia.

Zolpidem is a sedative-hypnotic medication that’s taken in the short term for insomnia. It binds to the gamma-aminobutyric acid-A (GABA-A) receptor at the same site where benzodiazepine medications bind.[2] This causes the receptor to attract more GABA, leading to less neuron firing and a sedative effect that induces sleep.

Ambien is also considered a “Z drug,” which is a group of drugs that have similar mechanisms of action. Like Belsomra, Ambien is a Schedule IV drug that has legitimate medical uses but a risk of dependence and misuse.

Benefits of Belsomra vs. Ambien

Belsomra and Ambien have some similar benefits, but they have some differences.

Belsomra can help maintain sleep through the night and has a lower risk of dependence compared to some other sleep medications.[3] Unlike Z drugs, Belsomra has a newer mechanism of action that can help with sleep. As a result, it may be more suitable for prolonged use.

Ambien is an effective drug for helping you fall asleep. It can also improve sleep duration by helping you sleep longer, improving overall sleep quality.[4] Different dosing options, including immediate and extended-release formulations, allow for more flexibility.

Belsomra vs. Ambien Side Effects

While there may be some overlap, Belsomra and Ambien have different side effects. Belsomra’s side effects include excessive sleepiness, headaches, and dizziness, as well as less common, serious side effects like sleep paralysis, abnormal dreams, hallucinations, and daytime sleepiness that can make it difficult to drive or perform other activities that require alertness.[5]

Ambien also has dizziness and headache, as well as nausea and diarrhea as common side effects. More serious side effects include memory problems, behavioral changes, sleepwalking, and next-day hangover effects.[6] There may be a higher risk of dependence and withdrawal with Ambien as well.

Belsomra vs. Ambien Dosage

Belsomra and Ambien have standard dosages that vary based on your health history and medication response. Both medications are available as oral tablets.

Belsomra is available as an oral tablet in 5 mg, 10 mg, 15 mg, and 20 mg dosages.[7] The recommended starting dose is 10 mg taken within 30 minutes of sleep if you have at least 7 hours before waking. The dose may be increased or decreased as needed.

Ambien is available as an oral tablet in either 5 mg or 10 mg in immediate-release formulation and 6.25 mg or 12.5 mg in extended-release formulation.[8] The starting dose for Ambien differs for men and women, with men starting at 5 or 10 mg and women starting at 5 mg. Ambien is taken 30 minutes before bedtime and at least 7 hours before you have to wake up. The maximum dose is 10 mg of immediate and 12.5 mg of extended-release.

Neither drug is intended to be taken every night. Taking the exact dose prescribed is important if you’re prescribed Belsomra or Ambien. Taking Ambien or Belsomra at higher doses can lead to dangerous side effects without any enhanced effects. You should take the lowest possible dose that’s effective.

Warnings for Belsomra and Ambien

Belsomra and Ambien have specific warnings and precautions to be aware of.

The risks for Belsomra can include:[9]

• Worsening depression or suicidal thoughts
• CNS depression and daytime impairment can make some activities dangerous
• Risk of addiction or misuse
• Sleepwalking, sleep driving, or performing other activities while not fully awake
• Sleep paralysis or hallucinations during sleep/wake transitions
• Risk of respiratory depression or slowed breathing that can be dangerous

The risks for Ambien can include:

• Severe allergic reactions that require medical attention
• Abnormal thinking and behavioral changes, such as aggression or agitation
• Hepatic encephalopathy is a dangerous liver condition that can impair the liver and change the mental status
• Worsening depression or suicidal thoughts
• Risks of respiratory depression
• Complex sleep behaviors like sleepwalking or sleep driving
• CNS depression and daytime impairment
• Abuse, dependence, and withdrawal symptoms

Potential Drug Interactions with Ambien and Belsomra

Both Ambien and Belsomra can have dangerous drug interactions. These drugs affect the CNS, so they shouldn’t be combined with other medications that act on the CNS.

Some medications have known interactions with Ambien, including rifampin, opioids, sertraline, fluoxetine, ketoconazole, and St. John’s wort.[11] Belsomra also has known interactions, including rifampin, ketoconazole, antiviral medications, and some antibiotics.[12]

Make sure you discuss any medications you take with your doctor or healthcare provider to ensure that your medications are safe for you. Drug interactions with Ambien or Belsomra and alcohol or illicit drugs, such as heroin, methamphetamine, or cocaine, can have serious and unpredictable effects.

Belsomra vs. Ambien Abuse and Addiction Potential

Both Belsomra and Ambien are Schedule IV controlled substances, according to the Drug Enforcement Agency (DEA). They have recognized medical uses and some potential for misuse. However, there’s limited evidence to suggest that Belsomra may have a lower addiction potential than Ambien.[13]

If you become dependent on Ambien or Belsomra, your body becomes used to the drug and needs it to function properly. Stopping Ambien or Belsomra suddenly can cause withdrawal symptoms like insomnia, irritability, and anxiety may occur.

Dependence is more likely if you take these insomnia drugs for long periods or at high doses or combine them with other drugs. If you want to stop taking Belsomra or Ambien, talk to your doctor about how to stop safely. You may need a taper, which reduces your dose slowly to wean you off the drug.

You should discuss any substance abuse history with your doctor to ensure either of these drugs are a good choice for you.

Belsomra vs. Ambien: Which Is Right for You?

Belsomra and Ambien can contribute to better sleep, but they have different mechanisms of action and risks that may make one more suitable. Talk to your doctor about your options, medical history, mental health history, and specific sleep troubles to determine the best choice for you.