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Trazodone vs Ambien: Which Insomnia Treatment is Right for You?

Clinically Reviewed by: Dr. Robin Campbell, LMFT, PHD

Trazodone Vs. Ambien

Chronic insomnia is a pervasive issue affecting millions of individuals, often necessitating the use of prescription medications to manage symptoms and improve sleep quality. Two commonly prescribed medications for sleep disorders are trazodone and Ambien. Understanding the differences between these two drugs is essential for those dealing with sleep maintenance insomnia and other related conditions. Trazodone, a serotonin antagonist reuptake inhibitor, and Ambien, a benzodiazepine receptor agonist, offer distinct mechanisms of action and potential benefits. This blog will delve into the nuances of trazodone and Ambien, comparing their efficacy, side effects, and suitability for treating various sleep problems. We’ll also explore how these medications interact with other treatments, such as cognitive behavioral therapy, and consider their impacts on mental health disorders and conditions like obstructive sleep apnea. By examining the pros and cons of both trazodone and Ambien, we aim to provide a comprehensive guide for those seeking effective insomnia treatment while balancing personal responsibilities and potential risks.

Trazodone Vs Ambien: What is Trazodone?

Trazodone is a prescription medication primarily used to treat major depressive disorder. It is also sometimes prescribed for anxiety disorders, insomnia, and chronic pain. Trazodone works by affecting the balance of chemicals (neurotransmitters) in the brain, particularly serotonin.

It belongs to a class of drugs known as serotonin receptor antagonists and reuptake inhibitors (SARIs). Unlike many other antidepressants, trazodone is often used for its sedative properties, making it particularly useful for patients who have trouble sleeping.

Common side effects of trazodone include drowsiness, dizziness, dry mouth, and blurred vision. It is important to take trazodone exactly as prescribed by a healthcare professional and to discuss any concerns or side effects with them.

 

Trazodone Types and Dosages: Serotonin Antagonist Reuptake Inhibitor

Trazodone is available in several forms and dosages:

Forms:

  1. Immediate-release tablets: These are released into the bloodstream right after being taken.
  2. Extended-release tablets: These release the medication slowly over time to maintain a steadier level in the bloodstream.

 

Common Dosages:

  1. Immediate-release:
    • Typically available in 50 mg, 100 mg, 150 mg, and 300 mg tablets.
    • Dosage for depression usually starts at 150 mg per day, divided into several doses. It can be increased by the doctor up to a maximum of 400 mg per day for outpatients and 600 mg per day for inpatients.
    • For insomnia, lower doses (typically 25-100 mg) are often used.
  2. Extended-release:
    • Available in 150 mg and 300 mg tablets.
    • Initial dose is usually 150 mg once daily, preferably at bedtime. It can be increased by the doctor up to a maximum of 375 mg per day.
 

Trazodone Uses to Treat Insomnia

Trazodone is used for:

  1. Depression: Treatment of major depressive disorder.
  2. Anxiety: Alleviation of anxiety symptoms.
  3. Insomnia: As a sleep aid due to its sedative properties. Trazodone is often used as a sleep medicine to help patients with insomnia.
  4. Chronic Pain: Management of certain types of chronic pain conditions.
  5. Other Off-Label Uses: Sometimes prescribed for conditions like fibromyalgia and PTSD.
 

How Long Does Trazodone Stay in Your System?

Trazodone has a half-life of approximately 5 to 13 hours. This means it takes about 5 to 13 hours for half of the drug to be eliminated from the body. It generally takes around 1 to 2 days for trazodone to be mostly cleared from the system, though this can vary based on factors like dosage, metabolism, and overall health.

 

How Long is Trazodone Detectable in Your System?

Trazodone is typically detectable in your system for about 1 to 3 days after the last dose. In urine tests, trazodone and its metabolites can usually be detected for up to 3 days. Blood tests may detect trazodone for around 1 to 2 days. Hair tests, although less commonly used for trazodone, can potentially detect the drug for several weeks to months after use. The exact duration can vary based on factors such as dosage, frequency of use, metabolism, age, overall health, and the type of drug test used.

 

How Does Trazodone Work in the Brain and Body?

Trazodone works in the brain and body by primarily affecting the neurotransmitter serotonin. It functions as both a serotonin reuptake inhibitor and a serotonin receptor antagonist. Here’s a breakdown of its mechanisms:

  1. Serotonin Reuptake Inhibition: Trazodone blocks the reabsorption (reuptake) of serotonin into neurons, increasing the amount of serotonin available in the brain. This helps improve mood and alleviate symptoms of depression.
  2. Serotonin Receptor Antagonism: It blocks specific serotonin receptors (5-HT2A and 5-HT2C), which helps to reduce anxiety and improve mood.
  3. Histamine Receptor Antagonism: Trazodone also acts as an antagonist at histamine H1 receptors, contributing to its sedative effects and making it useful for treating insomnia.
  4. Adrenergic Receptor Antagonism: It blocks alpha-1 adrenergic receptors, which can help to reduce anxiety and promote relaxation.

 

Through these combined actions, trazodone helps to regulate mood, alleviate anxiety, and improve sleep.

 

Trazodone Effects on the Body

  1. Sedation: Promotes relaxation and sleep due to its action on histamine and adrenergic receptors.
  2. Drowsiness: Common, especially when starting the medication or increasing the dose.
  3. Dizziness: Can cause lightheadedness, particularly when standing up quickly.
  4. Dry Mouth: A frequent side effect resulting from reduced saliva production.
  5. Blurred Vision: Some users may experience visual disturbances.
  6. Gastrointestinal Issues: Can include nausea, constipation, or diarrhea.
  7. Orthostatic Hypotension: A drop in blood pressure when standing up, causing dizziness or fainting.
  8. Weight Changes: Possible weight gain or loss over time.
  9. Sexual Dysfunction: Can affect libido, cause erectile dysfunction, or result in delayed ejaculation.
  10. Cardiac Arrhythmias: Rare but serious, involving irregular heartbeats.

 

Consult a healthcare provider to manage any side effects and ensure the medication’s benefits outweigh its risks.

 

Trazodone Efficacy

Trazodone is generally considered effective for several conditions:

  1. Depression: Trazodone has been shown to be effective in treating major depressive disorder. Its dual action on serotonin helps improve mood and reduce depressive symptoms.
  2. Insomnia: Due to its sedative properties, trazodone is often used off-label to treat insomnia. Many patients find it helps them fall asleep and stay asleep.
  3. Anxiety: Trazodone can help alleviate anxiety symptoms, particularly when anxiety is associated with depression.
  4. Chronic Pain: Some studies suggest that trazodone can be helpful in managing chronic pain conditions, although this is not its primary use.

 

The efficacy of trazodone can vary based on individual factors such as the severity of symptoms, the specific condition being treated, and the presence of any coexisting medical issues. It is generally well-tolerated, but like all medications, it may not work for everyone, and some patients may experience side effects. It is important to use trazodone under the guidance of a healthcare professional to ensure the best outcomes.

 

Trazodone Side Effects 

Short-Term Side Effects:

  • Drowsiness
  • Dizziness
  • Dry mouth
  • Blurred vision
  • Nausea
  • Headache
  • Constipation

 

Long-Term Side Effects:

  • Weight gain
  • Sexual dysfunction
  • Cardiac arrhythmias (rare)
  • Orthostatic hypotension (drop in blood pressure when standing up)

 

Patients should consult their healthcare provider to discuss any side effects experienced and to ensure the benefits outweigh the risks.

 

Is Trazodone Addictive? 

Trazodone is generally not considered addictive or habit-forming. Unlike some other medications used for anxiety or insomnia, such as benzodiazepines, trazodone does not typically lead to dependency. However, abrupt discontinuation after prolonged use can cause withdrawal symptoms such as anxiety, agitation, and sleep disturbances. Therefore, it is recommended to taper off the medication gradually under the guidance of a healthcare provider.

 

Can You Overdose on Trazodone?

Yes, it is possible to overdose on trazodone. Symptoms of a trazodone overdose can include:

  • Extreme drowsiness
  • Vomiting
  • Seizures
  • Irregular heart rhythms (arrhythmias)
  • Difficulty breathing
  • Prolonged and painful erection (priapism)
  • Loss of consciousness

 

An overdose can be serious and potentially life-threatening. If an overdose is suspected, it is important to seek immediate medical attention.

 

Alcohol Use and Trazodone

Combining alcohol and trazodone is generally not recommended. Both substances can cause sedation, dizziness, and drowsiness, and using them together can amplify these effects, increasing the risk of accidents and injuries. Additionally, alcohol can enhance some of trazodone’s side effects, such as impaired coordination, cognitive impairment, and respiratory depression.

Furthermore, alcohol can interfere with the effectiveness of trazodone in treating depression or anxiety and may worsen these conditions. It is best to avoid alcohol while taking trazodone and discuss any concerns with a healthcare provider.

 

Trazodone and Pregnancy

Using trazodone during pregnancy should be done with caution and under medical supervision. The limited research available suggests potential risks to the fetus, including withdrawal symptoms and developmental effects. The benefits to the mother should be carefully weighed against these risks. Alternative treatments with a better-established safety profile may be considered. Always consult a healthcare provider for guidance.

 

Trazodone Interaction with Other Medications

Trazodone can interact with several other medications, potentially increasing the risk of side effects or altering its effectiveness. Key interactions include:

  1. MAO Inhibitors: Can lead to serious and potentially life-threatening reactions.
  2. CNS Depressants: Enhanced sedation and risk of respiratory depression (e.g., alcohol, benzodiazepines, opioids).
  3. SSRIs/SNRIs: Increased risk of serotonin syndrome (e.g., fluoxetine, sertraline).
  4. Antihypertensives: Can enhance the blood pressure-lowering effects, leading to hypotension.
  5. Antifungals: Increased concentration of trazodone in the blood (e.g., ketoconazole).
  6. Antibiotics: Certain antibiotics (e.g., erythromycin) can increase trazodone levels.
  7. Anticonvulsants: Altered trazodone metabolism (e.g., phenytoin, carbamazepine).
  8. Warfarin: Increased risk of bleeding.
  9. Digoxin: Increased blood levels of digoxin, potentially leading to toxicity.
 

Trazodone Controlled Substance Classification

Trazodone is not classified as a controlled substance. This means it is not considered to have a high potential for abuse or addiction compared to controlled substances like opioids or benzodiazepines. However, it still requires a prescription from a healthcare provider for use.

 

What is Ambien?

Ambien, the brand name for zolpidem, is a prescription medication primarily used to treat insomnia. It belongs to a class of drugs known as sedative-hypnotics. Ambien works by slowing down brain activity, helping individuals fall asleep more quickly and stay asleep longer. It is typically prescribed for short-term use due to the risk of dependency and potential side effects, which can include dizziness, daytime drowsiness, and complex sleep-related behaviors like sleepwalking or sleep driving.

 

Ambien Types and Dosages

Ambien (zolpidem) is available in several forms and dosages:

Forms:

  1. Immediate-release tablets: Designed to help you fall asleep.
  2. Extended-release tablets (Ambien CR): Designed to help you fall asleep and stay asleep.
  3. Sublingual tablets (Edluar, Intermezzo): Dissolve under the tongue for quick absorption.
  4. Oral spray (Zolpimist): Sprayed into the mouth for quick absorption.

 

Common Dosages:

  1. Immediate-release tablets:
    • Standard dose: 10 mg for adults.
    • Lower dose: 5 mg for older adults or those with liver impairment.
  2. Extended-release tablets (Ambien CR):
    • Standard dose: 12.5 mg for adults.
    • Lower dose: 6.25 mg for older adults or those with liver impairment.
  3. Sublingual tablets:
    • Edluar: 5 mg or 10 mg.
    • Intermezzo: 1.75 mg for women and 3.5 mg for men (used for middle-of-the-night awakenings).
  4. Oral spray:
    • Zolpimist: 5 mg per spray, typically 1-2 sprays as needed.

 

Dosages may vary based on individual factors, and it’s important to follow a healthcare provider’s instructions.

 

Ambien Dosage Guidelines

  1. Immediate-release tablets:
    • Adults: 10 mg before bedtime.
    • Older adults or those with liver impairment: 5 mg before bedtime.
  2. Extended-release tablets (Ambien CR):
    • Adults: 12.5 mg before bedtime.
    • Older adults or those with liver impairment: 6.25 mg before bedtime.
  3. Sublingual tablets (Edluar):
    • 5 mg or 10 mg before bedtime.
  4. Sublingual tablets (Intermezzo):
    • Women: 1.75 mg for middle-of-the-night awakenings.
    • Men: 3.5 mg for middle-of-the-night awakenings.
  5. Oral spray (Zolpimist):
    • 5 mg per spray, typically 1-2 sprays before bedtime.

 

Always follow a healthcare provider’s specific instructions when using Ambien.

 

Ambien Uses

Ambien (zolpidem) is primarily used for:

  1. Insomnia: To help people fall asleep quickly and stay asleep.
  2. Sleep Initiation: Immediate-release forms help with falling asleep.
  3. Sleep Maintenance: Extended-release forms help with staying asleep through the night.
  4. Middle-of-the-night Awakenings: Sublingual tablets like Intermezzo address waking up in the middle of the night.
 

How Long Does Ambien Stay in Your System?

Ambien (zolpidem) has a half-life of approximately 2 to 3 hours. This means it takes about 2 to 3 hours for half of the drug to be eliminated from the body. Due to this half-life, Ambien is typically cleared from the system within 10 to 14 hours, though this can vary based on individual factors such as metabolism, age, and overall health.

Ambien Onset and Duration

  • Onset: Ambien typically begins to work within 15 to 30 minutes after ingestion.
  • Duration: The effects of immediate-release Ambien generally last for about 6 to 8 hours, helping to ensure a full night’s sleep. Extended-release formulations (Ambien CR) have a longer duration, lasting through the night to help with both sleep initiation and maintenance.

 

It is important to take Ambien right before going to bed to avoid the risk of performing activities while not fully awake.

 

How Long is Ambien Detected in Your System?

Ambien (zolpidem) can be detected in the system for varying durations depending on the type of test used:

  1. Urine: Detectable for up to 24-48 hours after the last dose.
  2. Blood: Detectable for about 6-20 hours after the last dose.
  3. Saliva: Detectable for up to 8 hours after the last dose.
  4. Hair: Detectable for up to several weeks to months, though hair tests for Ambien are less common.

 

The exact duration can vary based on individual factors such as metabolism, dosage, frequency of use, and overall health.

 

How Does Ambien Work in the Brain and Body?

Ambien (zolpidem) works by enhancing the activity of gamma-aminobutyric acid (GABA), a neurotransmitter in the brain. Here’s how it functions:

  1. GABA Enhancement: Ambien binds to GABA receptors, specifically the GABA-A subtype, which increases the inhibitory effects of GABA. This leads to a calming effect on the brain.
  2. Sedative Effects: By enhancing GABA activity, Ambien slows down brain activity, promoting sedation and helping individuals fall asleep more quickly.
  3. Short-Term Action: Ambien’s design allows for quick onset and relatively short duration, which helps to induce sleep without lingering effects the next day, making it effective for treating insomnia.

 

Overall, Ambien helps regulate sleep by calming the nervous system and promoting relaxation, facilitating the onset and maintenance of sleep.

 

Ambien Effects on the Body

  1. Sedation: Promotes relaxation and sleep by calming the central nervous system.
  2. Drowsiness: Common side effect that can persist into the next day.
  3. Dizziness: Can cause a feeling of lightheadedness or vertigo.
  4. Muscle Relaxation: Reduces muscle tension, contributing to overall relaxation.
  5. Cognitive Impairment: May affect memory, concentration, and decision-making abilities.
  6. Complex Sleep Behaviors: Can lead to activities like sleepwalking, sleep eating, or even sleep driving without full awareness.
  7. Digestive Issues: Possible side effects include nausea, diarrhea, or constipation.

 

Always use Ambien as prescribed and consult a healthcare provider about any concerns or side effects experienced.

 

Ambien Efficacy

Ambien (zolpidem) is generally considered effective for short-term treatment of insomnia. It helps individuals fall asleep quickly and stay asleep through the night. Its efficacy is supported by its rapid onset and duration of action, which typically lasts 6 to 8 hours. However, it is intended for short-term use due to potential risks of dependency and tolerance. Always use Ambien under the guidance of a healthcare provider.

 

Ambien Side Effects

Short-Term Side Effects:

  • Drowsiness
  • Dizziness
  • Headache
  • Nausea
  • Diarrhea
  • Dry mouth
  • Memory problems
  • Complex sleep behaviors (e.g., sleepwalking, sleep driving)

Long-Term Side Effects:

  • Dependence or tolerance
  • Rebound insomnia
  • Cognitive impairment
  • Mood changes, such as increased anxiety or depression
  • Potential for abuse

 

Always consult a healthcare provider for personalized advice and to manage any side effects.

 

Is Ambien Addictive?

Yes, Ambien (zolpidem) can be addictive. Prolonged use can lead to physical and psychological dependence, tolerance, and potential abuse. Users may find they need higher doses to achieve the same effect, and they might experience withdrawal symptoms if they stop taking it abruptly. Therefore, Ambien is typically prescribed for short-term use, and it is important to follow your healthcare provider’s instructions to minimize the risk of addiction.

 

Can You Overdose on Ambien?

Yes, it is possible to overdose on Ambien (zolpidem). Symptoms of an overdose can include:

  • Extreme drowsiness
  • Confusion
  • Shallow or slowed breathing
  • Unconsciousness or coma
  • Slowed heart rate
  • Severe dizziness

 

An Ambien overdose can be life-threatening and requires immediate medical attention. If an overdose is suspected, contact emergency services right away.

 

Alcohol Use and Ambien

Combining alcohol and Ambien (zolpidem) is not recommended. Both substances are central nervous system depressants, and using them together can amplify sedative effects, leading to extreme drowsiness, dizziness, impaired coordination, memory problems, and an increased risk of accidents or injuries. This combination can also cause respiratory depression, which can be life-threatening. Always avoid alcohol while taking Ambien and follow your healthcare provider’s advice.

 

Ambien and Pregnancy

Using Ambien (zolpidem) during pregnancy should be done with caution and under medical supervision. The potential risks to the fetus include withdrawal symptoms, respiratory issues, and developmental problems. The benefits to the mother should be carefully weighed against these risks. Alternative treatments with a better-established safety profile may be considered. Always consult a healthcare provider for personalized advice if you are pregnant or planning to become pregnant while using Ambien.

 

Ambien Interaction with Other Medications

Ambien (zolpidem) can interact with several other medications, including:

  1. CNS Depressants: Enhanced sedation and risk of respiratory depression (e.g., benzodiazepines, opioids, antihistamines).
  2. Alcohol: Increased drowsiness, impaired coordination, and respiratory issues.
  3. Antidepressants: Increased sedation and potential side effects (e.g., SSRIs, MAOIs).
  4. Antifungals: Increased Ambien concentration and effects (e.g., ketoconazole).
  5. Antibiotics: Reduced effectiveness of Ambien (e.g., rifampin).
  6. Liver Enzyme Affecting Drugs: Altered Ambien metabolism and effects (e.g., cimetidine).
 

Ambien Controlled Substance Classification

Ambien (zolpidem) is classified as a Schedule IV controlled substance in the United States. This classification indicates that it has a lower potential for abuse and dependence compared to Schedule I, II, and III drugs, but still requires a prescription and careful monitoring by a healthcare provider.

 

Trazodone vs. Ambien

Trazodone and Ambien (zolpidem) are prescription medications with different primary uses and mechanisms of action. Trazodone is primarily used to treat depression but is also prescribed off-label for insomnia, anxiety, and chronic pain. It works as a serotonin receptor antagonist and reuptake inhibitor (SARI), and also affects histamine and adrenergic receptors, which contributes to its sedative effects. Ambien, on the other hand, is specifically designed for short-term treatment of insomnia. It enhances the activity of the neurotransmitter GABA by binding to GABA-A receptors, promoting sedation and helping users fall and stay asleep.

Both trazodone and Ambien are used as sleep medicine to help patients with insomnia.

The efficacy of both medications varies by their intended use. Trazodone is effective in treating depression and can help with insomnia due to its sedative properties. Ambien is highly effective for quickly inducing sleep and maintaining it through the night, making it a strong choice for managing short-term sleep disturbances. However, Ambien is intended for short-term use due to its potential for dependence and tolerance, whereas trazodone is generally not considered addictive and can be used for longer periods under medical supervision.

Both medications come with a range of side effects. Trazodone’s short-term side effects include drowsiness, dizziness, dry mouth, and nausea, with potential long-term effects such as weight changes, sexual dysfunction, and orthostatic hypotension. Ambien’s side effects include drowsiness, dizziness, headache, and complex sleep behaviors such as sleepwalking. Long-term use of Ambien can lead to dependence, tolerance, cognitive impairment, and mood changes.

When considering use during pregnancy, both medications should be approached with caution and under the guidance of a healthcare provider. Trazodone is not classified as a controlled substance, while Ambien is a Schedule IV controlled substance due to its potential for abuse. Both medications can interact with other drugs, so it’s important to consult a healthcare provider to manage these interactions and ensure safe use. The choice between trazodone and Ambien should be based on the specific needs and medical history of the patient.

 

Which is Right for You?

Choosing between trazodone and Ambien depends on your specific needs:

Trazodone:

  • Best for: Treating depression with added sleep benefits.
  • Use: Suitable for long-term use, less risk of addiction.
  • Additional Benefits: May help with anxiety and chronic pain.

 

Ambien:

  • Best for: Short-term relief from insomnia.
  • Use: Quick sleep induction, short-term use due to higher addiction risk.
  • Considerations: Effective for falling and staying asleep.

 

Consult your healthcare provider to determine the best option based on your health history and treatment goals.

 

Conclusion

When comparing trazodone and Ambien for treating chronic insomnia, it’s clear that each medication has unique advantages and drawbacks. Trazodone, often preferred for its dual role in treating depression and insomnia, may be more suitable for individuals with a mental health disorder requiring a long-term solution. However, it carries risks such as trazodone addiction and misuse. Ambien, known for its efficacy in sleep onset and maintenance, is typically used for short-term treatment due to its potential for physical dependence and complex sleep behaviors. Both medications require careful consideration of drug interactions, especially with conditions like kidney disorders and when combined with other prescription drugs or sleep aids. Doctors prescribe these medications based on individual needs, medical conditions, and potential adverse effects. Incorporating good sleep hygiene and considering therapies like cognitive behavioral therapy can enhance the effectiveness of these treatments. Ultimately, the choice between trazodone and Ambien should be made in consultation with a healthcare provider, considering the unique sleep problems and overall health of the patient.

 

Seeking Treatment? We Can Help!

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If you or a loved one are struggling with mental health challenges or substance abuse, reach out to New Hope Healthcare today. Our team of compassionate professionals is here to support your journey towards lasting well-being. Give us a call at 866-799-0806

Frequently Asked Questions

  • Trazodone is primarily used to treat depression but is also prescribed off-label for insomnia, anxiety, and chronic pain. Its sedative properties make it beneficial for those experiencing sleep maintenance insomnia.
  • Ambien (zolpidem) is specifically designed for short-term treatment of insomnia, particularly for helping individuals fall asleep and stay asleep through the night.
  • Trazodone works as a serotonin antagonist reuptake inhibitor (SARI), affecting serotonin levels and other receptors to promote sleep and alleviate depressive symptoms.
  • Ambien is a benzodiazepine receptor agonist that enhances the activity of GABA, a neurotransmitter that induces sedation and helps with sleep onset and maintenance.
  • Trazodone side effects include drowsiness, dizziness, dry mouth, blurred vision, and nausea. Long-term use may lead to weight changes, sexual dysfunction, and orthostatic hypotension.
  • Ambien side effects include drowsiness, dizziness, headache, and potential complex sleep behaviors like sleepwalking. Long-term use can lead to dependence, tolerance, and cognitive impairment.
  • Trazodone is generally not considered addictive but can lead to dependence if misused. Its risk of addiction is lower compared to many other sleep medications.
  • Ambien can be addictive, with a higher potential for physical dependence and withdrawal symptoms. It is typically prescribed for short-term use to minimize these risks.
  • Using trazodone and Ambien together is generally not recommended due to the risk of enhanced sedative effects and potential for severe drowsiness, dizziness, and respiratory depression. Always consult a healthcare provider before combining medications to ensure safety and avoid adverse interactions.

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