Benzodiazepines vs. Ambien

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Facts on Benzodiazepines vs. Ambien

What are Benzodiazepines? What is Ambien?

Benzodiazepines are central nervous system depressants that cause sedation (drowsiness) and are used to treat anxiety disorders, panic disorders, seizures, muscle spasms, nervousness, sleeplessness, alcohol withdrawal, status epilepticus, premenstrual syndrome, and as sedation during surgery. Benzodiazepines may work by boosting the effects of gamma-aminobutyric acid (GABA), a neutrotransmitter in the brain. Anxiety, seizures, and other illnesses may be caused by excessive activity of nerves in the brain. GABA reduces this nerve activity in the brain.

Ambien (zolpidem) is a sedative/hypnotic that shares some characteristics of a family of sedatives called benzodiazepines but Ambien has selectivity in that it has little of the muscle relaxant and anti-seizure effects and more of the sedative effect so it is used primarily as a medication for sleep.

What are the side effects of benzodiazepines and Ambien?

Benzodiazepines

Common side effects include:

  • Lightheadedness
  • Drowsiness
  • Confusion
  • Sedation
  • Memory impairment
  • Improper body balance
  • Increase or decrease in appetite
  • Nausea
  • Vomiting
  • Constipation
  • Weight gain
  • Dry mouth
  • Reduced libido
  • Fatigue

Serious side effects include:

Ambien

The most common side effects of zolpidem are:

  • Drowsiness
  • Headache
  • Weakness
  • Dizziness
  • A "drugged" feeling, which probably reflect the action of the drug

Other side effects include:

Can I get addicted to benzodiazepines and Ambien?

Benzodiazepines

Benzodiazepines or benzos are habit forming and you can become addicted to them - even if you take them as your doctor or health care professional has prescribed. People who have a history of drug or alcohol abuse are more likely to develop an addiction to these drugs. If you use these drugs over a long period of time you can develop a tolerance for them. This means that you will need higher doses of the drug to treat your health condition or disease because you've become tolerant of the weaker formulations of the drug. These drugs may be very effective for the treatment of several conditions, for example, anxiety and insomnia; but be careful because you can become addicted to them.

The street names for benzodiazepine drugs are "Benzos" and "Downers." Drug addicts abuse these drugs to get "high." They can cause addiction similar to opioids (narcotic drugs like oxycodone, morphine, hydrocodone, and fentanyl), cannabinoids (marijuana), and the club drug GHB (gamma-hydroxybutyrate).

They are commonly abused by young adolescents and young adults who crush it up and snort it, or take the tablet to get high. If you abuse this medication you may have adverse effects with symptoms include:

  • Disturbing or vivid dreams
  • Irritability
  • Hostility
  • Amnesia

Signs and symptoms that you might be addicted include:

  • Problems sleeping
  • Diarrhea
  • Vomiting
  • Nausea
  • Goose bumps
  • Uncontrollable leg movements
  • Bone and muscle pain

It is very difficult to recover from benzodiazepine addiction because these drugs change the chemistry of the brain. Contact a drug addiction treatment center if you or a loved one are suffering from a addiction. Quitting cold turkey is not likely to be successful and can be dangerous because of symptoms of withdrawal. Doctors and other health care professionals that treat addiction will formulate a taper schedule to slowly wean off the medication to reduce the severity of withdrawal symptoms during treatment.

Signs and symptoms of overdose include:

Benzodiazepine withdrawal symptoms and signs

If you stop taking these medications abruptly you may experience withdrawal symptoms that include:

  • Problems concentrating
  • Sleep problems
  • Irritability
  • Increased anxiety and tension
  • Panic attacks
  • Hand tremors
  • Dry heaving and vomiting
  • Palpitations
  • Headache
  • Muscle pain and stiffness
  • A host of perceptual changes

The severity of the withdrawal symptoms depends on amount and duration of benzodiazepine use. Withdrawal symptoms can be deadly.

These medications are classified by the Drug Enforcement Administration (DEA) as Schedule IV drugs. This means that they have a lower potential and risk of dependence than other more powerful drugs like codeine, testosterone, anabolic steroids, Vicodin (hydrocodone and acetaminophen), OxyContin (oxycodone), Adderall (amphetamine and dextroamphetamine), and Ritalin (methylphenidate).

Ambien

Zolpidem can cause withdrawal symptoms (muscle cramps, sweats, shaking, and seizures) when the drug is abruptly discontinued. Zolpidem can cause abnormal behavior with confusion, paradoxical insomnia or "complex sleep-related behaviors," which may include sleep-driving (driving with no memory of having done so). If these side effects occur, zolpidem should be discontinued.

What is the dosage of benzodiazepines and Ambien?

Benzodiazepines

All oral benzodiazepines are available in tablet forms.

  • Alprazolam and clorazepate are available as extended-release tablets.
  • Alprazolam, clobazam, diazepam, and lorazepam are available in oral liquid form.
  • Alprazolam and clonazepam are available in orally dissolving tablets.
  • Chlordiazepoxide, oxazepam, and temazepam are available in capsule form.
  • Diazepam also is available as a rectal gel.

Some benzodiazepines are available for injection.

Ambien

  • The recommended adult dose of zolpidem conventional tablets or spray is 5 mg for females, the elderly, or fragile individuals, and 5 to 10 mg for males.
  • The maximum dose is 10 mg daily.
  • For females and the elderly, give 6.25 mg of extended-release tablets; and males should receive 6.25 to 12.5 mg.
  • The maximum dose of extended-release tablets is 12.5 mg daily.
  • Elderly patients have decreased ability to eliminate zolpidem from the body, and accumulating zolpidem may cause side effects.

What drugs interact with benzodiazepines and Ambien?

Benzodiazepines

Combining alcohol with a benzodiazepine is very dangerous. People who drink alcohol while taking this medicine will feel the effects of alcohol faster. It's not safe to drink alcohol or take other drugs that have similar effects on the central nervous system (CNS) at the same time because these drugs or substances interact with oral benzodiazepines by causing additional depression of the brain and respiratory depression. Respiratory depression can lead to breathing that's inadequate for supplying oxygen to the body. This can cause death. Examples of these drugs and products that increase sedative side effects or the risk of respiratory depression from benzodiazepines include:

Pain medications called opioids that also cause respiratory depression, for example:

Sedatives (for example, insomnia medicine) and other medicine that cause sedation, for example:

Ambien

  • Alcohol has an additive effect with zolpidem and the two should not be combined. Zolpidem should not be combined with other sedative drugs because of the additive effects.
  • Itraconazole (Sporanox) and ketoconazole (Nizoral, Extina, Xolegel, Kuric) may increase the blood concentration of zolpidem by reducing the activity of the enzymes that breakdown zolpidem in the liver. Conversely, rifampin may reduce the concentration of zolpidem by increasing the activity of the enzymes that breakdown zolpidem.

Are benzodiazepines and Ambien safe to use while pregnant and breastfeeding?

Benzodiazepines

  • The FDA classifies benzodiazepines as pregnancy category D, which means that benzodiazepines can potentially cause fetal harm if administered to pregnant women. If benzodiazepines have to be used in pregnant women or if the patient may become pregnant while taking benzodiazepines, the patients must be informed of potential risks to the fetus.
  • Benzodiazepines enter breast milk and can cause lethargy and weight loss in the newborn. Therefore, they should not be used in nursing mothers.

Ambien

  • There are no adequate studies of zolpidem use in pregnant women.
  • Zolpidem is excreted in human breast milk and may adversely affect the infant.

Summary

Benzodiazepines and Ambien (zolpidem) are used to treat insomnia. Benzodiazepines are a drug class of central nervous system depressants that cause drowsiness. Ambien belongs to a different drug class called sedatives/hypnotics that have some similar characteristics to benzodiazepines. Side effects of benzodiazepines and Ambien that are similar include drowsiness, confusion, and balance problems.

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Medically Reviewed on 8/21/2018
References
REFERENCES:

https://www.dea.gov/factsheets/benzodiazepines

https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/019908s038lbl.pdf
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