Klonopin (clonazepam) vs. Ambien (zolpidem)

• Clonazepam and Ambien (zolpidem) are used to treat insomnia.
• Clonazepam is primarily used for treating panic disorder and preventing certain types of seizures, treating Lennox-Gastaut syndrome, and providing short-term relief of anxiety symptoms.
• A brand name for clonazepam is Klonopin.
• Clonazepam and Ambien belong to different drug classes. Clonazepam is a benzodiazepine, which include anti-anxiety medications, and Ambien is a sedative/hypnotic.
• Side effects of clonazepam and Ambien that are similar include sedation/drowsiness, dizziness, depression, headache, weakness, unsteadiness, sleep problems (insomnia), confusion, amnesia, and rash.
• Side effects of clonazepam that are different from Ambien include loss of orientation, lack of inhibition, fatigue, changes in sexual desire, and irritability.
• Side effects of Ambien that are different from clonazepam include a "drugged" feeling, diarrhea, dry mouth, euphoria, and vision changes.
• Suddenly stopping clonazepam or Ambien after prolonged use can lead to withdrawal symptoms.

Clonazepam is an anti-anxiety drug primarily used for treating panic disorder and preventing certain types of seizures, and for short-term relief of anxiety symptoms. Clonazepam belongs to the benzodiazepine class, which also includes diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), and flurazepam (Dalmane). Clonazepam and other benzodiazepines enhance the effects of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain. Research shows excessive activity in the brain may lead to anxiety or other psychiatric disorders.

Ambien (zolpidem) is a sedative/hypnotic used to treat insomnia. Conventional tablets are used for short-term treatment of insomnia associated with difficulty falling asleep. Long-acting tablets are used for treating insomnia associated with difficulty falling asleep or staying asleep. Ambien improves initiation of sleep and keeps patients asleep longer.

The most common side effects associated with clonazepam are sedation, which is reported in approximately half of patients. Dizziness is reported in one-third of patients.

Other common side effects include:

• A feeling of depression,
• Loss of orientation,
• Headache,
• Weakness,
• Unsteadiness, and
• Sleep disturbance
• Lack of inhibition
• Fatigue
• Amnesia
• Confusion
• Changes in sexual desire
• Rash
• Irritability

Other serious side effects of clonazepam include:

• Respiratory depression
• Fainting
• Enlarged liver
• Withdrawal symptoms (if stopped suddenly)
• Increased heart rate
• Low blood pressure
• Blood disorders

Other serious adverse reactions:

• Antiepileptic medications have been associated with an increased risk of suicidal thinking and behavior. Anyone considering the use of antiepileptic drugs must balance this risk of suicide with the clinical need for the antiepileptic drug. Patients who begin antiepileptic therapy should be closely observed for clinical worsening, suicidal thoughts or unusual changes in behavior.

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:

• Confusion
• Insomnia
• Diarrhea
• Depression
• Dry mouth
• Rash
• Euphoria
• Ataxia (balance problems), and
• Visual changes.

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.

Clonazepam

The dose of clonazepam is tailored to the patient's needs.

• For seizures in adults the initial dose is 1.5 mg daily in 3 divided doses.
• Dosage may be increased by 0.5 to 1 mg daily every 3 days until seizures are controlled or side effects preclude further increases in dose.
• The maximum dose is 20 mg daily. The initial dose for panic disorders is 0.25 mg twice daily.
• The dose may be increased to the target dose of 1 mg daily after 3 days.

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.

Clonazepam

• Clonazepam, like all other benzodiazepines, accentuates the effects of other drugs that slow the brain's processes, such as alcohol, barbiturates, and narcotics and leads to increased sedation.

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.

Clonazepam

• Clonazepam and other benzodiazepines have been associated with fetal damage, including congenital malformations, when taken by pregnant women in their first trimester. Clonazepam is best avoided in the first trimester and probably throughout pregnancy.
• Benzodiazepines are secreted in breast milk. Mothers who are breastfeeding should not take clonazepam.

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.