Diazepam vs. Ambien: What's the difference?

What is diazepam? What is Ambien?

Diazepam is a benzodiazepine used to treat anxiety, seizures, alcohol withdrawal symptoms, to relieve muscle spasms in certain neurological diseases, and as sedation during surgery. Other benzodiazepines include alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin), and flurazepam (Dalmane). Benzodiazepines act by enhancing the effects of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain. It is believed that excessive activity in the brain may lead to anxiety or other psychiatric disorders.

Ambien (zolpidem) is a sedative/hypnotic used for treating 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. Ambien shares some characteristics of benzodiazepines, which cause sedation, muscle relaxation, act as anti-convulsants (anti-seizure medications), and reduce anxiety. Ambien has selectivity in that it has little of the muscle relaxant and anti-seizure effects and more of the sedative effect. The oral spray form of zolpidem, Zolpimist, has more rapid absorption than the tablet form because it is absorbed through the lining of the mouth.

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What are the side effects of diazepam and Ambien?

Diazepam

The most common side effects of diazepam are:

Other important side effects include:

  • Paradoxical reactions with excitability
  • Muscle spasm
  • Lack of sleep
  • Rage
  • Confusion
  • Speech problems
  • Double vision

Possible serious side effects:

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:

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 diazepam vs. Ambien?

Diazepam

  • Diazepam may be taken with or without food.
  • Diazepam is disposed of by the liver and excreted mainly by the kidney. Dosages of diazepam may need to be lowered in patients with abnormal kidney function.
  • The usual oral diazepam dose for anxiety or seizures is 2-10 mg given 2-4 times daily.
  • The usual rectal dose is 0.2-0.5 mg/kg and depends on the age of the patient.

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 diazepam and Ambien?

Diazepam

Alcohol or medications that cause sedation may add to the sedative effects of diazepam. Patients taking benzodiazepines should avoid such combinations.

The following drugs may prolong the effects of diazepam by inhibiting liver enzymes that eliminate diazepam:

Dosages may need to be decreased when these drugs are used with diazepam.

Carbamazepine (Tegretol), rifampin (Rifadin), and St. John's Wort decrease levels of diazepam by increasing the elimination of diazepam by liver enzymes.

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 diazepam and Ambien safe to use while pregnant or breastfeeding?

Diazepam

  • Benzodiazepines, including diazepam, can cause fetal abnormalities and should not be used during pregnancy.
  • Diazepam is excreted in breast milk and can affect nursing infants. Therefore, diazepam should not be used by women who are nursing.

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.

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Summary

Valium (diazepam) and Ambien (zolpidem) are used to treat insomnia. Diazepam is primarily used to treat anxiety, alcohol withdrawal symptoms, seizures, for relief of muscle spasms in some neurological diseases, and for sedation during surgery. Diazepam and Ambien belong to different drug classes. Diazepam is a benzodiazepine and Ambien is a sedative/hypnotic.

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Medically Reviewed on 8/5/2019
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