Drug Comparisons

Some drugs used to treat sleep disorders are difficult to group together with other drugs based on their mechanism of action because the exact mechanism may be unknown or no other medication works exactly in the same manner. These drugs are thus listed as miscellaneous sedatives and hypnotics.

Drugs in this Class
Eszopiclone Tablets (Lunesta Tablets)
Zolpidem extended-release  (Ambien CR)
Zolpidem (Ambien)
Zaleplon (Sonata)
Ramelteon  (Rozerem)

Summarizing the Evidence

• Each of the drugs in this class are FDA-approved for the treatment of insomnia. Zolpidem (Ambien), zolpidem extended-release (Ambien CR), zaleplon (Sonata) and eszopiclone (Lunesta) are thought to work similarly in the body to treat insomnia. Each of these medications is considered a schedule IV controlled substance (meaning, they each potentially have addictive or dependence effects, especially if not taken properly). These drugs are believed to possess similar abuse potentials. The last drug in this class, ramelteon (Rozerem), works differently in the body to treat insomnia. It is not considered a controlled substance (and thus does not have addictive potential).

• Zolpidem (Ambien) and zaleplon (Sonata) are approved for short-term use (7 to 10 days) while package labelings for eszopiclone (Lunesta), ramelteon (Rozerem) and zolpidem extended-release (Ambien CR) do not specify a treatment duration limit. However, Ambien and Sonata have been routinely used on a long-term basis in clinical practice, and Lunesta has been studied in at least one study that lasted 6 months supporting its long-term safety and effectiveness.

• Zolpidem (Ambien), zolpidem extended-release (Ambien CR), and eszopiclone (Lunesta) have been shown to reduce the time until sleep occurs and increase total sleep time. The effects of these medications are said to better resemble natural sleep. These medications may be more useful for people who have trouble falling to sleep or for people who have difficulty staying asleep.

• Zaleplon (Sonata) and ramelteon (Rozerem) have been shown to reduce the time until sleep occurs. These medications may be more useful for people who mainly have trouble falling to sleep. They may be less effective for patients who routinely awake during the night.

• Each drug in this class has published studies to support its safety and effectiveness. However, the two newest drugs, zolpidem extended-release (Ambien CR) and ramelteon (Rozerem) have fewer studies. Ramelteon (Rozerem) has not been directly compared to any other drug in this class in a published study. Comparative studies involving eszopiclone (Lunesta) are sparse. Conversely, zolpidem (Ambien) and zaleplon (Sonata) have been around the longest and have the most published studies that compare their effectiveness to each other. Some of these studies contained design flaws making it difficult to draw firm conclusions on comparative effectivness. However, from the evidence thus far, Sonata and Ambien appear to be similar in effectiveness in reducing time until sleep occurs; however, some evidence shows that Ambien may be more effective in increasing total sleep time and decreasing the number of nighttime awakenings. Higher doses of Sonata (10 mg or 20 mg) appear to be more effective than a lower dose (5mg) without a significant increase in side effects. In one study, Ambien caused an increase in hangover effect and rebound insomnia once the drug was discontinued compared to Sonata. Sonata may cause less memory impairment compared to Ambien especially in the first few hours after taking the medication.

• Ramelteon (Rozerem) appears to have a few advantages over other drugs in this class in that Rozerem does not have addictive effects nor does it impair memory or body movement functioning (ie. motor functioning). This may be of particular importance for elderly individuals with insomnia--especially those individuals who have memory impairment such as dementia or Alzheimer's disease or who have impaired muscle or motor functioning from arthritis or other conditions that cause difficulties in walking or body movement).

• The medications in this class are each generally safe and effective for sleep, but tend to be more expensive than other medications (including over-the-counter sleep aids) for insomnia because they are not yet available in a generic formulation. Zolpidem (Ambien) is scheduled to lose patent protection in April 2007. However, it is unknown exactly when generic versions of Ambien will become available.

• Adverse effects appear to be similar between the drugs in this class except eszopiclone (Lunesta) may be more strongly associated with an unpleasant taste. Additionally, as previously stated, ramelteon (Rozerem) may be better tolerated in terms of impaired memory and body movement function effects.

• If it is deemed that you need to be treated with one of the drugs in this class, the choice of which of these drugs to use will generally depend upon your doctor's preference and/or your prescription benefits formulary since no one drug in this class appears to offer any significant advantages over the others--the only exception being that ramelteon (Rozerem) may be a better choice for elderly patients.

Dosing and Administration

• Ramelteon (Rozerem) should be taken within 30 minutes of going to bed. Each of the other medications in this class should be taken immediately before retiring for sleep.

Generic Availability

• Zolpidem (Ambien) is currently available generically. None of the other medications in this class are available generically and are thus more expensive than other types of medications used to treat insomnia (eg. over-the-counter sleep medications).

Drug Interactions

Some interactions between medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how the drugs interact and the severity of the interaction, please use our Drug Interactions Checker.

Side Effects

To view specific side effect information, please use our Side Effect Checker.

Additional Information

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Last Updated: December 2007
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