If you or a loved one experience insomnia or anxiety, you are not alone. The National Institutes of Health estimates that about 30% of the U.S. population struggles with sleep problems; other estimates are much higher. Anxiety disorders affect 40 million American adults every year. Two popular prescription drugs for these conditions are Ambien (for insomnia) and Xanax (for anxiety/panic attacks).
Ambien (zolpidem) is a sedative-hypnotic drug (sleep aid), which works on receptors in the brain, helping you to fall asleep. Some people refer to these types of medications as “sleeping pills.” Ambien slows brain activity, allowing you to fall asleep more quickly. Ambien CR is an extended-release tablet with two layers—one to help you fall asleep, and another to help you stay asleep.
Xanax (alprazolam) is in the benzodiazepine class of drugs, and works in the central nervous system (CNS). Benzodiazepines work by increasing activity at receptors for gamma-aminobutyric acid (GABA), a neurotransmitter. By doing this, benzodiazepines produce a relaxing and calming effect. A dose of Xanax starts working within about one hour, and the effects last for about five hours (the extended-release tablet lasts up to about 11 hours).
Because of the potential for abuse and/or psychological or physical dependence, both Ambien and Xanax are controlled substances and are classified as Schedule IV drugs.
What are the main differences between Ambien and Xanax?
Ambien (What is Ambien?) is categorized as a sedative-hypnotic. The generic name of Ambien is zolpidem, or zolpidem tartrate. It is available in tablet form as an immediate-release or extended-release tablet. Ambien should be taken immediately before bedtime, just before getting into bed, when you have at least seven to eight hours to sleep. Food can decrease the absorption of Ambien, so it’s best taken on an empty stomach. The recommended starting dose for women is 5 mg at bedtime, and the recommended starting dose for men is 5 or 10 mg at bedtime. Patients who are elderly or have mild to moderate liver problems should start with the 5 mg dose as well. (Patients with severe liver problems should not take Ambien.)
Xanax (What is Xanax?) is a benzodiazepine available in both brand and generic form. The generic name of Xanax is alprazolam. It is available in tablet form (immediate-release or extended-release) and as an oral concentrate.
|Main differences between Ambien and Xanax|
|Brand/generic status||Brand and generic||Brand and generic|
|What is the generic name?||Zolpidem||Alprazolam|
|What form(s) does the drug come in?||Immediate-release tablet (Ambien), extended-release tablet (Ambien CR)||Immediate-release tablet (Xanax), extended-release tablet (Xanax XR), oral concentrate|
|What is the standard dosage?||Example: 5 to 10 mg taken just before bedtime as needed for sleep||Example: 0.5 mg taken 3 times daily as needed for anxiety; dosage varies|
|How long is the typical treatment?||4-5 weeks (as studied in clinical trials); some patients use for longer under prescriber’s supervision||Short-term use; some patients take for long-term use under prescriber’s supervision|
|Who typically uses the medication?||Adults||Adults|
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Conditions treated by Ambien vs. Xanax
Ambien is indicated for the treatment of insomnia, with difficulty initiating sleep. It should be used for short-term treatment. (Ambien CR is used in patients who have trouble falling asleep and staying asleep.)
Xanax is indicated for the short-term relief of the symptoms of anxiety, and short-term relief of anxiety associated with depressive symptoms. Xanax is also indicated for the treatment of panic disorder, with or without agoraphobia. (Xanax XR is indicated for panic disorder with or without agoraphobia, as well.)
|Short-term treatment of insomnia characterized by difficulties with sleep initiation||Yes||Off-label|
|Management of anxiety disorders||No||Yes|
|Short-term relief of the symptoms of anxiety||No||Yes|
|Short-term relief of anxiety associated with depressive symptoms||No||Yes|
|Panic disorder with or without agoraphobia||No||Yes|
Is Ambien or Xanax more effective?
There are no studies comparing Ambien to Xanax because they are different drugs used for different indications. If you have sleep problems, where you have trouble falling and/or staying asleep, Ambien may be an appropriate medication for you. If you are experiencing anxiety or panic disorder, Xanax may be the right drug for you. The best drug for you can only be determined by your healthcare provider, who can take into account your symptoms, medical condition(s) and history, and any medications you take that could potentially interact with Ambien or Xanax.
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Coverage and cost comparison of Ambien vs. Xanax
Ambien is usually covered by private insurance and Medicare Part D in its generic form of zolpidem. The brand-name product may not be covered or may have a much higher copay. A common prescription is for 30 tablets of 10 mg zolpidem and would cost about $60-$100 out of pocket. A SingleCare card can lower the price of generic Ambien to about $10.
Xanax is typically covered by private insurance and Medicare Part D in the generic form of alprazolam. The brand-name Xanax may not be covered or may have a high copay. A typical prescription of alprazolam would be for 60 tablets of 0.5 mg and cost about $33 out-of-pocket. Using a SingleCare card for generic Xanax can bring the price down to as little as $10.
|Typically covered by insurance?||Yes (generic)||Yes (generic)|
|Typically covered by Medicare Part D?||Yes (generic)||Yes (generic)|
#30 tablets of 10 mg generic zolpidem
#60 tablets of 0.5 mg generic alprazolam
|Typical Medicare copay||$0-$2 (generic)||$0-$33 (generic)|
Common side effects of Ambien vs. Xanax
The most common side effects of Ambien are drowsiness, dizziness, headache, and diarrhea. Other side effects may occur, such as palpitations, a drugged feeling, lightheadedness, abnormal dreams, and sinusitis.
Side effects of Xanax usually increase with higher doses. The most common side effects of Xanax are sedation, dizziness, and weakness. Other side effects may include fatigue, lightheadedness, memory problems/memory loss, confusion, depression, euphoria, suicidal thoughts/attempt, incoordination, lack of energy, dry mouth, convulsions/seizures, vertigo, visual problems, slurred speech, sexual problems, headache, coma, respiratory depression, weight gain or weight loss, worsening of sleep apnea or obstructive pulmonary disease, and gastrointestinal symptoms including nausea, constipation, or diarrhea.
Other, serious side effects may occur. Consult your healthcare professional for a complete list of side effects.
|Ejaculation disorder/sexual problems||No||–||Yes||7.4%|
|Weakness||Yes||Reported as rare||Yes||6-7%|
Drug interactions of Ambien vs. Xanax
Because of its CNS depressant effects, Ambien should not be taken with other drugs that have the same effect, such as opioids, benzodiazepines, antidepressants, and alcohol, due to additive effects. Ambien should not be taken with rifampin, because rifampin can decrease Ambien levels. Ambien should not be taken with ketoconazole (or the Ambien dose should be lowered), because ketoconazole can increase Ambien levels.
Xanax should not be taken in combination with opioid painkillers, due to increased risk of sedation, respiratory depression, and overdose, possibly leading to death. If no other combination is possible, the patient should receive each medication at the lowest possible dose and for the shortest duration, and be closely monitored. Benzodiazepines also should not be taken with other CNS depressants such as alcohol, antipsychotics, antidepressants, sedating antihistamines, and anticonvulsants.
Alcohol should not be used with Ambien or Xanax.
Other drug interactions may occur. Consult your healthcare provider for a full list of drug interactions.
|St. John’s Wort||Supplement||Yes||Yes|
|Macrolide antibiotics||Yes (clarithromycin)||Yes|
Warnings of Ambien and Xanax
- Ambien has a boxed warning, which is the strongest warning required by the FDA. Complex sleep behaviors have been reported with Ambien use. These may include sleep-walking, sleep-driving, and engaging in other activities (such as cooking, making phone calls, having sex) while not fully awake. Some of these actions could result in serious injury or death. Ambien should be discontinued immediately if this behavior occurs.
- Due to CNS depressant effects, Ambien has additive effects with other CNS depressants (see drug interaction section). The combination should be avoided, or the dosage of either or both medication(s) may be adjusted if the combination cannot be avoided. Your healthcare provider can determine the best course of action in this scenario. Ambien should especially not be used with other CNS depressants at bedtime or in the middle of the night.
- Ambien should be taken immediately before bed, just before getting into bed, when you have time to sleep for at least seven to eight hours, due to the risk of next-day psychomotor impairment (including impaired driving). The risk of impairment is increased if Ambien is taken with less than 7-8 hours of sleep remaining; if a higher than recommended dose is taken; or if Ambien is taken with other CNS depressants, alcohol, or other drugs that increase Ambien levels.
- A full night of sleep (seven to eight hours) is recommended due to the risk of drowsiness, prolonged reaction time, dizziness, sleepiness, blurred or double vision, reduced alertness, and impaired driving the morning after taking Ambien. Ambien can also put patients, especially elderly patients, at higher risk of falls.
- Sleep problems can be a sign of another disorder, so the patient should be evaluated.
- Rare but serious cases of anaphylaxis have been reported, requiring emergency medical attention. Swelling of the tongue, throat, glottis, or larynx (angioedema) can be dangerous or fatal. If angioedema occurs, seek emergency medical attention, stop Ambien, and do not take it again.
- Abnormal thinking and changes in behavior have been reported in patients taking Ambien, including hallucinations. Any changes in behavior should be immediately evaluated.
- Patients who are depressed and take Ambien should be monitored for worsening of depression and suicidal thoughts and actions. Patients and caregivers should be aware of this possibility, and immediate medical treatment should be sought in the case of suicidal thoughts or action. Because of the risk of intentional overdose, the lowest number of tablets should be prescribed.
- Because of the potential for respiratory depression, Ambien should be used with caution in patients with breathing problems such as sleep apnea.
- Ambien should not be used in patients with severe liver problems.
- Patients who take Ambien should be monitored for tolerance, abuse, and dependence. Withdrawal symptoms may occur following abrupt discontinuation of Ambien.
- Ambien CR tablets are designed to release over time and should be swallowed whole. Ambien CR tablets should not be chewed, crushed, dissolved, or broken.
- Xanax also has an FDA boxed warning. Xanax should not be taken in combination with opioid pain relievers because of an increased risk of extreme sedation, severe respiratory depression, coma, or death. If the combination of a benzodiazepine and opioid cannot be avoided, the patient should be prescribed the lowest dose for the shortest period of time and must be closely monitored. Patients should not drive or operate machinery until effects are known.
- Xanax may cause dependence—the risk increases with higher doses, longer duration of use, and/or a history of drug or alcohol abuse. If you take Xanax, take the medication only as prescribed, and do not take additional doses.
- Keep Xanax out of the reach of children and others. Keep under lock and key if possible.
- Xanax should be used as a short-term treatment. When discontinuing Xanax, it should be slowly tapered to avoid withdrawal symptoms. Patients with seizure disorders are at higher risk for withdrawal symptoms. Your prescriber can provide you with a tapering schedule.
- There is a risk of suicide in patients with depression. Patients with depression should also be treated with an antidepressant and should be closely monitored.
- Xanax should be used with caution in patients with breathing problems such as COPD or sleep apnea.
- Use Xanax with caution and/or use lower doses in patients with severe liver problems.
- Xanax should not be used in pregnancy because of the risk to the fetus. If you are taking Xanax and find out that you are pregnant, consult your doctor immediately.
Both Ambien and Xanax are on the Beers’ List (drugs that may be inappropriate in older adults). There is an increased risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in older adults when Ambien or Xanax is used.
Frequently asked questions about Ambien vs. Xanax
What is Ambien?
Ambien is a sedative-hypnotic medication. It is also known by its generic name of zolpidem. It is used as a short-term treatment for sleep. It is approved by the FDA and because of its abuse potential, it is a controlled substance.
What is Xanax?
Xanax, also known by its generic name, alprazolam, is a benzodiazepine drug used to treat anxiety and panic disorder. Other drugs in the benzodiazepine category of medications that you may have heard of include Valium (diazepam), Ativan (lorazepam), Dalmane (flurazepam), Restoril (temazepam), Klonopin (clonazepam), and Halcion (triazolam). All of these drugs are approved by the FDA and are controlled substances like Xanax.
Are Ambien and Xanax the same?
No. While people may mention these drugs in the same sentence, they are quite different. They are in different categories of medication and have different dosing, indications, and side effects. Ambien is prescribed for the treatment of insomnia, and Xanax is used for anxiety or panic disorder.
Is Ambien or Xanax better?
Studies do not directly compare the two drugs, because they are different categories of medication used for different indications. Ambien is a drug that is used to help with sleep, while Xanax is for anxiety and/or panic. Ask your healthcare provider if Ambien or Xanax is appropriate for you.
Can I use Ambien or Xanax while pregnant?
No. Ambien taken during the third trimester can cause respiratory depression and sedation in the neonate. Xanax may cause fetal abnormalities and should not be used during pregnancy.
If you are already taking Ambien or Xanax, and find out that you are pregnant, contact your healthcare provider for guidance.
Can I use Ambien or Xanax with alcohol?
No. Combining either Ambien or Xanax with alcohol is dangerous and can cause psychomotor impairment, respiratory depression, extreme sedation, coma, or even death.
What is stronger than Ambien for sleep?
Ambien is one of the most commonly prescribed sleep medications, and it is similar to several other prescription sleep medications such as Lunesta (eszopiclone) and Sonata (zaleplon). If Ambien is not working for you, consult your healthcare provider for medical advice. Many patients do well, instead, with an OTC (over-the-counter) dietary supplement called melatonin. Melatonin helps regulate the sleep cycle, is available without a prescription, and because it is not a controlled substance, it does not have the potential for abuse or dependence.
What drugs should not be taken with Ambien?
You should not drink alcohol while taking Ambien. Other drugs that cause CNS depression also interact with Ambien. See the above table of drug interactions. Ambien has many drug interactions, and there are too many to list them all. Consult your healthcare provider for a full list of drug interactions.
Can I take Ambien every night?
Ambien should be taken immediately before bedtime, just before getting into bed, when you have at least seven to eight hours to sleep. In clinical trials, Ambien was studied for up to four to five weeks. If you need to take it for longer than four to five weeks, consult your healthcare provider. Many patients do take Ambien for longer periods, but you should be closely monitored by your prescriber.