Dr. Ahmed
Switching from Ambien to Lunesta is reasonably straightforward. However, before making the switch, it’s important to consider a few key factors.
Here are some questions to help guide your transition:
- Why am I switching from Ambien to Lunesta?
- What dose should I start with?
- Should I expect any side effects that may be more common with Lunesta?
- Am I taking any other medications that may interact with Lunesta? Should I be concerned?
- Should I anticipate any withdrawal symptoms when switching to Lunesta?
Some key differences and similarities between Ambien and Lunesta:
Before we dive into answering your queries and help you switch from one sleep medicine to another, let’s first know the subtle similarities and differences between Ambien and Lunesta:
Drug Names:
- Ambien: Zolpidem Tartrate
- Ambien CR: Zolpidem Tartrate extended-release tablets
- Lunesta: Eszopiclone
Strengths available:
- Ambien:
- 5 mg and 10 mg
- Ambien CR:
- 6.25 mg and 12.5 mg
- Lunesta:
- 1 mg
- 2 mg
- 3 mg
Parameters | Ambien | Ambien CR | Lunesta |
Starting Dose | 5 mg | 6.25 mg | 1 mg |
Maximum Dose | 10 mg | 12.5 mg | 3 mg |
Onset of action | Within 30 minutes | About 30 minutes | 1 hour |
Duration of action | 6 hours | 10 hours | 8 hours |
FDA-approved indications:
Ambien: Indicated for the short-term treatment of insomnia of up to 5 weeks
Ambien CR: Indicated for treating insomnia in adults for up to 24 weeks and for 3 weeks in the elderly.
Lunesta: Indicated for the treatment of Insomnia in adults and elderly for up to 6 months (24 weeks)
In addition, Ambien is highly protein-bound (90%) and may interact with drugs that are protein-bound.
On the other hand, Lunesta and Sonata are only moderately bound to plasma proteins (50 – 60%) and hence drug interactions are relatively less compared to Ambien.
Why Am I Switching From Ambien To Lunesta?
There are only a few instances where people would switch from one to another sleeping pill:
Lack of efficacy:
When talking about switching from Ambien to Lunesta, the most common reason is the lack of efficacy of Ambien.
It is not unusual that one sleeping pill might not work for you and you would like to try another.
In addition, Lunesta is unlikely to provide the desired results if Ambien has proven ineffective for you. However, it may increase your total sleep time by an hour or two.
If lack of efficacy is the reason you are switching from Ambien to Lunesta, it’s important to be aware that direct clinical trials comparing the efficacy of Ambien and Lunesta are not available.
Additionally, both drugs are recognized as effective treatments for insomnia. Before making the switch from Ambien to Lunesta, you might want to explore these alternative options:
Consider increasing the dose:
If you’re currently on a low dose of Ambien (5 mg), consider increasing it to 10 mg under the guidance of your healthcare provider.
Consider switching from Ambien to Ambien CR:
If you find that you wake up early and your total sleep time is less than 6 hours while taking Ambien, switching to Ambien CR (Controlled Release) could be an option to explore.
Take Ambien on an empty stomach:
Avoid taking Ambien with food, as this practice may delay the onset of sleep and potentially affect the absorption of the medication.
Have you developed tolerance to Ambien?
If Ambien worked for you but you have developed tolerance to it, one approach is to discontinue Ambien for a few days and then resume it.
During this interim period, you can consider taking melatonin, Remeron, or other over-the-counter (OTC) supplements like magnesium.
Frequent awakenings during the night:
If Ambien or Lunesta helps you go to sleep but you wake up frequently at night, you may take an ultrashort-acting drug such as Sonata (Zaleplon) to facilitate sleep, using it 2 or 3 times during the night, as needed, depending on how often you wake up in the middle of the night.
These alternative approaches may help improve the efficacy of Ambien before considering a switch to Lunesta.
If these approaches fail, you may try Lunesta.
Switching from Ambien to Lunesta because of Side Effects?
Most side effects associated with Ambien, such as nausea, dizziness, drowsiness, headache, dry mouth, and complex sleep-related side effects like hallucinations and anxiety, are also common with Lunesta.
Since Lunesta is longer-acting, some side effects may be more common with Lunesta compared to Ambien.
Therefore, when transitioning from Ambien to Lunesta, you might experience next-day drowsiness, increased somnolence, and a metallic taste more frequently than when using Ambien.
For some individuals, this metallic taste can be so bothersome that they opt to discontinue Lunesta, as it may linger throughout the day.
Switching from Ambien to Lunesta because of Other Reasons?
Additional reasons for switching from one medication to another may include factors such as limited availability, medical professionals’ preferences, and concerns related to the cost of the medication.
You should discuss each issue with your healthcare provider, including your financial situation and insurance coverage, and ask for a patient assistance program, explore generic medications, and research discount programs.
What Dose Should I Start With When Switching From Ambien To Lunesta?
This depends on what dose of Ambien you are currently taking. When switching from Ambien to Lunesta or from Lunesta to Ambien, you may experience the following symptoms during the first few days:
- Withdrawal symptoms, especially when switching from a higher dose of Ambien to a lower dose of Lunesta.
- More side effects, especially when switching from a lower dose of Ambien to a higher dose of Lunesta.
- Changes in sleep time, onset, and duration of sleep
- Unrelated side effects are probably caused by drug interactions.
How to minimize withdrawal symptoms when switching from Ambien to Lunesta?
Some people can experience strong withdrawal symptoms, like severe insomnia, when they suddenly stop taking Ambien.
If your insomnia isn’t too severe, you can lower your Ambien dose for a few days before stopping it completely. Then, you can begin taking Lunesta on the day you stop Ambien.
For those dealing with severe insomnia who cannot easily stop Ambien, a good approach is to reduce Ambien to half its usual dose while starting Lunesta at a low dose simultaneously. After a few days, you can increase the Lunesta dose and stop taking Ambien.
However, most people can switch directly from Ambien to Lunesta without experiencing any withdrawal effects.
To switch directly from Ambien to Lunesta, here is a general guideline comparing the equivalent dosages of different sleeping pills [Ref]:
Parameters | Low Dose | Moderate Dose | High Dose |
| Ambien | 5 mg or less | >5 mg to 10 mg | 10 mg |
| Lunesta | 1 mg | 2 mg | 3 mg |
| Belsomra | <10 mg | 10 mg to 15 mg | 15 gm |
| Dayvigo | 5 mg or less | 5 mg to 10 mg | 10 mg |
| Quviviq | < 10 mg | 10 mg to 25 mg | 25 mg |
The above table demonstrates the comparable doses based on the efficacies of these commonly used sleeping pills.
For example, 5 mg of Ambien is equivalent to 1 mg of Lunesta. Both are considered low doses.
Similarly, 10 mg of Ambien is equivalent to 3 mg of Lunesta. Both doses are considered high doses.
Equivalent doses of other novel sleep medications are also mentioned in the table. This will help people who would like to switch to another class of medicines.
In summary:
Switching from Ambien to Lunesta may be straightforward for most people. However, some might develop side effects or withdrawal symptoms.
Such patients must consult their healthcare provider and follow the guidelines mentioned in the post above.
Nevertheless, if all else proves ineffective, you may have to transition to a different class of medications, such as Trazodone, Mirtazapine, Remeron, Benzos (Xanax, Rivotril), Busron (Buspirone), or the Orexin inhibitors (Belsomra, Dayvigo, and Quiviq).
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