Trazodone vs. Ambien: Differences, similarities, and which one is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

According to the American Sleep Association, insomnia is a common condition, affecting between 50 to 70 million people in the United States.

Trazodone and Ambien are two medications that are approved by the U.S. Food and Drug Administration (FDA). Both medicines are used to help people sleep. Trazodone is indicated for the treatment of depression, but is used off-label for insomnia. Trazodone causes a sedative effect of sleepiness and drowsiness, which is why many doctors prescribe it as a sleep aid for sleep problems.

Ambien is classified as a sedative-hypnotic and is thought to work by slowing down brain activity. Ambien helps you fall asleep. Ambien CR, an extended-release formulation, releases over time to help you fall asleep and stay asleep. 

Although both medications are used for sleep, they have many differences. Continue reading to learn about trazodone and Ambien.

What are the main differences between trazodone and Ambien?

Trazodone is classified as an antidepressant. It is also known as an atypical antidepressant and serotonin modulator. Trazodone is a generic medication. The brand name of trazodone is Desyrel. However, Desyrel is no longer commercially available. 

Ambien is classified as a sedative-hypnotic medication. It is a controlled substance. This means it is habit-forming and has the potential for abuse or dependence. It is available in both brand and generic form. Generally, women start at a lower dose of 5 mg. Men can start at 5 mg or a higher dose of 10 mg. Ambien should be taken immediately before bedtime.

Ambien is also available in an extended-release formulation, called Ambien CR. The generic name for Ambien is zolpidem. Ambien is indicated for short-term use; however, some people take Ambien for a more extended time under close supervision of the doctor.

Main differences between trazodone and Ambien
	Trazodone	Ambien
Drug class	Antidepressant (atypical antidepressant, serotonin modulator)	Sedative-hypnotic (also called benzodiazepine receptor agonist)
Brand/generic status	Generic	Brand and generic
What is the generic name? What is the brand name?	Brand: Desyrel	Generic: zolpidem
What form(s) does the drug come in?	Tablet	Ambien: tablet Ambien CR: tablet
What is the standard dosage?	For depression: The starting dose is 150 mg by mouth daily in divided doses. May increase by 50 mg per day every 3 to 4 days to a maximum of 400 mg per day in divided doses. Off-label for insomnia: The dose is usually 50 to 100 mg by mouth at bedtime.	Starting dose is 5 mg by mouth at bedtime for women, and 5 or 10 mg by mouth at bedtime for men. The medication should only be taken once at nighttime (it should not be taken again during the night), immediately before bed, with at least 7 to 8 hours to sleep. The maximum dosage is 10 mg at bedtime.
How long is the typical treatment?	Varies	Short-term, varies
Who typically uses the medication?	Adults	Adults

Conditions treated by trazodone and Ambien

Trazodone is indicated to treat major depressive disorder (depression) in adults. It is also used off-label for insomnia treatment. 

Ambien is used to treat insomnia on a short-term basis. However, some people take Ambien for a longer time, under the close supervision of their doctor. Ambien CR is an extended-release formulation, and it is designed to release over time to help people fall and/or stay asleep.

Condition	Trazodone	Ambien
Treatment of major depressive disorder in adults	Yes	No
Short-term treatment of insomnia	Off-label	Yes (Ambien)
Insomnia with difficulty falling and/or staying asleep	Off-label	Yes (Ambien CR)

Is trazodone or Ambien more effective?

One study looked at trazodone vs Ambien for insomnia. Both drugs were tolerated well with few side effects. Both trazodone and Ambien helped people in the study sleep better during the first week, but only Ambien helped people sleep better the second week. The study found Ambien to be more effective than trazodone. 

The American Academy of Sleep Medicine Clinical guidelines recommend the following:

Trazodone: “We suggest that clinicians not use trazodone as a treatment for sleep onset or sleep maintenance insomnia (versus no treatment) in adults.”

Ambien: “We suggest that clinicians use zolpidem as a treatment for sleep onset and sleep maintenance insomnia (versus no treatment) in adults.”

However, both recommendations are categorized as weak, which the American Academy of Sleep Medicine defines as a low level of certainty or appropriateness.

Therefore, because everyone is different, the most effective medication for a patient should only be determined by a doctor, who can consider the patient’s medical condition(s), history (including history of drug or alcohol abuse) and other medications they are taking that could interact with trazodone or Ambien. 

You can also talk to your healthcare provider about other recommendations to help with sleep problems, including counseling and sleep hygiene.

Coverage and cost comparison of trazodone vs. Ambien

Most insurance and Medicare prescription plans cover trazodone. A typical prescription for 30, 100 mg tablets of trazodone would cost about $80 out-of-pocket, but if you use a free SingleCare card, you could pay as little as $4. 

Most insurance and Medicare prescription plans cover generic Ambien, but they do not cover the brand-name product, or if they do, they charge a much higher copay. A typical prescription for 30, 10 mg tablets of generic Ambien costs about $55 if you pay out-of-pocket, but SingleCare coupon can lower the price to approximately $12.

As plans vary and are subject to change, contact your insurance provider for the most up-to-date insurance coverage information.

	Trazodone	Ambien
Typically covered by insurance?	Yes	Yes (generic)
Typically covered by Medicare Part D?	Yes	Yes (generic)
Quantity	30, 100 mg tablets	30, 10 mg tablets
Typical Medicare copay	$0-$20	$0-$20
SingleCare cost	$4+	$12+

Common side effects of trazodone vs. Ambien

The most common side effects of trazodone include blurred vision, dry mouth, dizziness/lightheadedness, drowsiness, and headache.

In short-term clinical trials, the most common side effects of Ambien included drowsiness, dizziness, and diarrhea. In people who took Ambien for 28 to 35 nights, the most common side effects were dizziness and a drugged feeling.

This is not a complete list of side effects. Other adverse effects may occur. Talk with your healthcare professional about what side effects to expect and how to address them. 

	Trazodone		Ambien
Side effect	Applicable?	Frequency*	Applicable?	Frequency
Blurred or abnormal vision	Yes	6-15%	Yes	>1%
Constipation	Yes	7-8%	Yes	2%
Dry mouth	Yes	15-34%	Yes	3%
High blood pressure	Yes	1-20%	Yes	<1%
Low blood pressure	Yes	4-7%	Yes	<0.1%
Confusion	Yes	5-6%	Yes	>1%
Dizziness/lightheadedness	Yes	20-28%	Yes	1-5%
Drowsiness	Yes	24-41%	Yes	2-8%
Fatigue	Yes	6-11%	Yes	<1%
Headache	Yes	10-20%	Yes	7%
Nervousness	Yes	6-15%	Yes	<1%
Nausea/vomiting	Yes	10-13%	Yes	>1%
Diarrhea	Yes	0-5%	Yes	3%
Drugged feeling	No	–	Yes	3%

*trazodone data includes inpatient and outpatient groups

Source: DailyMed (trazodone), DailyMed (Ambien)

Drug interactions of trazodone vs. Ambien

Trazodone should not be used within 14 days of an MAOI antidepressant. Trazodone should not be taken in combination with other drugs that increase serotonin due to the risk of serotonin syndrome. These drugs include other antidepressants, lithium, triptans, St. John’s Wort, opioids, dextromethorphan, and muscle relaxants. Do not take Ambien with other medicines that cause central nervous system (CNS) depression or other drugs that prolong the QT interval.

Because of its CNS depressant effects, do not take Ambien with other drugs with the same effect, such as opioids, benzodiazepines, antidepressants, or 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.

Avoid alcohol if you take trazodone or Ambien. 

This is not a full list of drug interactions. Other, serious side effects may occur. See the Warnings section for more information. Consult your doctor for a full list of drug interactions.

Drug	Drug class	Trazodone	Ambien
Alcohol	Alcohol	Yes	Yes
Phenelzine  Selegiline  Tranylcypromine	MAOIs (monoamine oxidase inhibitors)	Yes	Yes
Rifampin	CYP3A4 inducer	Yes	Yes
Lithium	Bipolar disorder agent	Yes	No
Digoxin	Cardiac glycoside	Yes	No
Clopidogrel	Antiplatelet agent	Yes	No
Warfarin	Anticoagulant	Yes	No
Amiodarone  Chlorpromazine Disopyramide  Procainamide  Quinidine  Sotalol  Thioridazine  Ziprasidone	Drugs that prolong the QT interval	Yes	Some (chlorpromazine, thioridazine, ziprasidone)
Itraconazole Ketoconazole	CYP3A4 inhibitor	Yes	Yes
St. John’s Wort	Supplement	Yes	Yes
Alprazolam Clonazepam  Diazepam  Lorazepam	Benzodiazepines	Yes	Yes
Codeine Fentanyl Hydrocodone Hydromorphone Methadone Morphine Oxycodone   Tramadol	Opioids	Yes	Yes
Clarithromycin  Erythromycin	Macrolide antibiotics	Yes	Yes (clarithromycin)
Citalopram  Escitalopram  Fluoxetine  Fluvoxamine  Paroxetine  Sertraline	SSRI antidepressants	Yes	Yes
Desvenlafaxine  Duloxetine  Venlafaxine	SNRI antidepressants	Yes	Yes
Amitriptyline  Desipramine  Imipramine </span Nortriptyline	Tricyclic antidepressants	Yes	Yes
Baclofen  Carisoprodol  Cyclobenzaprine  Metaxalone	Muscle relaxants	Yes	Yes
Carbamazepine Divalproex sodium Gabapentin Lamotrigine Levetiracetam Phenobarbital Phenytoin Pregabalin Topiramate	Anticonvulsants	Yes	Yes
Diphenhydramine	Sedating antihistamine	Yes	Yes

Warnings of trazodone and Ambien

Before taking trazodone or Ambien, talk to your doctor about all of the medical conditions you have and all of the medications you take, including prescription drugs, over-the-counter (OTC) medications, and vitamins or supplements. When you fill or refill your trazodone or Ambien prescription, you will receive a Medication Guide that discusses warnings, side effects, and other important information. Read the Medication Guide every time you fill your prescription.

Trazodone

Trazodone has a black box warning, or boxed warning, which is the most serious warning required by the FDA. All antidepressants, including trazodone, can increase the risk for suicidal thoughts and behavior. The risk is higher in children, adolescents, and young adults. Anyone who takes trazodone should be closely monitored for mood changes and suicidal thoughts and behavior. Trazodone is not approved for use in children. 

Other trazodone warnings:

• Do not use an MAOI (monoamine oxidase inhibitor) drug within 14 days of using trazodone. 
• There is an increased risk of serotonin syndrome when trazodone is taken with other drugs that increase serotonin. These drugs include other antidepressants, triptans, opioid pain relievers, muscle relaxants, dextromethorphan (found in prescription and OTC cough and cold medications), tryptophan, and St. John’s Wort. 
• Using aspirins, NSAIDs, antiplatelet drugs, or warfarin can increase the risk of bleeding. 
• Trazodone increases the QT interval. Do not take trazodone if you take other drugs that increase the QT interval or if you have risk factors for prolonged QT interval. 
• Low blood pressure and fainting may occur, especially when going from a sitting or lying position to standing up. 
• Priapism may occur. Priapism is a painful and prolonged erection. Seek immediate medical attention if this happens.
• Before using trazodone, patients should be screened for bipolar disorder (including family history). 
• Trazodone can impair judgment, thinking, and motor skills. Do not drive or operate machinery until you know how trazodone affects you.
• Do not drink alcohol while taking trazodone.
• Trazodone can cause withdrawal symptoms if you stop taking it too quickly. Do not stop taking trazodone unless your doctor instructs you to do so and provides you with a tapering schedule. 
• Use caution in patients with angle-closure glaucoma.

Ambien

Ambien also has a boxed warning. Ambien may cause complex sleep behaviors. These behaviors include sleep-walking, sleep-driving, cooking, eating, having sex, or other activities performed while not fully awake after using Ambien. Some of these events can be dangerous and result in death. If you experience a complex sleep behavior, stop taking Ambien and consult your doctor. Ambien is not approved for use in children. 

Other Ambien warnings:

• Ambien is a central nervous system depressant (CNS depressant). Do not take Ambien with other CNS depressants such as alcohol, benzodiazepines (like Valium or Xanax), or opioids.
• Take Ambien when you have at least seven or eight hours to sleep. Take Ambien immediately before bedtime. For example, if you take a shower and brush your teeth before bed, take Ambien after you do these things, just before bedtime. Ambien can cause impairment on the next day as well. Symptoms can include drowsiness, prolonged reaction time, dizziness, vision disturbances, reduced alertness, and impaired driving. Do not drive (or perform other activities that require mental alertness) the next day unless you have slept at least seven or eight hours after taking Ambien and are alert. 
• Ambien can cause drowsiness and a decreased level of consciousness. People who take Ambien, especially older adults, have an increased risk of falls.
• If insomnia does not improve after seven to 10 days of treatment, another illness may be causing insomnia. Insomnia treatment should start only after careful examination of the patient.
• Severe allergic reactions are rare. If you take Ambien and have nausea, vomiting, throat closing, shortness of breath, or swelling of the tongue or throat, seek emergency medical treatment. 
• Ambien may cause abnormal thinking and behavior changes, including low inhibition, aggressiveness, agitation, and hallucinations. 
• In people who have depression, taking Ambien can lead to worsened depression and suicidal thoughts and behavior. The lowest dose for the shortest amount of time should be prescribed. 
• Use caution prescribing Ambien in people with breathing problems such as sleep apnea or myasthenia gravis.
• Avoid Ambien in people with severe liver problems.
• Withdrawal symptoms may occur when Ambien is stopped abruptly. If you want to stop taking Ambien, consult your healthcare provider for guidance and a tapering schedule. 
• With Ambien CR, swallow whole. Do not chew, crush, or break tablets.

Frequently asked questions about trazodone vs. Ambien

What is trazodone?

Trazodone is an antidepressant drug that treats major depressive disorder in adults. It is also used off-label to treat insomnia in adults.

What is Ambien?

Ambien is a sedative-hypnotic medication that treats insomnia. It is a controlled substance due to the potential for abuse or dependence.

Are trazodone and Ambien the same?

Trazodone and Ambien are commonly used to treat insomnia. Trazdone is approved to treat depression, but is used off-label for insomnia. Ambien is indicated for insomnia treatment. However, the two drugs are not the same. They are in different drug categories and have other differences, as described above.

Is trazodone or Ambien better?

Studies suggest that Ambien may be more effective than trazodone. However, Ambien is a controlled substance and has the potential for abuse and dependence. Your doctor can look at your medical history and other factors to determine if one of these drugs is appropriate for you.

Can I use trazodone or Ambien while pregnant?

If you are pregnant, planning to become pregnant, or breastfeeding, consult your healthcare provider for medical advice. 

Using trazodone late in pregnancy may cause withdrawal symptoms in the baby, including breathing problems, jitteriness, and difficulty feeding. Using Ambien in late pregnancy can cause similar symptoms. Ambien can also cause respiratory depression and sedation in newborns.

Can I use trazodone or Ambien with alcohol?

Trazodone should not be combined with alcohol. Trazodone may worsen the effects of alcohol, such as dizziness, sedation, and motor impairment. The combination can also cause respiratory depression (slowed breathing which could lead to a coma or death) and increase the risk for trazodone overdose.

Ambien and alcohol should not be combined. The combination can cause excess sedation and motor impairment, as well as respiratory depression. Also, if you have a history of drug or alcohol abuse, Ambien may not be appropriate for you because of its potential for abuse and dependence.