Insomnia is a common sleep disorder. It is defined as continuous difficulty in going to or maintaining sleep, or a report of inadequate sleep, leaving you tired or sleepy during the daytime.1
To help manage insomnia or other sleep-related disorders, healthcare providers may prescribe Quviviq (daridorexant) or Ambien (zolpidem).
Quviviq and Ambien belong to two different classes of medications with varying mechanisms of action. Quviviq contains the active ingredient daridorexant, classified as a dual orexin receptor antagonist (DORAs). Ambien includes the active ingredient zolpidem, a non-benzodiazepine hypnotic agent.23
These drugs differ in categorization, dosing regimens, specific uses, and potential side effects. Their only significant similarity is that they both treat insomnia.45
To help you make an informed decision about which drug may be suitable for you or a loved one, this article will highlight the specific features of each drug, including indications, dosing regimens, storage requirements, and more.
How They Work: Quviviq vs. Ambien
Insomnia is a significant public health problem with high prevalence and management challenges. According to various population-based studies, approximately 30% of adults from different countries report one or more insomnia symptoms.6
The following outlines how each drug works to help with sleep onset or staying asleep through the night.
Both Quviviq and Ambien are orally administered (taken by mouth) medications.45
Quviviq contains the novel drug daridorexant, a DORA product.
Daridorexant works on orexin receptors OX1R and OX2R to block orexins from binding, which are wake-promoting neuropeptides (natural substances in the brain that enable wakefulness) and endogenous ligands (molecules derived from host tissues or cells) to OX1R and OX2R receptors.7
Quviviq attaches to orexin binding sites to block the binding of orexin neuropeptides.4 As a result of this action, orexin can no longer signal the brain to stay awake, allowing you to fall asleep.
Quviviq, which came on the U.S. market in May 2022, is only available in brand-name form, meaning no generic version exists.4
Ambien and another version, Ambien CR, contain the same active ingredient, zolpidem. Zolpidem, as a non-benzodiazepine hypnotic agent, works like that of a gamma-aminobutyric acid (GABA) agonist.38
GABA is an inhibitory neurotransmitter that helps the body and mind relax, fall asleep, and increase sleep continuity. Low GABA activity is linked to insomnia and disrupted sleep.9 Zolpidem increases the amounts of GABA, which helps you fall asleep.10
Like Quviviq, Ambien is only available as a brand-name drug with no generic equivalent.11
Unlike Quviviq, however, Ambien is primarily prescribed to help with sleep onset only since it has a shorter duration of action.8
Efficacy: Quviviq vs. Ambien
Quviviq and Ambien are both effective at treating problems associated with insomnia.45
Head-to-head clinical studies are yet to be performed comparing the effectiveness of these drugs. But both drugs are more effective than the placebo, according to the results of clinical trials.23
Quviviq has proven effective at managing the symptoms of sleep problems.12 Specifically, it has exhibited promising results in animal and human studies. Quviviq is considered safe, with no clinically significant side effects, including the absence of next-morning residual effects.13
In comparison, Ambien is a short-acting, non-benzodiazepine hypnotic and is one of the most-used supplemental treatments.14
Administration: Quviviq vs. Ambien
Quviviq and Ambien are available in different dosage forms and dosage regimens.
Despite the following guidelines, both these drugs should be taken only as prescribed by your healthcare provider.
Quviviq oral tablets are available in 25 mg and 50 mg strengths. The recommended dosage range of Quviviq is 25 mg to 50 mg once per night.215
When taking Quviviq, be sure to take it within 30 minutes of going to bed. Also, it’s recommended that you commit to a whole night’s rest after taking Quviviq (between seven to eight hours).
Don’t take the tablets with a meal, as food can delay its onset of action (ability to begin working). Be sure to take the tablets as a whole. Don’t chew, crush, or break them.4
Quviviq is not recommended for people with severe liver impairment. A change in dose may be required when taken for specific health conditions and with certain other drugs. Always take the prescribed dose.2
The safety and effectiveness of Quviviq have yet to be established in people under 18.4
Ambien is available as immediate-release (IR, a form of medication where a pill disintegrates quickly inside the body to achieve an immediate effect) in 5 and 10-mg strength tablets.8
Ambien CR extended-release (ER) dissolves slowly inside the body. It has a longer-lasting impact and lessens the need for more doses. Tablets come in strengths of 6.25 mg or 12.5 mg.3
Ambien IR tablets:8
- The recommended dose of Ambien is either 5 mg or 10 mg and is taken once daily, at bedtime, allowing for at least seven hours of sleep before awakening.
- The recommended initial doses of Ambien may differ in females and males as clearance is lower in females. Your healthcare provider will start the dose at 5 mg and may increase it to 10 mg.
- Older people may be sensitive to the effects of zolpidem tartrate. The recommended dose of Ambien is 5 mg once daily, taken immediately before bedtime.
- The dose in people with mild to moderate liver disease is 5 mg once daily, taken immediately before bedtime.
- Avoid taking Ambien with a meal, as it may lessen the drug’s effect.
Ambien CR ER tablets:3
- The recommended initial dose is either 6.25 or 12.5 mg. A single, once-daily dose of Ambien CR should not exceed 12.5 mg.
- Take the prescribed dose once per night immediately before bedtime, at least seven to eight hours before awakening in the morning.
- The initial dose for women may be less than for men because zolpidem clearance is lower in women and is 6.25 mg. Your healthcare provider will increase the dose as required.
- In older people, the recommended dose of Ambien CR is 6.25 mg once daily, taken immediately before bedtime.
- The initial dose of Ambien CR in people with mild to moderate liver problems is 6.25 mg once daily, immediately before bedtime.
- Take Ambien CR tablets as a whole. Don’t chew, crush, or break the tablets.
Ambien and Ambien CR should be used for the short term.
Long-term use of Ambien is not recommended without re-evaluating the ability to avoid the risk of abuse, dependence, remission of insomnia symptoms, or abnormal thinking during treatment.16
The IR tablets are used to treat symptoms related to delayed sleep onset. The ER tablets treat both delayed sleep onset and decreased sleep latency.16
Ambien CR treats trouble achieving sleep onset or sleeping through the night, while Ambien is used to help solely with sleep onset. Ambien has a relatively shorter duration of action when compared to Ambien CR.38
There is a difference in dosage between Ambien and Ambien CR, and it must be used as advised by your healthcare provider.
Which Drug Lasts Longer in the Body?
Quviviq reaches peak plasma concentrations (when a drug begins having an effect) within one to two hours, a figure known as Tmax.17
Quviviq is primarily expelled from the body via feces (nearly 57%) and urine (almost 28%).17
The pharmacokinetic properties (how the body interacts with the drug) of Quviviq are not clinically affected by age, sex, race, body size, or mild-to-severe renal impairment.13
Ambien CR and Ambien are rapidly absorbed upon consumption and start working quickly after taking them. Both formulations reach the mean peak plasma concentration in 1.5 hours.38
Compared to Quviviq, however, Ambien’s chemical properties may be affected by age, sex, race, or health conditions.16
Quviviq and Ambien are generally safe drugs when taken according to the prescribed dose. However, both share common, mild side effects and rare, severe side effects.
The dosage and risk of side effects may vary from person to person depending on age, race, sex, and health conditions.
Some common side effects of Quviviq and Ambien are:45
- Somnolence or fatigue
- Daytime sleepiness
Some additional adverse effects observed when using Ambien are:8
- Dry mouth
- Body as a whole
- Back pain
- Influenza-like symptoms
- Chest pain
- Abnormal dreams
- Sleep disorders
- Abdominal pain
- Pharyngitis (throat pain or irritation)
Safety and Warnings:
Quviviq and Ambien may cause severe side effects, which must be reported to your healthcare provider.
The use of these drugs requires close monitoring in the following conditions:
- CNS-depressant effects and daytime impairment
- Worsening of depression/suicidal ideation (suicidal thoughts or ideas)
- Sleep paralysis
- Complex sleep behaviors (normal movements, talk, or emotions)
- Patients with compromised respiratory function
- CNS-depressant effects and next-day impairment
- Severe anaphylactic and anaphylactoid reactions
- Abnormal thinking and behavior changes
- Withdrawal effects
Ambien comes with a black box warning from the Food and Drug Administration (FDA), warning about walking, driving, cooking, and eating while under the influence of Ambien. Tell your healthcare provider about any unusual sleep behavior while taking Ambien.8
Who Should Not Take Quviviq or Ambien?
Quviviq is discouraged from use in people with narcolepsy.2
Ambien should be avoided by those with a natural hypersensitivity to zolpidem, the active ingredient in Ambien. It is also not approved in people who experience complex sleep behaviors after taking this medicine.8
As mentioned earlier, those with severe liver impairment should not use Quviviq or Ambien.23
No data are available on the safety of Quviviq or Ambien in pregnant or breastfeeding people. Therefore, your healthcare provider will determine the risk-to-benefit ratio of using Quviviq or Ambien while pregnant or breastfeeding.23
Interactions: Quviviq vs. Ambien
Drug-drug interactions may result when taking Ambien and Quviviq with other drugs. Quviviq and Ambien interact with the following medicines.
Alcohol and CNS Depressants:218
The simultaneous use of alcohol and central nervous system (CNS) depressants with Quviviq and Ambien may lead to motor-skill impairment and the risk of CNS depression.
Strong or Moderate CYP3A4 Inhibitors:218
Simultaneously taking Ambien or Quviviq with strong or moderate CYP3A4 (an enzyme found in the liver) inhibitors increase the amount of zolpidem or daridorexant in your system, heightening the risk of adverse reactions. If this applies, consider using a lower dose of these drugs with CYP3A4 inhibitors (but first consult a healthcare provider).
A CYP3A4 inducer drug significantly reduced the exposure and efficacy of Ambient and Quviviq. Therefore, using a CYP3A4 inducer medication is not recommended with either of these drugs.
Ambien may also interact with the following drugs:18
- Opioids include heroin, Actiq (fentanyl), or methadone
- Tofranil (imipramine)
- Zoloft (sertraline)
- Prozac (fluoxetine)
- Haldol (haloperidol)
The simultaneous administration of these drugs may increase or decrease the efficacy of Ambien.
Your healthcare provider will determine the need and best suitable dose of Ambien for you.
Quviviq and Ambien are effective treatment options when used for insomnia. However, these drugs differ in some significant categories, including dosing regimens, safety-related hazards, and specific indications.
Ambien is one of the most commonly used drugs for insomnia, while Quviviq is a newer drug on the market.
While generally tolerable, they must only be used as prescribed. Long-term use of these drugs may lead to dependency and addiction. In the case of Ambien, it comes with an FDA warning about next-day drowsiness, impaired driving, and other activities while not fully awake.8
Various medicines interact with Quviviq and Ambien, particularly the ones acting on the CNS. Thus, always tell your healthcare provider about all your medications before taking Quviviq or Ambien.