Overview

Both Quviviq and Ambien are effective oral prescription medicines used to help balance chemical effects in your brain that may cause trouble with sleep (known as insomnia).

Quviviq and Ambien CR, an extended-release formulation, are used for people who have trouble getting to sleep or staying asleep through the night, while Ambien is used to help with sleep onset only because it has a shorter duration of action.

Quviviq and Ambien / Ambien CR are considered sedative / hypnotics but differ in structure, drug class, uses, doses, length of action, side effects, and cost. Both medicines are C-IV federally controlled substances because they have some potential for misuse and abuse.

Are Quviviq and Ambien in the same drug class?

No, Quviviq is in the class of drugs known as a dual orexin receptor antagonist (DORA) and Ambien / Ambien CR is an oral sedative / hypnotic nonbenzodiazepine (often called a “Z-drug”). Both drugs are effective treatments if you have insomnia.

Quviviq (generic name: daridorexant) is a dual orexin receptor antagonist (DORA) medication that works by blocking orexin receptors.

• It is thought to turn down overactive wakefulness by blocking orexins, which are chemical messengers in the brain.
• You can take Quviviq over the long-term if this is how your healthcare provider prescribes it, but don’t take more Quviviq than prescribed.
• It is classified by the DEA as a Schedule IV federally controlled substance because it does have some potential for misuse or abuse.

Ambien (generic name: zolpidem) and Ambien CR (generic name: zolpidem extended-release) are oral sedative / hypnotic nonbenzodiazepine prescription drug (“Z-drug”).

• Ambien is used for the short-term treatment of adults who have trouble falling asleep.
• Ambien is also available as an extended-release oral product called Ambien CR (zolpidem extended-release tablets) that is used to help you get to sleep and stay asleep through the night.
• These drugs can lead to a similar level of dependence or abuse as benzodiazepines. Ambien is classified by the DEA as a Schedule IV federally controlled substance because of this potential.

Examples of sedative / hypnotic medications found in Schedule IV include:

• eszopiclone (Lunesta)
• daridorexant (Quviviq)
• lemborexant (Dayvigo)
• suvorexant (Belsomra)
• zaleplon (Sonata)
• zolpidem (Ambien, Ambien CR, Edluar, and Zolpimist)

How do Quviviq and Ambien work?

Both Quviviq and Ambien are oral prescription medicines that help to balance chemical effects in your brain that may cause trouble with getting to sleep or staying asleep (called insomnia).

• Quviviq is in a newer group of drugs known as dual orexin receptor antagonists (DORAs). Quviviq works by turning down overactive wakefulness. It does this by blocking orexin A and orexin B, which are chemical messengers in the brain that regulate wakefulness, to their receptors (OX1R and OX2R).
• Ambien works by slowing activity in the brain to allow you to get to sleep. Nonbenzodiazepines raise the levels of the amino acid Gamma-Aminobutyric Acid (GABA) by attaching to the GABA-BZ receptors found close by the benzodiazepine receptors. GABA slows down brain activity, allowing the mind and body to relax to promote sleep.

How are they given?

Both Quviviq and Ambien / Ambien CR are given as oral tablets used to help treat insomnia in adult patients 18 years of age and older. They are given at least 30 minutes before bedtime, as they work quickly. If they are taken with a meal, it may slow down absorption of the medicine and how quickly it works.

• Both Ambien and Ambien CR are preferred for short-term use, using the lowest effective dose. Quviviq can be used on a longer-term basis, if your doctor prescribes it this way.
• Quviviq and Ambien CR work throughout the night and can help you to fall asleep and stay asleep. Ambien is shorter -acting and is used if you have trouble falling asleep.
• Use of Ambien or Ambien CR should be as short as possible, since longer treatment increases the risk of abuse, dependence and withdrawal side effects.

Do not take Quviviq, Ambien or Ambien CR together, or with other sedating medicines, unless prescribed by your doctor.

Dosing for Quviviq

Either Quviviq or Ambien are taken only once daily at bedtime. They work quickly, so it’s best to take them within 30 minutes of bedtime.

Quviviq: The recommended dose is one either one 25 mg oral tablet OR one 50 mg tablet taken once per night within 30 minutes before going to bed (with at least 7 hours remaining before you plan to wake up). Quviviq may not work as quickly if you take it with or soon after a meal. Do not take more Quviviq than prescribed by your doctor.

You should not use Quviviq if you have been diagnosed with narcolepsy (narcolepsy is when you fall asleep often at unexpected times).

You may not be able to use Quviviq, or your doctor may need to adjust your dose if you take certain medicines or have liver disease. Tell your healthcare providers about all of the medicines you take, including prescription, over-the-counter (OTC), vitamins, and herbal or dietary supplements.

Dosing for Ambien / Ambien CR

In 2013, the FDA required the makers of all zolpidem-containing products to lower the dose for women and to suggest lower doses for men in the package insert. The recommended initial doses for women and men are different because zolpidem clearance (how quickly it’s removed from the body) is slower in women.
Lower doses are also recommended for older patients.

Ambien or Ambien CR can be taken only when needed for insomnia; it does not need to be taken every night if you can get to sleep without it. Long-term use of Ambien medicines is not recommended.

Ambien and Ambien CR work quickly, usually within 15 to 30 minutes. Do not take Ambien or Ambien CR twice in the same night, and do not take them together.

Higher doses may lead to next-day drowsiness, impairment of driving and other activities that require you to be alert.

As with all nonbenzodiazepines, these drugs should be slowly discontinued with prolonged use to help prevent withdrawal side effects.

Ambien

• The recommended starting dose of Ambien for women is 5 mg, and either 5 or 10 mg for men, taken only once per night right before bedtime with at least 7 to 8 hours remaining before you plan on waking up.
• If the 5 mg dose is not effective, the dose can be increased to 10 mg if your doctor prescribes it this way. Higher doses may lead to next-day drowsiness, impairment of driving and other activities that require you to be alert.
• Do not take more than 10 mg of Ambien once daily right before bedtime.
• The recommended dose of Ambien in elderly or debilitated patients is 5 mg once daily right before bedtime.

Ambien CR

• The recommended starting dose of Ambien CR for women is 6.25 mg, and either 6.25 or 12.5 mg for men, taken only once per night right before bedtime with at least 7 to 8 hours remaining before you plan on waking up.
• If the 6.25 mg dose is not effective, the dose can be increased to 12.5 mg if prescribed by your doctor.
• Ambien CR extended-release tablets should be swallowed whole because it has 2 layers: the first layer dissolves quickly to help you get to sleep, and the second layer dissolves slowly to help you stay asleep. Do not divide, crush, or chew them.
• Do not take more than 12.5 mg of Ambien CR once daily right before bedtime.
• The recommended dose of Ambien in elderly or debilitated patients or patients with mild to moderate liver disease is 6.25 mg once daily right before bedtime.
• If you have severe liver disease, your doctor may recommend that you do not use Ambien or Ambien CR.

Which is more effective - Quviviq or Ambien?

Head-to-head, randomized, controlled studies comparing the effectiveness and safety of Quviviq with Ambien or Ambien CR are not available. In addition, studies evaluating the efficacy of long-term treatment for insomnia with Quviviq or zolpidem are not available.

Both Quviviq and Ambien / Ambien CR have been shown to be more effective than a placebo (an inactive treatment) for the treatment of insomnia. Quviviq and Ambien CR can be used to help you get to sleep and stay asleep, while Ambien is more short-acting and is used primarily to help you get to sleep.

In one meta-analysis that reported head-to-head comparisons of several treatmenst for insomnia, after 4 weeks of treatment, short-acting benzodiazepines (for example, Ambien) were more effective than daridorexant (Quviviq).

Ambien

Immediate-release Ambien has been shown to be effective for both short-term and longer-term (chronic) insomnia in placebo-controlled studies up to 5 weeks long.

• Zolpidem 7.5 and 10 mg doses were superior to placebo on objective (polysomnographic) measures of sleep latency, sleep duration, and number of awakenings in patients with transient, acute insomnia.
• For chronic insomnia, zolpidem 10 mg was superior to placebo on sleep latency for the first 4 weeks and on sleep efficiency for weeks 2 and 4. Zolpidem was comparable to placebo on the number of awakenings at both doses studied. In another study, zolpidem 10 mg was superior to placebo on subjective measures of total sleep time, number of awakenings, and sleep quality for the first treatment week.

Ambien CR

Ambien CR was evaluated in 3 placebo-controlled studies for the treatment of patients with chronic (long-term) insomnia. ​​

• In adults, a 3-week trial compared Ambien CR 12.5 mg with a placebo. Ambien CR decreased wake time after the subject had fallen asleep for the first 7 hours during the first 2 nights and for the first 5 hours after 2 weeks of treatment.
• Ambien CR 12.5 mg decreased wake time after sleep onset (WASO) for the first 7 hours during the first 2 nights and for the first 5 hours after 2 weeks of treatment. Ambien CR 12.5 mg was superior to placebo by helping people get to sleep during the first 2 nights of treatment and after 2 weeks of treatment.
• In elderly patients at least 65 years of age, Ambien CR decreased wake time after sleep onset (WASO) for the first 6 hours during the first 2 nights and for the first 4 hours after 2 weeks of treatment.
• Older and younger patients reported positive effects on the sleep effect after the first 2 nights and after 3 weeks of treatment.

Quviviq

In two phase 3 studies, Quviviq showed significant improvement over placebo (an inactive treatment) in sleep onset, sleep maintenance and total sleep time, while also reducing daytime sleepiness.

• In studies, 1854 patients with insomnia received Quviviq or a placebo once daily, in the evening, for 3 months.
• Study results showed that Quviviq provided a statistically significant improvement compared to placebo on polysomnography (LPS, WASO) and self-reported total sleep (sTST), at month 1 and month 3.

How do side effects compare between Quviviq and Ambien / Ambien CR?

Both Quviviq and Ambien share some similar side effects such as next-day drowsiness (which can make driving or other activities dangerous), complex sleep behaviors (such as sleep walking, sleep driving), worsening of depression / suicidal Ideation, headache, and dizziness.

Drowsiness also may increase the risk of falls and bone fractures in some patients.

Rates of side effects between drugs cannot be compared outside of comparative studies as patient populations, doses and study designs may differ.

Side effects: Quviviq

Quviviq is well-tolerated by most people. Long-term side effects are not as well described, as this medicine was approved in 2022.

The safety of Quviviq was evaluated in 3 placebo-controlled studies with 1232 patients (with 40% of patients at least 65 years of age). A total of 576 patients were treated for at least 6 months and 331 for at least 12 months.

In Quviviq studies, the most commonly reported side effects, compared to a placebo (an inactive agent) are:

• Headache: 6% to 7% (vs. 5% on placebo)
• Somnolence or fatigue: 5% to 6% (vs. 4% on placebo)
• Dizziness: 2% to 3% (vs. 2% on placebo)
• Nausea: Up to 3% (vs. 2% on placebo)

You may still feel drowsy the next day after taking Quviviq. Quviviq can worsen next-day alertness and motor coordination which can make driving, work performance, or other activities more dangerous. This risk increases if you are taking other agents that make you drowsy or less alert (for example: other CNS depressants like alcohol, opioids, tranquilizers, anti-anxiety medicines, some antihistamines).

Do not drive, use heavy machinery or perform other hazardous activities if you do not feel mentally alert, have had less than 7 hours of sleep after taking this medicine, or took a higher dose than your doctor prescribed.

Quviviq may also cause complex sleep behaviors such as sleepwalking, sleep driving, talking on the phone, making and eating food, having sex, or other actions while not fully awake. In some cases, patients may have no memory of these activities. Stop using this medicine and contact your doctor right away if this side effect occurs.

Serious side effects such as worsening of depression / suicidal ideation, sleep paralysis (an inability to move or speak for several minutes) and hallucinations (which may be vivid and disturbing) may also occur. If you experience these side effects, contact your doctor immediately.

Other reported side effects with orexin receptor antagonists include cataplexy-like symptoms (such symptoms can include periods of leg weakness lasting from seconds to a few minutes).

Side effects: Ambien / Ambien CR

The most common side effects with Ambien CR are headache and dizziness. Other common side effects reported with Ambien are sleepiness, diarrhea, and grogginess or feeling like you have been drugged.

Boxed warning

Ambien and Ambien CR both contain a Boxed Warning, found at the top of the prescribing information. A Boxed Warning is the most prominent safety warning from the FDA. It details important or life-threatening side effects that may occur and appears at the top of the package insert as well as in the Patient Medication Guide.

Zolpidem (Ambien, Ambien CR) prescribing information contains a Boxed Warning about complex sleep behaviors like sleepwalking, sleep driving, talking on the phone, making and eating food, having sex, or other actions while not fully awake. Usually people do not remember these events. While Quviviq warns of this complex sleep behaviors, it does not display this in a Boxed Warning.

• Rarely, complex sleep behaviors with zolpidem (Ambien, Ambien CR) has led to severe injuries or death. These events can occur with lower doses and even with the first use of the medicine.
• These activities may happen with Ambien whether or not you drink alcohol or take other medicines that make you sleepy.
• If you know this has happened or you are told it happended, stop taking Ambien, Ambien CR or any form of zolpidem and tell your doctor right away. Do not take Ambien if you have had complex sleep behaviors that happened after taking Ambien in the past.

These risks are greatly increased when zolpidem is combined with alcohol or other sedating drugs (like tranquilizers, opioids, and anti-anxiety medicines). Zolpidem should not be combined with medicines that cause CNS depression unless directed by your doctor. Do not use Ambien / Ambien CR if you drank alcohol that evening or before bed.

Other serious side effects can include:

• Sleepiness or dizziness: can slow your thinking and motor skills, make driving or operating equipment dangerous, or increase your risk for a fall that may cause injury. Do not drink alcohol or take opioids or other medicines that may make you sleepy or dizzy while taking Ambien / Ambien CR without first talking to your healthcare provider.
• Severe allergic reactions
• Abnormal thoughts and behavior
• Risk of suicide and worsening of depression
• Breathing problems
• Hepatic encephalopathy (nervous system problems due to severe liver disease)
• Withdrawal symptoms

Tell your doctor if you have lung disease, breathing problems or sleep apnea.

In one meta-analysis review, zolpidem caused more dropouts due to adverse events than did placebo after 4 weeks of treatment.

These are not all of the possible side effects or warnings for these drugs. Call your healthcare provider for medical advice about side effects.

For more information, see:

• Quviviq: Side Effects and Warnings
• Ambien: Side Effects and Warnings

Drug Interactions: Quviviq and Ambien

Quviviq and Ambien / Ambien CR are both metabolized (broken down in the body) by a special enzyme called CYP3A4. These medicines may be subject to many drug interactions, some serious, due to this enzyme property.

• Be sure your doctor and pharmacist are aware of any medications you take, including prescription, over-the-counter, vitamins and herbal or dietary supplements, so that a review for drug interactions can occur.
• Your doctor may need to adjust your dose of medicine or you may need to be prescribed a different medicine altogether.

You should not drink alcohol if you are taking Quviviq, Ambien or Ambien CR. This may increase the risk of central nervous system (CNS) depression like drowsiness or sedation, which may lessen your ability to safely drive, work or complete other tasks.

If you use Ambien or Ambien CR, you should avoid the use of opioids or other CNS depressants unless prescribed by your doctor. The combination can lead to dangerous breathing problems.

Tell your doctor if you take:

• Benzodiazepines
• Opioids (sometimes called "narcotics") as these may increase the risk of breathing problems (respiratory depression)
• Tricyclic antidepressants (for example: amitriptyline, imipramine)
• Other medicines that can make you sleepy or affect your breathing (including other zolpidem medicines)
• Drink alcohol

Can I get addicted to Quviviq or Ambien?

Quviviq contains daridorexant and Ambien contains zolpidem, both Schedule IV controlled substances used in the treatment of insomnia (trouble with sleep). Abuse and addiction are different from physical dependence and tolerance.

Quviviq

Long-term use of Quviviq in clinical studies did not produce withdrawal signs or symptoms when the drug was stopped. This suggests that it does not produce physical dependence.

In addition, in studies conducted by the manufacturer, there were no reports to indicate that Quviviq can lead to abuse. However, people with a history of drug or alcohol abuse or addiction may be at a greater risk for Quviviq abuse or addiction.

Abuse potential properties have been reported for the dual orexin receptor antagonists (DORAs and a clinical study has shown “drug-liking” of daridorexant (Quviviq).

• In one study with Quviviq among recreational sedative drug users, Quviviq doses of 50 mg (an FDA-approved dose), 100 mg or 150 mg mg produced a “drug liking” effect when compared to placebo.
• When Quviviq was given at a 50 mg dose, “drug liking” was significantly lower compared to suvorexant (150 mg) and zolpidem (30 mg).
• When a 100 mg dose of Quviviq was given and compared to suvorexant (150 mg) and zolpidem (30 mg), “drug-liking” effects were similar for all drugs.
• Tell your doctor before treatment with this medicine if you have a history of alcohol or drug abuse or addiction.

Ambien / Ambien CR

Ambien / Ambien CR can lead to tolerance, physical and / or psychological dependence. It has the potential for misuse, abuse and withdrawal symptoms upon abrupt discontinuation.

In studies of former drug abusers looking at abuse potential of zolpidem 40 mg compared to with diazepam 20 mg, a similar level of effect was seen, but 10 mg zolpidem was difficult to distinguish from placebo.

• Withdrawal symptoms can be serious and may include stomach and muscle cramps, vomiting, sweating, shakiness, seizures, and confusion. Talk to your healthcare provider about slowly stopping treatment to avoid withdrawal symptoms.
• Individuals with a history of alcohol, drug or substance abuse or addiction may at an increased risk for abuse or addiction to these medicines.
• Tell your doctor if you have a history of alcohol or drug abuse before Ambien / Ambien CR treatment.

Do not drink alcohol while taking these medicines due the increased risk for dangerous or deadly side effects.

Keep these all controlled substances, including Quviviq, Ambien, and Ambien CR in a safe place to prevent misuse, abuse and theft. Keep away from children and pets. Selling or giving away these medicines may harm others and is against the law.

Comparing Prices for Quviviq vs. Ambien

Quviviq cost

• The cost for Quviviq 25 or 50 mg oral tablets is about $515 for a supply of 30 tablets.
• A generic option is not yet available for this medicine.
• Quviviq was first approved by the FDA in January 2022 and is manufactured by Idorsia Pharmaceuticals.

Ambien / Ambien CR cost

• The cost for brand name Ambien 5 or 10 mg oral or Ambien CR 6.25 mg or 12.5 mg extended-release tablets is about $750 for a supply of 30 tablets.
• Generic options are available for these brands (generic name: zolpidem) and cost about $$20 to $40 per month for a supply of 30 tablets. Generic zolpidem is usually covered by most insurance plans.
• Ambien was first approved in 1992, and Ambien CR was first approved in 2005. Both products are manufactured by Sanofi Aventis.

Generic choices are also available for other zolpidem products and include: include the oral sublingual form (brand name: Edular), which dissolves under your tongue. Zolpimist, an oral spray, is not yet available as a generic option.

Insurance, discount coupons, copay cards, and manufacturers financial assistance may help lower your out-of-pocket costs, if you qualify.

For more information, coupons, and manufacturer promotions visit:

• The Drugs.com Quviviq Price Guide
• The Drugs.com Ambien Price Guide

This is not all the information you need to know about these medicines for safe and effective use and does not take the place of your doctor’s directions. Review the full patient medication guide and discuss this information and any questions you have with your doctor or other health care provider.