Ambien (Zolpidem) and Lunesta (Eszopiclone) are prescription nonbenzodiazepine hypnotic drugs used to treat insomnia. They have comparable efficacy, but both also have the potential to become addictive with serious risks. Unlike Ambien, Lunesta is not restricted to short-term use. Other differences between the two lie in their available forms, dosage, and some side effects.
Ambien (generic name Zolpidem), is a prescribed to treat insomnia. It's a sedative-hypnotic that helps patients fall asleep faster, and is available in the form of 5 and 10-milligram tablets, and 6.25- and 12.5-milligram extended-release tablets. The extended-release tablets help users stay asleep longer. Zolpidem is also available in sublingual tablets and an oral spray.
Lunesta (generic name Eszopiclone) is also prescribed to treat insomnia. Lunesta, which is a hypnotic, helps users fall asleep faster, and sleep better and longer. Lunesta comes in 1, 2, and 3-milligram tablets.
Directions for Use
Ambien is taken orally, on an empty stomach only for a short treatment period, a maximum of two weeks. Patients take Ambien by mouth on an empty stomach. Taking the drug on a full stomach decreases its efficacy. Because the time lapse between when the drug is taken and when it starts working is very short, users are cautioned to take it directly at bedtime. They also need to have a full seven to eight hours to dedicate to sleep.
Lunesta, also taken orally and on an empty stomach, can be taken for longer than two weeks.
Both Ambien and Lunesta should be stored at room temperature away from light and moisture. Both Ambien and Lunesta have a shelf life of three years.
How It Works
Hypnotics like Ambien and Lunesta work by slowing brain activity to produce a calming effect.
While there aren't many studies directly comparing Ambien  and Lunesta, there are no known distinct advantages of one over the other - zolpidem (Ambien) is comparable in efficacy to other hypnotic agents like eszopiclone (Lunesta). 
According to an article in the New England Journal of Medicine, Lunesta "was superior to placebo" per the largest of three Lunesta trials but it did not reduce the initial time falling asleep by more than 15 minutes on average. The drug’s efficacy information could not be found on the label: it only stated that Lunesta is superior to placebo. In the longest and biggest phase 3 trial, patients in the Lunesta group reported falling asleep an average of 15 minutes faster and sleeping an average of 37 minutes longer than those in the placebo group. Even then the average Lunesta patient still met the criteria for insomnia and reported no clinically meaningful improvement in alertness or functioning the next day.
Chronic Insomnia among the Elderly
Compared with the benzodiazepines, the nonbenzodiazepine (including zolpidem and eszopiclone) barely seemed to offer any significant clinical advantages in efficacy or tolerance in elderly persons. Long-term use of sedative-hypnotics for insomnia has no evidence base and has traditionally been discouraged out of concerns about potential adverse effects like cognitive impairment (anterograde amnesia), daytime sedation, motor incoordination, and increased risk of motor vehicle accidents and falls. Also, the efficacy and safety of long-term use of these agents has not yet been determined. The long-term effects of treatment and the most appropriate management strategy for elderly persons with chronic insomnia still needs to be researched and evaluated.
Medical History Precautions
Patients need to detail their medical history to their doctors before seeking treatment. Concerning Ambien, patients especially need to mention kidney or liver disease, and any mental or mood problems such as depression or thoughts of suicide. Patients should be honest about any personal or family history of regular use/abuse of drugs, alcohol or other substances, and their personal or family history of sleepwalking. Doctors also need to know about lung or breathing problems, such as chronic obstructive pulmonary disease-COPD and sleep apnea, or the presence of myasthenia gravis, a muscle disease.
Concerning Lunesta, patients especially need to mention any history of intoxication with medications that depress the nervous system or breathing, such as CNS or respiratory depressants as well as alcohol or sedatives. They also need to discuss liver disease or lung diseases, such as chronic obstructive pulmonary disease or sleep apnea. Patients should be honest about any personal or family history of regular use/abuse of drugs, alcohol or other substances as well as mental or mood problems such as depression.
According to the U.S. Drug Enforcement Administration, zolpidem is rapidly replacing illegal sedatives as the most common date-rape drug. Sexual molesters or perpetrators of sexual assault have used zolpidem to lull unsuspecting victims.
Reach your doctor immediately if your experience any of the following after taking Ambien: rash, hives, itching, swelling, difficulty breathing or swallowing, shortness of breath, nausea, vomiting or chest pain.
Allergic reactions to Lunesta include rash, hives, itching, swelling, difficulty breathing or swallowing or shortness of breath.
The following side effects of Ambien are fairly common but not serious: dizziness, daytime sleepiness, headache, unsteadiness, nausea, constipation, diarrhea, gas, heartburn, stomach pain, uncontrollable shaking, numbness, unusual dreams, muscle pain and heavy menstruation. The elderly are more susceptible to many of the side effects. Serious but rare side effects include mental, mood or behavior changes, such as new/worsening depression, abnormal thoughts, thoughts of suicide, hallucinations, confusion, agitation, aggressive behavior or anxiety. Patients may also experience memory loss, sleep-driving and other sleep behavior issue or vision problems.
Common and not very serious side effects of Lunesta include headache, pain, daytime drowsiness, lightheadedness, nausea, vomiting, heartburn, an unpleasant taste, unusual dreams, a decreased sexual desire, painful menstrual periods and breast enlargement in males. The elderly are more susceptible to many of the side effects. Serious but rare side effects are loss of coordination, memory loss and mental, mood or behavior changes, such as new/worsening depression, abnormal thoughts, thoughts of suicide, hallucinations, confusion, agitation, aggressive behavior or anxiety.
A new study shows bigger risks of taking sleeping pills, sometimes even death:
Abuse and Overdose
Unless taken as directed, Ambien and Lunesta can both be habit-forming.
Zolpidem should be used for short periods of time using the lowest effective dose. 10 mg is effective in treating insomnia when used intermittently no fewer than three and no more than five pills per week for a period of 12 weeks . The 15-mg zolpidem dosage has no apparent clinical advantage over the 10-mg zolpidem dosage. Overdose symptoms include slowed breathing or loss of consciousness if taken more than directed.
Overdose of Lunesta may result in anxiety, abdominal cramps, vomiting, sweating or shakiness extreme drowsiness, confusion, fainting or coma if they take more than directed. If consumed within the last hour, eszopiclone overdose can be treated with the administration of activated charcoal or via gastric lavage .
Dependence and Withdrawal
Drug tolerance and physical dependence to zolpidem is usually treated with a gradual dose reduction over a period of months to minimise withdrawal symptoms. Patients who take Ambien are likely to experience withdrawal symptoms such as nausea, vomiting, flushing, stomach cramps, nervousness or shakiness.
In the US, eszopiclone is a schedule IV controlled substance under the Controlled Substances Act. Use of eszopiclone may lead to physical and psychological dependence, the risk of which increases with the dose and duration of usage and simultaneous use of other psychoactive drugs. The risk is also greater in patients with a history of alcohol or drug abuse or psychiatric disorders. Lunesta patients may experience withdrawal symptoms like anxiety, abdominal cramps, vomiting, sweating or shakiness
Ambien interacts with certain drugs: sodium oxybate; rifampin; azole antifungals such as ketoconazole; medicine for sleep or anxiety, such as alprazolam, diazepam and lorazepam; muscle relaxants; narcotic pain relievers such as codeine; antidepressants, such as imipramine and sertraline; chlorpromazine; itraconazole; medications for anxiety, colds or allergies, mental illness, pain, or seizures; rifampin; sedatives; sleeping pills; and tranquilizers.
Lunesta also interacts with certain drugs: drugs affecting enzymes that remove the medication from your body; azole antifungals, such as ketoconazole and itraconazole; macrolide antibiotics such as clarithromycin and nefazodone; HIV medications such as ritonavir and nelfinavir and rifampin; antihistamines that cause drowsiness, such as diphenhydramine; anti-anxiety drugs, such as diazepam; anti-seizure drugs, such as carbamazepine; muscle relaxants, such as cyclobenzaprine, methocarbamol; narcotic pain relievers such as codeine; other medicines for sleep; psychiatric medicines, such as phenothiazines, tricyclics and amitriptyline; and tranquilizers.
- Ambien Oral Uses and How to Use - HealthCentral
- Zolpidem - NIH.gov
- Wikipedia: Zolpidem
- Ambien CR - RxList
- Zolpidem Tartrate 5mg Tablets - eMC
- Lunesta Oral Uses and How to Use - HealthCentral
- Eszopiclone - NIH.gov
- Wikipedia: Eszopiclone
- Prescription sleeping pills: What's right for you? - Mayo Clinic