Sleep medication cost: zolpidem, trazodone and cheaper options

Common prescription sleep medicines

• Zolpidem. Used for insomnia. It comes as regular tablets (Ambien), extended-release tablets (Ambien CR), tablets that dissolve under the tongue (Edluar, Intermezzo) and an oral spray (Zolpimist) (MedlinePlus). Ask which form you really need, and price the regular generic tablet as well as any extended-release or under-the-tongue version you’re offered.
• Trazodone. An antidepressant that doctors sometimes prescribe for insomnia, an off-label use. Its brand versions are no longer sold, but generic alternatives may be available (MedlinePlus). See our antidepressant cost guide.
• Other classes. NHLBI lists eszopiclone and zaleplon, ramelteon, suvorexant and some benzodiazepines among insomnia medicines. Benzodiazepines are generally used for only a few weeks because they can be habit-forming (NHLBI).

The safety warning on Z-drugs

In 2019, FDA added a boxed warning, its most prominent kind, to eszopiclone (Lunesta), zaleplon (Sonata) and zolpidem. Rare but serious injuries, including deaths, have followed sleepwalking, sleep driving and other activities done while not fully awake (FDA). These behaviors can happen after the first dose or later, even at lower doses, and people may not remember them (FDA).

• Stop the medicine and call your doctor right away if you do anything while not fully awake (FDA).
• Don’t combine it with other sleep medicines, including over-the-counter ones, or with alcohol (FDA).
• You may still be drowsy the next morning, so be careful driving (FDA).
• Take zolpidem only when you can stay in bed for 7 to 8 hours, and don’t stop suddenly after long use. It may be habit-forming (MedlinePlus).

Trazodone has its own warnings. MedlinePlus notes a risk of suicidal thoughts in people under 25 who take antidepressants, and says an erection lasting more than 6 hours needs emergency care (MedlinePlus). If you or someone you know is in crisis, call or text 988.

Options that may cost less than pills

NHLBI says CBT-I is a 6 to 8 week program, offered in person, by phone or online, and is usually the first treatment recommended for long-term insomnia. Healthy sleep habits help too (NHLBI). Ask your plan whether it covers CBT-I, and whether online or phone sessions cost less than office visits. A few weeks of treatment may save you years of refills.

Over-the-counter sleep aids usually contain antihistamines, which can be unsafe for some people. NHLBI says research hasn’t proven melatonin works for insomnia, and it can cause side effects. Tell your doctor about any OTC products or supplements you take, and talk to them before trying either (NHLBI).

How to pay less

• Choose the generic. FDA says generic prices tend to drop as more companies make the same drug (FDA).
• Compare cash prices. Prices for the same prescription can differ from one pharmacy to the next. Check a free discount card such as RxGo before you fill.
• On Medicare? If your income is limited, apply for Extra Help. Drugs bought with a discount card instead of your plan don’t count toward your plan’s out-of-pocket limit (Medicare.gov).
• Ask about a 90-day supply. If you take a medicine every night, ask your plan or pharmacy whether a 90-day fill costs less per dose.
• No insurance? HRSA-funded health centers charge on a sliding scale. Find one near you.