doxepin
Doxepin (Silenor) is a tricyclic antidepressant that's used to help adults who have insomnia (trouble sleeping) stay asleep. Doxepin (Silenor) is a tablet that you take by mouth 30 minutes before bedtime. As expected, the most common side effects are sleepiness and tiredness, so only take the medication when you're ready to fall asleep for the night. Unlike some other sleep medications, doxepin (Silenor) isn't considered a controlled substance. Doxepin (Silenor) is available as brand-name and generic versions.
What is Doxepin (Silenor)?
What is Doxepin (Silenor) used for?
- Insomnia (specifically trouble staying asleep)
How Doxepin (Silenor) works
Doxepin (Silenor) is a tricyclic antidepressant (TCA). It blocks histamine receptors in the brain. This helps you stay asleep during the night and keeps you from waking up too early in the morning.
Drug facts
Side effects of Doxepin (Silenor)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Sleepiness or tiredness (up to 9%)
Less Common Side Effects
Doxepin (Silenor) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Allergic reaction: hives, rashes, swollen face or throat, difficulty breathing
- Worsened depression
- Suicidal thoughts or actions
- Unusual behaviors while not fully awake with no memory of them the next day (e.g., driving, eating, cooking, having sex)
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The following Doxepin (Silenor) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Irritability, confusion, fast or irregular heartbeat, muscle stiffness, twitching muscles, sweating, high fever, seizure, chills, vomiting, diarrhea, which may be signs of serotonin syndrome
- Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss
- Thoughts of suicide or self-harm, worsening mood, or feelings of depression
- Trouble passing urine
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Change in sex drive or performance
- Constipation
- Dizziness
- Drowsiness
- Dry mouth
- Tremors
- Weight gain
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Pros and cons of Doxepin (Silenor)
Pros
- Taken once a day close to bedtime
- Few side effects (other than sleepiness)
- Non-addictive sleep medication
Cons
- Shouldn't take with food (must take at least 3 hours before or after food)
- Risk of doing activities while you're not fully awake and not remembering that you did them the next day
- Not approved for people younger than 18 years of age
Pharmacist tips for Doxepin (Silenor)
- Take doxepin (Silenor) 30 minutes right before you go to bed. Don't take doxepin (Silenor) unless you know you can get a full night's sleep. Otherwise, you might still feel sleepy during the next day.
- Avoid taking doxepin (Silenor) within 3 hours of a meal. Food can make the medication take longer to kick in and also raise the risk that you'll still feel sleepy the next day.
- Don't mix doxepin (Silenor) with alcohol because it can make you become too sleepy. It can also raise your risk of doing activities, like driving a car, talking on the phone, making food, while you're not fully awake. This can be very dangerous.
- Avoid driving or do anything requiring concentration after you take doxepin (Silenor). This medication can make you feel very sleepy and make it harder to think clearly or react quickly.
- Speak with your prescriber if you're still having problems sleeping after you've taken doxepin (Silenor) for 7 to 10 days. Your sleep problem might be caused by another medical condition. Your care team can also recommend other options for sleep.
- Doxepin (Silenor) is approved for insomnia only. There are other forms of doxepin that are available at higher doses and are specifically for treating depression.
Common questions about Silenor
No, doxepin tablets for insomnia aren't discontinued. Generic doxepin tablets and brand-name Silenor tablets are available at pharmacies with a prescription from a healthcare professional. There's also a capsule version of doxepin that's taken at a higher dose for depression and anxiety and also still available.
The recommended dose of Silenor for most adults with insomnia is 6 mg taken by mouth 30 minutes before bedtime. This is also the maximum dose of the medication, so don't take more than this. Otherwise, you might have more side effects. If you're 65 years or older, the recommended starting dose is lower (3 mg taken by mouth 30 minutes before bedtime) because you can be more sensitive to the medication's effects. It's important to take no more than the recommended Silenor dose prescribed to you to prevent serious side effects.
It's a good idea to speak with your prescriber if you still have trouble sleeping or if your sleep problems get worse after you've taken Silenor for 7 to 10 days. Your prescriber can check to see whether something else might be causing your sleep problems that need more appropriate treatment. But studies suggest that people with insomnia have taken Silenor for up to 3 months. Speak with your prescriber if you need more help staying asleep so they can find the best treatment plan for you.
No, Silenor isn't addictive or habit-forming. Silenor is one of the few sleep medications that doesn't have a risk for addiction or dependency.
Taking Silenor with food can cause the effects of the medication to take longer to kick in. It can also cause the effects of the medication to linger until the next day, leading to daytime sleepiness. To get the most benefit from the medication and to lessen the risk for daytime sleepiness, don't take Silenor within 3 hours of a meal.
When taken as prescribed at recommended doses, Silenor doesn't cause weight gain. But it's possible if you take higher-than-recommended doses of the medication. For this reason, don't take more Silenor than what's prescribed to you.
Discuss with your prescriber or obstetrician-gynecologist (OB-GYN) about the risks and benefits of taking Silenor while pregnant. There's not enough information to know whether there's a higher risk of birth defects or pregnancy loss when the medication is taken during pregnancy. But there have been cases of complications in the newborn after delivery when some mothers took Silenor late in the third trimester.
Speak with your prescriber or obstetrician-gynecologist (OB-GYN) about the risks and benefits of breastfeeding while you're taking Silenor. This medication can be found in breast milk and can possibly cause your baby to have side effects. Be careful if you decide to breastfeed while you're taking Silenor. Look out for signs of unusual sleepiness or slower breathing in your baby.
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Risks and warnings for Doxepin (Silenor)
Doxepin (Silenor) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Check for other causes of insomnia
Sometimes, insomnia can be caused by other issues, such as depression, stress, or pain. Talk to your prescriber if you're still having trouble sleeping after you've taken doxepin (Silenor) for more than a week. They can evaluate other reasons why you're not getting good sleep.
Behavior changes
- Risk factors: Alcohol | Taking other medications that cause sleepiness | Taking higher-than-recommended dose of doxepin (Silenor)
Some people have had instances where they've done activities while they're not fully awake after they've taken a sleep medication, such as doxepin (Silenor). These activities can include driving, cooking, or having sex. Most people don't remember these events when they're fully awake. This is more likely to happen if you're drinking alcohol or taking other medications that can make you sleepy, such as opioids or other sedatives, with .
Talk to your prescriber right away if you or your loved ones notice this side effect happening to you while you're taking doxepin (Silenor).
Worsened depression and risk for suicidal thoughts and behavior
- Risk factors: People under 24 years old
When taken at much higher doses, the active ingredient doxepin works to treat depression. Studies show that people with depression who take antidepressants can have worsening mental health, including a higher risk for self-harm or suicide.
Even though doxepin (Silenor) is taken at lower doses for sleep, the likelihood that it can cause worsening depression or suicidal thoughts can't be ruled out. Talk to your prescriber or a healthcare professional right away if you have symptoms of depression or feelings of self-harm or suicide while you're taking doxepin (Silenor).
Sleepiness and tiredness
- Risk factors: Alcohol | Taking opioid medications at the same time | Taking medications that cause sleepiness (e.g., antihistamines, opioids
Doxepin (Silenor) can make you sleepy and tired. Only take doxepin (Silenor) when you're ready to go to bed. Don't do any activities that require you to focus, operate machinery, or drive after you take doxepin (Silenor) to prevent accidental injuries.
Don't mix doxepin (Silenor) with alcohol. And avoid taking doxepin (Silenor) with any other medications that can make you sleepy, such as other sleep medications, opioids, and sedatives. Sleepiness can be more intense and make you have an even harder time thinking clearly and focusing.
Doxepin (Silenor) dosage
Typical dosage for Doxepin (Silenor)
- Adults: The typical dose is 6 mg by mouth daily 30 minutes before bedtime.
- Adults 65 years and older: The recommended starting dose is 3 mg by mouth daily 30 minutes before bedtime.
Your prescriber will adjust the dose depending on your needs. The maximum dose is 6 mg by mouth daily.
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Doxepin (Silenor) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Doxepin (Silenor) will not be safe for you to take.
- Currently taking or have taken a monoamine oxidase inhibitor (MAOI) within the last 14 days
- Narrow-angle glaucoma
- Can't urinate (urinary retention)
What are alternatives to Doxepin (Silenor)?
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