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Home > Drug Category > Insomnia Medication > Silenor and Equivalent

Silenor Information

Silenor (Doxepin) is a low-dose formulation of Doxepin specifically indicated for insomnia. While higher doses of generic Doxepin are used for depression and anxiety, Silenor is formulated only for sleep maintenance. Doxepin hydrochloride is a medication that belongs to the tricyclic antidepressant class. While its mechanism of action is not fully understood, doxepin is believed to work through two major mechanisms. It acts as a potent antagonist at the histamine receptors and muscarinic acetylcholine receptors, while also inhibiting the reuptake of serotonin and norepinephrine at the neuronal synapse. At very low doses, its high affinity for histamine receptors drives its sedative effects, making it useful in people with insomnia, whereas higher doses are required to achieve the neurotransmitter modulation necessary for its antidepressant effects.

Insomnia is a condition in which an individual has difficulty falling asleep and staying asleep throughout the night, often resulting in a lack of restorative sleep. Doxepin helps in this instance by blocking the wake-promoting effects of histamine in the brain, which appears to stabilize the sleep cycle and prevent early morning awakenings. Major depressive disorder involves complex shifts in brain chemistry that can lead to persistent low mood or excessive worry. This medication helps in treating depression by increasing the concentration of serotonin and norepinephrine in the brain, which may suggest an improvement in emotional regulation and a reduction in psychological distress. Doxepin’s effects on neurotransmitters in the brain also account for why it may be used for the treatment of anxiety disorders. It may also be used to treat itching associated with chronic hives (urticaria) or atopic dermatitis, due to its effects on histamine receptors.

Silenor Side Effects

Like any other medication, doxepin can cause a range of side effects, some of which are more common and others that are serious but rare. Some common side effects of this medication include constipation, dizziness, dry mouth, drowsiness, headache, nausea, and weight gain.

While serious side effects are rare, they can occur, especially in the case of an overdose or drug interactions. Therefore, if you experience any of the following, you should stop using the medication and seek immediate medical attention:
• Allergic reactions such as breathing difficulties, body itching, body rash, skin blistering, swelling of the face, mouth, tongue, lips, or throat;
• Cardiovascular problems such as fast, pounding, or irregular heartbeat, or fainting spells;
• Central nervous system effects such as confusion, disorientation, agitation, hallucinations, or seizures;
• Serotonin Syndrome with symptoms such as fever, seizures, muscle spasms or twitches, nausea, and vomiting;
• Urinating difficulties

Like other antidepressants, there is a risk of increased suicidal thoughts and behavior, especially in children, adolescents, and young adults (under 25), particularly when starting this medication or changing the dose. It is important to monitor individuals taking this medication, especially children and young adults, for unusual changes in behavior. Inform your doctor about any other side effects you notice that are not listed here.

Silenor Precautions

Do not use this oral medication if you are allergic to doxepin, other ingredients in Silenor, or other tricyclic antidepressants. Before you start taking this medication, ensure that you inform your doctor about any prior or current medical conditions, including the following:
• Blood disorders;
• Bipolar disorder/mania;
• Diabetes;
• Eye conditions such as glaucoma;
• Heart Disease;
• High blood pressure;
• Liver disease;
• Seizure disorders;
• Sleep apnea;
• Suicidal ideation and thoughts;
• Thyroid disease;
• Urinating difficulties

There is a risk of complex sleep behaviors while taking this medication, including sleep-driving, preparing food, or making phone calls while not fully awake and with no memory of the event afterward. Therefore, please don't drive or operate heavy machinery while taking this medication until you know how it affects you. Avoid the intake of alcohol as it can significantly increase sedation and worsen symptoms of depression. While there is no definitive evidence of major birth defects, taking the medication during the third trimester has been associated with neonatal withdrawal symptoms, including irritability, feeding problems, and respiratory distress in the newborn.

Therefore, do not use this medication during pregnancy unless recommended by your doctor. Doxepin is typically not recommended while breastfeeding as it can pass into breast milk in significant amounts. Some case reports have documented serious adverse effects in nursing infants, such as excessive sleepiness, poor sucking, and even episodes of shallow breathing (apnea), suggesting that alternative medications with a more established safety profile for breastfeeding are usually preferred.

It is important to avoid taking doxepin within 14 days of a monoamine oxidase inhibitor such as tranylcypromine and phenelzine, as this combination can lead to a life-threatening hypertensive crisis or serotonin syndrome. Inform your healthcare provider about all the medicines, including other topical medications, that you are taking before using doxepin to prevent potential drug interactions. Take a Silenor tablet 30 minutes before your planned bedtime. Your doctor will determine the appropriate dose of this medication for you. Ensure you can dedicate at least seven to eight hours to sleep before you need to be active again. Swallow the tablet whole; do not crush or chew it. Do not take this medication with or immediately after a meal, as high-fat foods specifically delay its onset and increase next-day grogginess. Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do I need a prescription to order Silenor?

Yes, a prescription is required from your physician to order Silenor.