Living with insomnia can leave you exhausted, and with so many insomnia treatment options available, finding the right medication can be a challenging process.
In this article, we will compare two commonly prescribed insomnia medications—doxepin vs. Ambien. We will go over the major similarities and differences between these two medications so that you can be better informed when discussing treatment options with your healthcare provider.
If you are experiencing disturbances to your sleep-wake cycle on a regular basis, you may benefit from insomnia treatment, and Klarity can help. Schedule an appointment today and be seen by a licensed healthcare provider within 48 hours.
|Drug Class||Tricyclic antidepressant||Sedative-hypnotic|
|Brand / Generic Status||Generic (Brand name: Silenor)||Brand name for zolpidem|
|Form(s) of the Drug||• Immediate-release capsules|
• Immediate-release tablets
• Clear, blueberry-mint flavored liquid suspension
• Topical cream (for itching)
|• Immediate-release tablet
• Extended-release tablet
• Nasal spray
|Standard Dosage||Immediate-release capsule:|
• 10mg per dose
• 5% formula
• 5mg per metered spray
|Typical Treatment Length||Short-term use only||Long-term use
|Conditions Treated||FDA-approved uses:|
• Major depressive disorder
• Anxiety disorder
• Itchiness due to atopic dermatitis, pruritus, or lichen simplex chronicus
• Topical neuropathic pain
|Cost||Brand name (Silenor): |
• $32 to $525 for a 30-day supply
Generic form (doxepin)
• $36 to $90 for a 30-day supply
• $8 for a 30-day supply with coupons/discounts
• $668 for a 30-day supply
• $8.30 to $58 for a 30-day supply (with insurance)
• $21.64 per pill (without insurance)
|Side-Effects||Common side effects:|
• Agitation, confusion
• Black, tarry stools, bleeding gums, blood in urine or stool
• Blurred vision
• A sensation of burning, itching, or “pins and needles” on the skin
• Chest pain or tightness, fast or irregular heartbeat
• Chills, cold sweats
• Urinary retention
• Dizziness upon standing, loss of consciousness
• Hearing loss
• Muscle spasms, stiffness, twitching
|Common side effects:
• Loss of coordination or balance
• Dry mouth
• Stomach ache
• Muscle pain
• Visual changes
Serious side effects:
• Memory loss
• Changes in behavior
• Suicidal ideation
|Warnings For Use||Drug interactions:|
• Thyroid supplements
• Anticholinergic drugs
• Some blood pressure medications: clonidine
• MAO inhibitors: isocarboxazid, linezolid, metaxalone, methylene blue
• St. John's Wort
• Drugs to treat irregular heart rate
• Alcohol intoxication
• Drug dependence
• Liver disease
• Renal dysfunction
• Liver disease
• Respiratory depression
What is Doxepin?
Doxepin, also known as Silenor, is a tricyclic antidepressant medication that is commonly used to treat anxiety and depression, but due to its sedating effects, it can also be used as an insomnia treatment medication as well.
Tricyclics work by increasing the levels of important neurotransmitters, serotonin, and norepinephrine, within the brain. These neurotransmitters are essential for several important functions, including sleep, mood, appetite, and sex drive, to name a few.
Doxepin Forms and Doses
Doxepin is available in capsules, tablets, an oral solution, and a topical cream. As with most psychiatric medication, the medication is started at a low dose of 75 mg and can be titrated up weekly but should not exceed 150 mg per day.
Doxepin capsules are available in the dosages:
- 10 mg
- 25 mg
- 50 mg
- 75 mg
- 100 mg
- 150 mg
Doxepin tablets are available in the dosage forms:
- 3 mg
- 6 mg
Conditions Doxepin Treats
As stated above, doxepin is primarily used to treat anxiety and depression, as well as chronic insomnia. In addition, doxepin is available in a topical cream and is used to treat itching from some dermatological issues, such as eczema. Doxepin has also been shown to be effective in treating chronic pain conditions, including neuropathic or nerve pain.
The price of your prescription will depend on multiple factors, including health insurance coverage, the dosing of your medication, and which pharmacy you use. Doxepin is typically covered by most health insurance plans.
If you are uninsured, the use of coupons can significantly reduce the cost of your medication from the retail price of around $50 to less than $10 for your 30-day supply. Coupons are available at most large pharmacies.
Doxepin Side Effects
Tricyclic medications are associated with a number of adverse side effects that should be considered before starting one. The most common side effects are mild, but if you begin to experience any serious adverse effects after starting the medication, it is important to contact your healthcare provider immediately.
Common side effects associated with doxepin include:
- Agitation or confusion
- Chills or cold sweats
- A sensation of burning, itching, or “pins and needles” on the skin
- Dizziness upon standing
- Muscle spasms, stiffness, twitching
Serious side effects of doxepin include:
- Signs of easy bruising or bleeding
- Chest pain or tightness
- Fast or irregular heartbeat
- Blurred vision
- Hearing loss
- Loss of consciousness
Doxepin Warnings For Use
It is important to note a few warnings with the use of tricyclic antidepressants, such as doxepin. First and foremost, most antidepressants have a black box warning due to the potential risk of increased depression and suicidal ideation after starting the medication. This is a rare occurrence and is most common in those under the age of 24.
Another rare but serious condition that may occur when starting a tricyclic medication is serotonin syndrome. This occurs when there are increased levels of serotonin within the body—this most commonly occurs when you are on more than one medication that increases levels of serotonin. If you begin to experience any of the following symptoms, contact your healthcare provider immediately:
- Agitation or restlessness
- Increased heart rate and blood pressure
- Fever and increased sweating
- Vomiting, diarrhea
- Muscle twitching, rigidity, or tremor
- Confusion or altered consciousness
Lastly, tricyclic medications should not be taken during pregnancy due to the potential risk of adverse effects to both mom and baby. Common complications include miscarriage, preeclampsia, postpartum hemorrhage, or preterm labor.
There are several medications that interact with doxepin, and it is important to disclose all medications you are currently taking with your healthcare provider, including all over-the-counter medications and supplements.
Medications to avoid when taking doxepin include:
- MAO inhibitors
- Anticholinergic drugs
- SSRIs or SNRIs
- Certain antihypertensive medications, such as clonidine
- Thyroid supplements
- Some antifungal medications
- Antiarrhythmic medications
- St. John’s Wort
What is Ambien?
Ambien is the name brand of the generic drug Zolpidem, a sedative-hypnotic medication that is commonly prescribed for the treatment of insomnia. This medication acts on GABA inhibitory receptors in the brain to slow activity within the brain, promoting relaxation and progression into a sleep state.
Ambien Forms and Doses
Ambien is available in a few different forms, including an oral solution, sublingual tablets, immediate-release, and extended-release tablets. The initial starting dose is typically 5 mg taken at night immediately before bed, and the dose can be titrated up as needed, with a maximum dose of 12.5 mg per day.
Immediate-release tablets are available in the following forms:
- 5 mg and 10 mg
Extended-release tablets are available as:
- 6.25 mg and 12.5 mg
Sublingual Tablets are available as:
- 1.75 mg, 3.5 mg, 5 mg, and 10 mg
Conditions Ambien Treats
Ambien is only FDA-approved for the treatment of insomnia for those over the age of 18 years old.
As with any medication, the price will significantly differ depending on insurance coverage, dosing, and which pharmacy you use. The average retail price of a 30-day supply of Ambien will cost over $700, but with the use of coupons, this price can be lowered to around $5-$40 for those who are uninsured.
Ambien Side Effects
Ambien is associated with several side effects and it is important that you are closely monitored when starting the medication. Most of the common side effects are mild, but there are a few serious adverse effects that can be fatal and will be thoroughly discussed in the warnings section.
Common side effects associated with Ambien:
- GI upset, including nausea, abdominal pain, dry mouth, constipation, or diarrhea
- Loss of coordination
- Changes in mood or mental state
- New or worsening anxiety or depression
- Visual changes
- Muscle pain
- Complex sleep behaviors, such as sleepwalking or sleep-driving
Ambien Warnings For Use
Ambien is classified as a Schedule IV controlled substance by the FDA, indicating its potential for abuse and dependence. Ambien should only be used short-term, as it carries a high risk for physical dependence . Long-term misuse of Ambien may result in increased tolerance, difficulty sleeping without the medication, and withdrawal symptoms upon discontinuation.
To minimize the risk of dependency, it is crucial to use Ambien as prescribed and limit its use to short-term treatment. The FDA recommends a maximum treatment duration of four weeks due to the potential for dependence. It is important to strictly follow the prescribed dosage and duration and communicate openly with a healthcare professional about any concerns.
Complex sleep behaviors are a serious adverse effect of Ambien. Your healthcare provider should monitor them when you initially start the medication. Complex sleep behaviors are actions performed when the individual is not fully awake or conscious. This includes sleepwalking or sleep-driving, which can be dangerous, not only for the person engaging in these behaviors, but also those around them.
Ambien has a few drug interactions that can have dangerous outcomes. It is important to disclose all medications that you are currently taking with your healthcare provider, including all over-the-counter medications and supplements.
Medications to avoid while taking Ambien includes:
- Opioid pain medications
- Antidepressants, including Lexapro, Lyrica, and Zoloft, to name a few
- Other central nervous system depressants, including alcohol and benzodiazepines
- Muscle relaxants
- Other insomnia medications
- Certain antihypertensive medications, including Lisinopril
Licensed providers on Klarity provide personalized mental health treatment. Find a provider that matches your needs and preferences.
Which Insomnia Medication Should I Take?
With so many insomnia treatment options available, finding the right medication for you can be challenging. After your thorough evaluation, your healthcare provider will help determine which medications may be best for you.
Doxepin and Ambien Frequently Asked Questions
Comparing different insomnia medications can be confusing, and it is normal to have additional questions. Below we have answered the most commonly asked questions about doxepin and Ambien:
Are Doxepin and Ambien the same class of drug?
No, these medications belong to two different classes of drugs. Doxepin is a tricyclic antidepressant, and Ambien is considered to be a unique sedative-hypnotic that acts on GABA receptors within the brain.
What’s better for Insomnia? Doxepin or Ambien?
In terms of potency and efficacy, Ambien is considered to be a better medication for insomnia. Although, depending on the severity of your symptoms and your medical history, doxepin may be a better medication for you. Your healthcare provider will help determine which medication is best for you.
How should Doxepin be taken? How should Ambien be taken?
Both doxepin and Ambien should be taken at night, immediately before bedtime. These medications have sedative effects and, therefore, should not be taken during the day.
Can Doxepin cause depression? Can Ambien?
Both doxepin and Ambien have the potential risk of causing new or worsening depression. Although, it is important to note that this is much less common in doxepin, as it is an antidepressant medication and will likely cause improvement in depressive symptoms.
Can I drive on Doxepin or Ambien?
No, you should not drive or operate heavy machinery after taking either medication. These medications have a sedative effect and driving can be dangerous for everyone involved.
Can I drink alcohol when taking Doxepin or Ambien?
You should avoid drinking alcohol while taking either medication, as alcohol is a central nervous system depressant, and mixing the two can cause dangerous sedative effects.
Does it matter what time of day I take Doxepin or Ambien?
Yes, it is important to take either medication at night or immediately before bedtime. These medications should not be taken during the day because of their sedative effects.
Start Your Insomnia Treatment Today With Healthcare Providers on Klarity
Insomnia can have serious implications for your mental and physical health. It is important not to let your symptoms go untreated, and Klarity can help.
At Klarity, we believe everyone should have access to affordable mental health care, all from the comfort of their own home. There is no insurance or monthly subscriptions necessary, and most importantly, no hidden fees.
Schedule an appointment on Klarity today and we will connect you with a licensed healthcare provider in your state within 48 hours. Let the providers on Klarity help you get the sleep you deserve.
“Doxepin: Drug Information” UpToDate. https://www.uptodate.com/contents/doxepin-systemic-drug-information?search=doxepin%20uses&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1&showDrugLabel=true#F8082233
“Doxepin Prices, Coupons and Patient Assistance Programs” Drugs.com. https://www.drugs.com/price-guide/doxepin
“Zolpidem: Drug information” UpToDate. https://www.uptodate.com/contents/zolpidem-drug-information?search=ambien&source=search_result&selectedTitle=1~50&usage_type=panel&kp_tab=drug_general&display_rank=1
“Zolpidem” GoodRx. https://www.goodrx.com/zolpidem