Dayvigo vs. Silenor

See how Dayvigo and Silenor compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Dayvigo is a newer orexin blocker approved for both trouble falling asleep and staying asleep, while Silenor is a low-dose tricyclic approved only for staying asleep.

  • Dayvigo is a Schedule IV controlled substance with abuse potential, while Silenor has shown no abuse potential in studies and is not scheduled.

  • Both carry next-day sedation risk, but they work through completely different mechanisms: orexin blockade versus antihistamine action.

Dayvigo vs. Silenor Drug Summary

Dayvigo

Dayvigo (lemborexant) is a dual orexin receptor antagonist approved for adults who have trouble falling asleep, staying asleep, or both. It comes as a 5 mg or 10 mg tablet taken once nightly, close to bedtime, on an empty stomach if possible.

Silenor

Silenor (doxepin) is a tricyclic antidepressant used at very low doses to treat insomnia by blocking histamine receptors rather than by its antidepressant action. It comes as a 3 mg or 6 mg tablet taken once daily, within 30 minutes of bedtime.

Dayvigo vs. Silenor Side Effects

Dayvigo

Most common
Somnolence (up to 10%)
Headache (up to 6%)
Diarrhea (up to 3%)
Nasopharyngitis (up to 3%)

Silenor

Most common
Somnolence/sedation (up to 9%)
Hypertension (up to 3%)
Nausea (up to 2%)
Gastroenteritis (up to 2%)

Dayvigo vs. Silenor Dosage

Dayvigo

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 5 mg once nightly At the start
Maximum dose 10 mg once nightly If needed
Dose changes 1 increase As tolerated

Silenor

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 3 mg once daily At the start
Maximum dose 6 mg once daily If needed
Dose changes 1 increase As tolerated

Dayvigo vs. Silenor Indications

Dayvigo

Dayvigo is FDA-approved for adults with insomnia, covering both difficulty falling asleep and difficulty staying asleep. It works by blocking orexin receptors, which quiets the brain's wake-promoting signals rather than boosting sedation directly.

  • Difficulty falling asleep

  • Difficulty staying asleep

  • Adults only, not approved for children

  • Not approved for narcolepsy

Silenor

Silenor is FDA-approved specifically for insomnia involving trouble staying asleep, not for trouble falling asleep. At its low approved doses it acts mainly as an antihistamine rather than as a traditional antidepressant.

  • Difficulty staying asleep

  • Adults only, not approved for children

  • Off-label: depression and anxiety at much higher doses

  • Not approved for obstructive sleep apnea

Dayvigo vs. Silenor Pros and Cons

Dayvigo

Dayvigo covers a broader insomnia profile and has longer-term trial data showing sustained effect without rebound insomnia after stopping. As a controlled substance without a generic yet, cost and dependence risk are the main tradeoffs.

Pros

  • Approved for both falling asleep and staying asleep

  • Non-GABAergic mechanism, distinct from Z-drugs and benzodiazepines

  • 12-month trial data shows no rebound insomnia on stopping

Cons

  • Schedule IV controlled substance with dependence potential

  • Risk of complex sleep behaviors like sleep-walking or sleep-driving

  • No generic version currently available

  • Requires avoiding strong or moderate CYP3A interacting drugs

Silenor

Silenor's narrow approval and long history as an antidepressant mean it comes with more contraindications, but it is not a controlled substance and has shown no abuse potential. It costs more per month than Dayvigo on average.

Pros

  • Not a controlled substance, no reported abuse potential

  • Long clinical history as doxepin at higher doses

  • Non-controlled option for patients wary of dependence risk

Cons

  • Only approved for staying asleep, not falling asleep

  • Contraindicated with narrow-angle glaucoma or urinary retention

  • Cannot be used within two weeks of an MAOI

  • Roughly $500 to $650 per month, before savings programs

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