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
Silenor
Dayvigo vs. Silenor Dosage
Dayvigo
Silenor
| 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 |
| 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
| 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
| 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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