Lunesta vs. Silenor

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

Key Takeaways

  • Lunesta is a controlled-substance sleep aid taken nightly at 1 mg to 3 mg, while Silenor is a low-dose tricyclic antidepressant taken at 3 mg or 6 mg that is not a controlled substance.

  • Lunesta's most common side effect is an unpleasant metallic taste, while Silenor's most common side effect is mild daytime sleepiness.

  • Silenor is approved specifically for trouble staying asleep, while Lunesta is approved more broadly for insomnia, including trouble falling asleep.

Lunesta vs. Silenor Drug Summary

Lunesta

Lunesta (eszopiclone) is a nonbenzodiazepine hypnotic used to treat insomnia in adults. It's taken as a single tablet by mouth right before bed, at a dose of 1 mg, 2 mg, or 3 mg depending on the patient. It has been available since 2004, and generic versions are now widely used.

Silenor

Silenor (doxepin) is a tricyclic antidepressant used at very low doses as a selective sleep medication. It's taken as a single 3 mg or 6 mg tablet by mouth about 30 minutes before bedtime. At much higher doses, the same drug is used off-label for depression and anxiety, but Silenor itself is approved only for insomnia.

Lunesta vs. Silenor Side Effects

Lunesta

Most common
Unpleasant taste (up to 26%)
Headache (up to 15%)
Dry mouth (1% to 10%)
Somnolence (1% to 10%)

Silenor

Most common
Somnolence/sedation (up to 9%)
Upper respiratory infection (up to 4%)
Hypertension (up to 3%)
Nausea (up to 2%)

Lunesta vs. Silenor Dosage

Lunesta

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 1 mg once daily At the start
Maximum dose 3 mg once daily If needed
Dose changes 2 increases 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

Lunesta vs. Silenor Indications

Lunesta

Lunesta is FDA-approved to treat insomnia in adults, helping with both falling asleep and staying asleep. It is not approved for use in children. Most people take it nightly, right before getting into bed, since it works quickly.

  • Treats difficulty falling asleep

  • Treats difficulty staying asleep

  • Approved for adults only

  • Works within about 30 minutes

Silenor

Silenor is FDA-approved specifically for insomnia involving trouble staying asleep through the night, rather than trouble falling asleep. It is not approved for children or for treating sleep apnea. Higher doses of the same drug, doxepin, are used off-label for depression and anxiety.

  • Treats difficulty staying asleep

  • Not approved for falling asleep issues

  • Approved for adults only

  • Works within about 30 minutes

Lunesta vs. Silenor Pros and Cons

Lunesta

Lunesta has been available since 2004 and offers flexible dosing across three strengths depending on response and tolerability. It's a Schedule IV controlled substance, so it carries some abuse potential and stricter prescribing rules than non-controlled options.

Pros

  • Three dose strengths for tailored dosing

  • Long track record since its 2004 approval

  • Generic eszopiclone widely available

  • Effective for both falling and staying asleep

Cons

  • Schedule IV controlled substance with abuse risk

  • Unpleasant taste is a common side effect

  • Risk of complex sleep behaviors like sleepwalking

  • Roughly $1,300 to $1,600 per month without insurance, before savings programs

Silenor

Silenor's active ingredient, doxepin, is not a controlled substance and has shown no evidence of abuse potential in clinical studies. It's approved for a narrower indication than Lunesta, covering only sleep-maintenance insomnia, and it carries tricyclic antidepressant-related warnings.

Pros

  • Not a controlled substance, no abuse potential

  • Fewer reported side effects overall

  • Non-habit-forming option for long-term use

  • Roughly $500 to $650 per month without insurance, before savings programs

Cons

  • Approved only for sleep-maintenance insomnia

  • Tricyclic class carries anticholinergic/cardiac warnings

  • Contraindicated with MAOIs and narrow-angle glaucoma

  • Only two dose strengths, less flexibility

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