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
Silenor
Lunesta vs. Silenor Dosage
Lunesta
Silenor
| 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 |
| 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
| 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
| 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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