Silenor vs. Halcion
See how Silenor and Halcion compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Silenor is a low-dose tricyclic antidepressant approved for sleep maintenance insomnia and is not a controlled substance, while Halcion is a fast-acting benzodiazepine meant only for short-term use.
Halcion carries an FDA boxed warning for abuse, dependence, and dangerous interactions with opioids, risks that Silenor does not carry.
Halcion typically costs far less per month than Silenor, but Silenor can be used long-term without the withdrawal risks tied to benzodiazepines.
Silenor vs. Halcion Drug Summary
Silenor
Silenor (doxepin hydrochloride) is a tricyclic antidepressant used at very low doses as a selective antihistamine to treat insomnia, specifically trouble staying asleep. It comes as an oral tablet taken once daily near bedtime and is not classified as a controlled substance.
Halcion
Halcion (triazolam) is a benzodiazepine, a Schedule IV controlled substance, approved for short-term insomnia treatment lasting about 7 to 10 days. It is taken as an oral tablet once daily at bedtime and works quickly to help with falling asleep.
Silenor vs. Halcion Side Effects
Silenor
Halcion
Silenor vs. Halcion Dosage
Silenor
Halcion
| 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 |
| STAGE | DOSE | WHEN |
| Starting dose | 0.125 mg once daily | At the start |
| Maximum dose | 0.5 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 |
Halcion
| STAGE | DOSE | WHEN |
| Starting dose | 0.125 mg once daily | At the start |
| Maximum dose | 0.5 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Silenor vs. Halcion Indications
Silenor
Silenor is FDA-approved specifically for insomnia involving difficulty staying asleep through the night, not trouble falling asleep. It is sometimes used off-label at much higher doses to treat depression and anxiety, since doxepin was originally developed as an antidepressant.
Treats sleep maintenance insomnia (staying asleep)
Off-label use for depression and anxiety at higher doses
Not approved for pediatric insomnia
Not approved for obstructive sleep apnea
Halcion
Halcion is FDA-approved only for short-term treatment of insomnia, generally limited to about 7 to 10 days. It is not intended for ongoing nightly use, and providers are expected to re-evaluate patients if longer treatment seems necessary.
Short-term insomnia treatment (7 to 10 days)
Not approved for long-term nightly use
Schedule IV controlled substance
Requires re-evaluation for continued use
Silenor vs. Halcion Pros and Cons
Silenor
Silenor's low-dose antihistamine mechanism gives it a milder side effect profile than benzodiazepine hypnotics, and it is not scheduled as a controlled substance. Its list price is markedly higher than older generic sleep aids, and insurance coverage can be inconsistent.
Pros
Not a controlled substance, no addiction risk shown in studies
Can be used long-term without withdrawal concerns
Lower risk of next-day sedation than benzodiazepines
Cons
Roughly $500 to $650 per month without insurance, much more than Halcion
Not recommended in patients with severe sleep apnea
Can raise blood pressure in some patients
Contraindicated with MAOIs, narrow-angle glaucoma, or urinary retention
Halcion
Halcion works quickly and is available at a fraction of Silenor's cost, but it carries the same boxed warnings for abuse and dependence as other benzodiazepines. It is intended only for brief use, with dosing that must be carefully individualized in older adults.
Pros
Roughly $20 to $65 per month without insurance, far less than Silenor
Multiple dose strengths allow flexible titration
Fast onset helps with falling asleep quickly
Cons
Boxed warning for abuse, misuse, and addiction
Boxed warning for dangerous interaction with opioids
Higher risk of anterograde amnesia than other benzodiazepines
Abrupt stopping can cause severe withdrawal reactions
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