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

Most common
somnolence/sedation (up to 9%)
upper respiratory tract infection/nasopharyngitis (up to 4%)
hypertension (up to 3%)
nausea (up to 2%)

Halcion

Most common
drowsiness (up to 4%)
dizziness (up to 4%)
light-headedness (up to 4%)
coordination disorder/ataxia (up to 4%)

Silenor vs. Halcion Dosage

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

Halcion

Dosage
Dosage Table
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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