Silenor vs. Hydroxyzine

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

Key Takeaways

  • Silenor is FDA-approved specifically for insomnia and taken once nightly, while hydroxyzine is approved for anxiety and itching and used for sleep off-label at multiple daily doses.

  • Hydroxyzine causes drowsiness in up to 28% of users, compared with up to 9% for Silenor, though individual reactions vary.

  • Generic hydroxyzine typically costs far less per month than brand-name Silenor, though insurance coverage can change the real-world price for either drug.

Silenor vs. Hydroxyzine Drug Summary

Silenor

Silenor (doxepin) is a tricyclic antidepressant used at very low doses as a selective antihistamine to treat insomnia. It is FDA-approved specifically for people who have trouble staying asleep through the night, and it is taken as a single 3 mg or 6 mg tablet about 30 minutes before bed.

Hydroxyzine

Hydroxyzine is a first-generation antihistamine FDA-approved to treat anxiety and itching from allergic skin conditions. It is taken as a 50 mg to 100 mg dose up to four times a day, and many people also use it off-label at bedtime for occasional sleeplessness.

Silenor vs. Hydroxyzine 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%)

Hydroxyzine

Most common
Drowsiness (up to 28%)
Dry mouth (up to 14%)
Weight gain (up to 12%)
Trouble concentrating (up to 9%)

Silenor vs. Hydroxyzine 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

Hydroxyzine

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 50-100 mg At the start
Maximum dose 50-100 mg Same as starting
Dose changes None Fixed dose

Silenor vs. Hydroxyzine Indications

Silenor

Silenor is FDA-approved for insomnia, specifically for people who have trouble staying asleep through the night. It is low-dose doxepin, a tricyclic antidepressant repurposed at a fraction of the dose used for depression. Doctors sometimes prescribe higher-dose doxepin off-label to treat depression or anxiety.

  • Approved for sleep maintenance insomnia

  • Not approved for pediatric insomnia

  • Not approved for obstructive sleep apnea

  • Off-label: depression and anxiety at higher doses

Hydroxyzine

Hydroxyzine is FDA-approved to relieve anxiety and tension, and to control itching from allergic skin conditions. It is also approved as a sedative before and after anesthesia. Many people use hydroxyzine off-label for occasional sleeplessness, taking advantage of its sedating antihistamine effect.

  • Approved for anxiety and tension

  • Approved for allergic itching (pruritus)

  • Approved as a pre/post-anesthesia sedative

  • Off-label: used for occasional insomnia

Silenor vs. Hydroxyzine Pros and Cons

Silenor

Silenor is the only drug here specifically FDA-approved for insomnia, and it only requires one dose at bedtime. As a low-dose tricyclic antidepressant, it is not a controlled substance, but insurance plans may require you to try cheaper options first.

Pros

  • Only drug here FDA-approved for insomnia

  • Taken once daily instead of multiple times

  • Not a controlled substance, low abuse potential

  • Lower reported rates of drowsiness and dry mouth in trials

Cons

  • Costs roughly $500 to $650 per month without insurance

  • Contraindicated with MAOIs, narrow-angle glaucoma, and severe urinary retention

  • Newer brand-name drug, may face insurance step-therapy requirements

  • Not approved for anxiety or itching relief

Hydroxyzine

Hydroxyzine is a decades-old antihistamine approved for anxiety and itching, not insomnia, so using it for sleep is off-label. It is taken multiple times a day, but its long track record and low generic cost make it accessible for many patients.

Pros

  • Generic and inexpensive, roughly $30 to $160 per month without insurance

  • Also treats anxiety and allergic itching, not just sleep

  • Long history of clinical use dating back decades

  • Can be dosed flexibly throughout the day for anxiety symptoms

Cons

  • Not FDA-approved for insomnia; use for sleep is off-label

  • Requires dosing up to four times a day

  • Higher rates of drowsiness and dry mouth than Silenor in trials

  • Not recommended for anxiety longer than four months without reassessment

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