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
Hydroxyzine
Silenor vs. Hydroxyzine Dosage
Silenor
Hydroxyzine
| 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 | 50-100 mg | At the start |
| Maximum dose | 50-100 mg | Same as starting |
| Dose changes | None | Fixed dose |
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 |
Hydroxyzine
| 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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