Silenor vs. Restoril

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

Key Takeaways

  • Silenor is a low-dose tricyclic antihistamine approved for sleep maintenance insomnia and is not a controlled substance, while Restoril is a Schedule IV benzodiazepine with a boxed warning for abuse and dependence.

  • Restoril is only recommended for short-term use of 7 to 10 days, while Silenor's low-dose formulation has data supporting longer-term nightly use.

  • Both drugs can cause next-day drowsiness, so anyone taking either should avoid alcohol and be cautious about morning driving.

Silenor vs. Restoril Drug Summary

Silenor

Silenor (doxepin) is a tricyclic antidepressant used at very low doses to block histamine receptors and promote sleep. It is FDA approved specifically for insomnia involving trouble staying asleep. Patients take one tablet, either 3 mg or 6 mg, about 30 minutes before bedtime.

Restoril

Restoril (temazepam) is a benzodiazepine hypnotic that enhances the calming effect of GABA in the brain to help people fall and stay asleep. It is FDA approved for short-term insomnia treatment only. Patients take one capsule, ranging from 7.5 mg to 30 mg, at bedtime.

Silenor vs. Restoril Side Effects

Silenor

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

Restoril

Most common
drowsiness (up to 9.1%)
headache (up to 8.5%)
fatigue (up to 4.8%)
nervousness (up to 4.6%)

Silenor vs. Restoril 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

Restoril

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 7.5 mg once daily At the start
Maximum dose 30 mg once daily If needed
Dose changes 3 increases As tolerated

Silenor vs. Restoril Indications

Silenor

Silenor is approved for people who fall asleep fine but wake up during the night or too early. It works by blocking histamine signals that promote wakefulness, at doses far below those used for depression. It is meant to be taken nightly on an ongoing basis, not just for a short course.

  • FDA approved for sleep maintenance insomnia

  • Not approved for pediatric insomnia or sleep apnea

  • Often used off-label at higher doses for depression or anxiety

  • Not recommended for people with severe sleep apnea

Restoril

Restoril is approved for short-term insomnia, typically used for 7 to 10 nights at a time. It works by boosting a calming brain chemical called GABA, which helps people fall asleep faster and stay asleep longer. It is not intended for routine long-term nightly use.

  • FDA approved for short-term insomnia only

  • Not approved for anxiety disorders

  • Not recommended for use beyond 7 to 10 days

  • Lower starting dose advised for elderly patients

Silenor vs. Restoril Pros and Cons

Silenor

Silenor's clinical profile centers on low abuse risk and suitability for longer-term use, though insurance coverage can be inconsistent given its list price. It is a reasonable option for people who specifically struggle with staying asleep rather than falling asleep. Its side effect profile is generally milder than benzodiazepine hypnotics.

Pros

  • Not a controlled substance and shows no significant abuse potential

  • Can be used nightly on an ongoing basis, unlike short-term hypnotics

  • No boxed warning for dependence or withdrawal

Cons

  • Only approved for sleep maintenance, not trouble falling asleep

  • Roughly $500 to $650 per month without insurance, before savings programs

  • Not effective for immediate, single-night sleep needs

  • Contraindicated with untreated glaucoma or severe urinary retention

Restoril

Restoril has decades of use and can work quickly for both falling asleep and staying asleep, but it carries a boxed warning for abuse, dependence, and dangerous interactions with opioids. It is best suited for brief, defined periods of insomnia rather than ongoing nightly use. Its cost is notably higher than many alternatives.

Pros

  • Effective for both sleep onset and sleep maintenance difficulty

  • Multiple dose strengths allow more individualized titration

  • Long track record of use since 1981

Cons

  • Schedule IV controlled substance with abuse and dependence risk

  • Boxed warning for fatal interactions with opioids

  • Not intended for use beyond 7 to 10 days

  • Roughly $920 to $1,270 per month without insurance, before savings programs

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