Sonata vs. Silenor
See how Sonata and Silenor compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Sonata is approved for trouble falling asleep, while Silenor is approved for trouble staying asleep, so the right pick depends on your insomnia pattern.
Sonata is a Schedule IV controlled substance with a boxed warning for complex sleep behaviors, while Silenor is not controlled and carries no such warning.
Sonata typically costs far less out of pocket than Silenor, though actual costs depend on insurance coverage.
Sonata vs. Silenor Drug Summary
Sonata
Sonata (zaleplon) is a nonbenzodiazepine sedative-hypnotic approved for short-term treatment of insomnia in adults who have trouble falling asleep. It's taken as an oral capsule right before bed, or in the middle of the night if at least 4 hours of sleep time remain. It carries a boxed warning for complex sleep behaviors and is a Schedule IV controlled substance.
Silenor
Silenor (doxepin) is a tricyclic antidepressant used at very low doses to treat insomnia in adults who have trouble staying asleep. It's taken as an oral tablet once daily, roughly 30 minutes before bedtime. Unlike Sonata, it's not a controlled substance and carries no boxed warning for complex sleep behaviors.
Sonata vs. Silenor Side Effects
Sonata
Silenor
Sonata vs. Silenor Dosage
Sonata
Silenor
| STAGE | DOSE | WHEN |
| Starting dose | 5 mg once nightly | At the start |
| Maximum dose | 20 mg once nightly | If needed |
| Dose changes | 2 increases | As tolerated |
| 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 |
Sonata
| STAGE | DOSE | WHEN |
| Starting dose | 5 mg once nightly | At the start |
| Maximum dose | 20 mg once nightly | 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 |
Sonata vs. Silenor Indications
Sonata
Sonata is FDA-approved for short-term treatment of insomnia in adults who have trouble falling asleep. It is not approved for long-term nightly use or for children under 18.
Short-term treatment of insomnia in adults
Best suited for difficulty falling asleep
Not approved for chronic, nightly long-term use
Not approved for children or adolescents under 18
Silenor
Silenor is FDA-approved for insomnia characterized by difficulty staying asleep, not trouble falling asleep. At much higher doses, the underlying drug doxepin is used off-label for depression and anxiety, but Silenor itself is approved only for insomnia.
Treatment of sleep-maintenance insomnia in adults
Best suited for difficulty staying asleep through the night
Not approved for pediatric insomnia
Not approved for obstructive sleep apnea
Sonata vs. Silenor Pros and Cons
Sonata
Sonata is a fast-acting, short half-life hypnotic best suited for occasional trouble falling asleep, with dosing flexible enough to use in the middle of the night. As a controlled substance, it carries a boxed warning for complex sleep behaviors and is intended for short-term use only.
Pros
Costs far less out of pocket, roughly $25 to $115 per month versus $500 to $650 for Silenor
Very short half-life allows dosing mid-night if at least 4 hours of sleep remain
Metabolized by a pathway that avoids most CYP-related drug interactions
Approved specifically for trouble falling asleep, not just staying asleep
Cons
Carries a boxed warning for complex sleep behaviors like sleep-walking and sleep-driving
Classified as a Schedule IV controlled substance with potential for misuse
Contains tartrazine dye, which can trigger allergic reactions in sensitive people
Only approved for short-term use, not long-term nightly insomnia
Silenor
Silenor is a low-dose tricyclic antidepressant approved specifically for staying asleep through the night, without the abuse potential or complex sleep behavior warning that come with controlled sedative-hypnotics. It is not approved for trouble falling asleep, and its tricyclic origins bring their own set of contraindications.
Pros
Not a controlled substance, with no signal for abuse or dependence in studies
No boxed warning for complex sleep behaviors such as sleep-walking or sleep-driving
Approved specifically for difficulty staying asleep, a different insomnia pattern than Sonata targets
Uses doses far below antidepressant strength, limiting typical tricyclic side effects
Cons
Costs substantially more, roughly $500 to $650 per month versus $25 to $115 for Sonata
Not approved for trouble falling asleep, only for staying asleep
Cannot be combined with MAOIs and is contraindicated in untreated narrow-angle glaucoma or severe urinary retention
As a tricyclic antidepressant derivative, brings a different side-effect profile some patients may find harder to tolerate
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