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

Most common
Headache (up to 28%)
Nausea (up to 7%)
Dizziness (up to 7%)
Somnolence (up to 5%)

Silenor

Most common
Somnolence/sedation (up to 9%)
Hypertension (up to 3%)
Nausea (up to 2%)
Gastroenteritis (up to 2%)

Sonata vs. Silenor Dosage

Sonata

Dosage
Dosage Table
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

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

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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