Trazodone vs. Silenor

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

Andre Stone | MD

Medically reviewed by Andre Stone | MD, University of Pittsburgh School of Medicine on September 9th, 2026.

Key Takeaways

  • Trazodone is FDA-approved for depression and used off-label for sleep, while Silenor is FDA-approved specifically for sleep-maintenance insomnia.

  • Both medicines can cause drowsiness and may affect alertness the next day. Avoid alcohol and use caution with driving or other activities that require alertness until you know how the medicine affects you.

  • Generic trazodone is typically far cheaper than brand-name Silenor, though a doctor should weigh cost against each drug's approved use before choosing.

Trazodone vs. Silenor Drug Summary

Trazodone

Trazodone is a serotonin antagonist and reuptake inhibitor (SARI) antidepressant approved by the FDA to treat major depressive disorder in adults. At much lower doses, it is widely prescribed off-label as a sleep aid because it causes drowsiness. For depression it is taken in divided daily doses; for off-label sleep use it is typically taken once, at bedtime.

Silenor

Silenor is a tricyclic antidepressant (doxepin) that, at very low doses, acts mainly as a selective antihistamine rather than a standard antidepressant. It is FDA-approved specifically to treat insomnia in adults who have trouble staying asleep. It comes as a 3 mg or 6 mg tablet taken once daily, close to bedtime.

Trazodone vs. Silenor Side Effects

Trazodone

Most common
drowsiness (up to 41%)
dizziness (up to 28%)
headache (up to 20%)
nasal congestion (up to 14%)

Silenor

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

Trazodone vs. Silenor Dosage

Trazodone

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 25-50 mg at bedtime At the start
Maximum dose 50-100 mg at bedtime If needed
Dose changes 1 increase 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

Trazodone vs. Silenor Indications

Trazodone

Trazodone is FDA-approved to treat major depressive disorder in adults. It is also widely prescribed off-label, at much lower doses, to help with sleep problems, especially trouble staying asleep. This off-label sleep use is common in practice but has not been specifically studied or approved by the FDA.

  • FDA-approved for major depressive disorder (MDD) in adults

  • Off-label use for insomnia, especially sleep maintenance issues

  • Off-label use for anxiety, often when it occurs with depression

  • Not approved for use in children or teens

Silenor

Silenor is FDA-approved to treat insomnia marked by trouble staying asleep through the night. At its low 3 mg and 6 mg doses, it works mainly as an antihistamine rather than a typical antidepressant. Off-label, doxepin at much higher doses is also used to treat depression and anxiety.

  • FDA-approved for sleep-maintenance insomnia in adults

  • Off-label use for depression and anxiety at much higher doxepin doses

  • Not approved for pediatric insomnia

  • Not approved for obstructive sleep apnea

Trazodone vs. Silenor Pros and Cons

Trazodone

Trazodone's sedating effect makes it a popular off-label choice for sleep, backed by decades of clinical use in depression and sleep patients alike. Because it was studied and approved for depression rather than insomnia, its use as a sleep aid relies on clinical experience rather than an insomnia-specific label indication.

Pros

  • Generic and inexpensive, often just a few dollars per month with a discount coupon

  • Also FDA-approved for depression, useful if sleep problems overlap with low mood

  • Available in several tablet strengths, allowing dosing to be fine-tuned

Cons

  • Not FDA-approved for insomnia, so nightly dosing is based on experience, not a studied label dose

  • Carries a boxed warning for increased suicidal thoughts in children and young adults

  • Can cause priapism, a rare but medically urgent side effect in men

  • Higher rates of dizziness and lightheadedness, which can raise fall risk

Silenor

Silenor is the only low-dose doxepin product built and studied specifically for sleep-maintenance insomnia, so its label reflects that exact use. As a narrower, brand-name product, it has less flexibility and a much higher price than a multi-purpose generic like trazodone.

Pros

  • FDA-approved specifically for sleep-maintenance insomnia, backed by insomnia-focused trials

  • Very low doxepin dose limits the anticholinergic and cardiac effects seen at antidepressant doses

  • Simple fixed dosing, 3 mg or 6 mg, with no titration schedule to manage

Cons

  • Costs far more than generic trazodone, roughly $500 to $650 a month before savings programs, versus about $15 to $30 for trazodone

  • Only approved for staying asleep, not for trouble falling asleep

  • Not approved for depression or anxiety, despite being a low-dose antidepressant

  • Newer brand-name option, so there is less long-term real-world use than with trazodone

Common Symptoms and Related Diseases You Can Explore

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