Doxepin vs. Ambien: Which One Should I Take?

Living with insomnia can leave you exhausted, and with so many insomnia treatment options available, finding the right medication can be a challenging process. 

In this article, we will compare two commonly prescribed insomnia medications—doxepin vs. Ambien. We will go over the major similarities and differences between these two medications so that you can be better informed when discussing treatment options with your healthcare provider. 

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What is Doxepin?

Doxepin, also known as Silenor, is a tricyclic antidepressant medication that is commonly used to treat anxiety and depression, but due to its sedating effects, it can also be used as an insomnia treatment medication as well. 

Tricyclics work by increasing the levels of important neurotransmitters, serotonin, and norepinephrine, within the brain. These neurotransmitters are essential for several important functions, including sleep, mood, appetite, and sex drive, to name a few. 

Doxepin Forms and Doses

Doxepin is available in capsules, tablets, an oral solution, and a topical cream. As with most psychiatric medication, the medication is started at a low dose of 75 mg and can be titrated up weekly but should not exceed 150 mg per day. 

Doxepin capsules are available in the dosages: 

• 10 mg 
• 25 mg 
• 50 mg 
• 75 mg 
• 100 mg 
• 150 mg 

Doxepin tablets are available in the dosage forms: 

• 3 mg 
• 6 mg 

Conditions Doxepin Treats

As stated above, doxepin is primarily used to treat anxiety and depression, as well as chronic insomnia. In addition, doxepin is available in a topical cream and is used to treat itching from some dermatological issues, such as eczema. Doxepin has also been shown to be effective in treating chronic pain conditions, including neuropathic or nerve pain. 

Doxepin Costs

The price of your prescription will depend on multiple factors, including health insurance coverage, the dosing of your medication, and which pharmacy you use. Doxepin is typically covered by most health insurance plans. 

If you are uninsured, the use of coupons can significantly reduce the cost of your medication from the retail price of around $50 to less than $10 for your 30-day supply. Coupons are available at most large pharmacies. 

Doxepin Side Effects

Tricyclic medications are associated with a number of adverse side effects that should be considered before starting one. The most common side effects are mild, but if you begin to experience any serious adverse effects after starting the medication, it is important to contact your healthcare provider immediately. 

Common side effects associated with doxepin include: 

• Agitation or confusion 
• Chills or cold sweats
• Headache 
• A sensation of burning, itching, or “pins and needles” on the skin 
• Dizziness upon standing 
• Muscle spasms, stiffness, twitching 

Serious side effects of doxepin include: 

• Signs of easy bruising or bleeding
• Chest pain or tightness
• Fast or irregular heartbeat 
• Blurred vision 
• Hearing loss 
• Seizures
• Loss of consciousness

Doxepin Warnings For Use

It is important to note a few warnings with the use of tricyclic antidepressants, such as doxepin. First and foremost, most antidepressants have a black box warning due to the potential risk of increased depression and suicidal ideation after starting the medication. This is a rare occurrence and is most common in those under the age of 24. 

Another rare but serious condition that may occur when starting a tricyclic medication is serotonin syndrome. This occurs when there are increased levels of serotonin within the body—this most commonly occurs when you are on more than one medication that increases levels of serotonin. If you begin to experience any of the following symptoms, contact your healthcare provider immediately: 

• Insomnia 
• Agitation or restlessness
• Increased heart rate and blood pressure 
• Fever and increased sweating 
• Vomiting, diarrhea 
• Muscle twitching, rigidity, or tremor 
• Confusion or altered consciousness 
• Seizures  

Lastly, tricyclic medications should not be taken during pregnancy due to the potential risk of adverse effects to both mom and baby. Common complications include miscarriage, preeclampsia, postpartum hemorrhage, or preterm labor. 

Doxepin Interactions

There are several medications that interact with doxepin, and it is important to disclose all medications you are currently taking with your healthcare provider, including all over-the-counter medications and supplements. 

Medications to avoid when taking doxepin include: 

• MAO inhibitors 
• Anticholinergic drugs 
• SSRIs or SNRIs
• Certain antihypertensive medications, such as clonidine
• Thyroid supplements
• Some antifungal medications
• Antiarrhythmic medications 
• St. John’s Wort

What is Ambien?

Ambien is the name brand of the generic drug Zolpidem, a sedative-hypnotic medication that is commonly prescribed for the treatment of insomnia. This medication acts on GABA inhibitory receptors in the brain to slow activity within the brain, promoting relaxation and progression into a sleep state. 

Ambien Forms and Doses

Ambien is available in a few different forms, including an oral solution, sublingual tablets, immediate-release, and extended-release tablets. The initial starting dose is typically 5 mg taken at night immediately before bed, and the dose can be titrated up as needed, with a maximum dose of 12.5 mg per day. 

Immediate-release tablets are available in the following forms: 

• 5 mg and 10 mg 

Extended-release tablets are available as: 

• 6.25 mg and 12.5 mg 

Sublingual Tablets are available as: 

• 1.75 mg, 3.5 mg, 5 mg, and 10 mg  

Conditions Ambien Treats

Ambien is only FDA-approved for the treatment of insomnia for those over the age of 18 years old. 

Ambien Costs

As with any medication, the price will significantly differ depending on insurance coverage, dosing, and which pharmacy you use. The average retail price of a 30-day supply of Ambien will cost over $700, but with the use of coupons, this price can be lowered to around $5-$40 for those who are uninsured. 

Ambien Side Effects

Ambien is associated with several side effects and it is important that you are closely monitored when starting the medication. Most of the common side effects are mild, but there are a few serious adverse effects that can be fatal and will be thoroughly discussed in the warnings section. 

Common side effects associated with Ambien: 

• Drowsiness
• Headache 
• GI upset, including nausea, abdominal pain, dry mouth, constipation, or diarrhea
• Loss of coordination 
• Confusion 
• Changes in mood or mental state
• New or worsening anxiety or depression 
• Visual changes
• Muscle pain 
• Congestion
• Complex sleep behaviors, such as sleepwalking or sleep-driving 

Ambien Warnings For Use

Ambien is classified as a Schedule IV controlled substance by the FDA, indicating its potential for abuse and dependence. Ambien should only be used short-term, as it carries a high risk for physical dependence . Long-term misuse of Ambien may result in increased tolerance, difficulty sleeping without the medication, and withdrawal symptoms upon discontinuation.

To minimize the risk of dependency, it is crucial to use Ambien as prescribed and limit its use to short-term treatment. The FDA recommends a maximum treatment duration of four weeks due to the potential for dependence. It is important to strictly follow the prescribed dosage and duration and communicate openly with a healthcare professional about any concerns.

Complex sleep behaviors are a serious adverse effect of Ambien. Your healthcare provider should monitor them when you initially start the medication. Complex sleep behaviors are actions performed when the individual is not fully awake or conscious. This includes sleepwalking or sleep-driving, which can be dangerous, not only for the person engaging in these behaviors, but also those around them. 

Ambien Interactions

Ambien has a few drug interactions that can have dangerous outcomes. It is important to disclose all medications that you are currently taking with your healthcare provider, including all over-the-counter medications and supplements. 

Medications to avoid while taking Ambien includes: 

• Opioid pain medications
• Antidepressants, including Lexapro, Lyrica, and Zoloft, to name a few
• Other central nervous system depressants, including alcohol and benzodiazepines 
• Muscle relaxants
• Other insomnia medications 
• Certain antihypertensive medications, including Lisinopril 

Which Insomnia Medication Should I Take?

With so many insomnia treatment options available, finding the right medication for you can be challenging. After your thorough evaluation, your healthcare provider will help determine which medications may be best for you.

Start Your Insomnia Treatment Today With Healthcare Providers on Klarity Health

Insomnia can have serious implications for your mental and physical health. It is important not to let your symptoms go untreated, and Klarity Health can help. 

At Klarity Health, we believe everyone should have access to mental health care from the comfort of their own home. There are no insurance or monthly subscriptions needed, and most importantly, no hidden fees. 

Schedule an appointment on Klarity Health today and we will connect you with a licensed healthcare provider in your state within 48 hours. Let the providers on Klarity Health help you get the sleep you deserve. 

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