Lunesta vs. Doxepin: What’s the Difference and Which One Should I Take?

If you’re having trouble sleeping at night, you are not alone. It is estimated that every year, nearly 70 million Americans are affected by insomnia symptoms, which is estimated to be about one-third of the adult population. 

Luckily, many treatment options target specific symptoms associated with sleep disturbances and treat the underlying cause of your insomnia. In this article, we will discuss two popular medications used for treating insomnia, Lunesta and Doxepin. 

If you need a compassionate healthcare provider who is experienced in treating insomnia or other sleep disturbances, Klarity Health can help. Schedule an appointment, and we will connect you with a licensed provider within 48 hours who will help you determine which, if any, sleep medication is best for you. 

This article discusses suicide, suicidal ideation, and self-harm. If you or someone you know is experiencing suicidal thoughts or is in crisis, contact the Suicide Prevention Lifeline immediately at 800-273-8255.

What is Lunesta?

Lunesta or eszopiclone is a unique drug and is considered a sedative-hypnotic medication. This medication works by activating and modulating GABA inhibitory receptors.  These GABA receptors, when activated, slow down the signaling and activity within the brain, resulting in sedation and allowing the brain to enter a sleep state.  

Lunesta Forms and Doses

Lunesta or its generic equivalent, eszopiclone, are available in tablets only. When taking the medication, your healthcare provider will start you on the lowest dose of a 1 mg tablet, to be taken immediately before bed. 

The dose can be increased over time, as needed, but should not exceed 3 mg daily. Lunesta is considered a schedule-IV controlled substance due to its potential for abuse and dependence. After long-term continuous use, you will need to be slowly tapered off of the medication. 

Lunesta tablets are available in the following doses: 

• 1 mg 
• 2 mg 
• 3 mg

Conditions Lunesta Treats

Lunesta is FDA-approved to treat insomnia, primarily for those who have problems with sleep onset, or falling asleep, and sleep maintenance, or staying asleep throughout the night. 

Insomnia

Insomnia is a fairly common sleep disturbance or disorder and can also present differently from person to person. Some may experience difficulty falling asleep, while others may not be able to stay asleep, with frequent nighttime awakenings or an inability to enter a deep sleep state.  

Overall, your sleep pattern is disturbed, and you’re not getting the good quality sleep your body needs. Without adequate sleep, your body cannot function properly, physically and cognitively. The effects of sleep deprivation can have detrimental effects on your personal and professional lives.

Some common secondary symptoms caused by insomnia include: 

• Excessive daytime sleepiness
• Lack of motivation or energy 
• Difficulty concentrating  
• Increased anxiety or depressive symptoms 
• Irritability or agitation 
• Increased appetite
• Changes in memory 

Lunesta Costs

In comparison to Doxepin, Lunesta is fairly expensive. The price of your medication will vary based on your dose, insurance coverage, and the pharmacy you use. 

The average retail price for name-brand Lunesta is roughly $586 for a month’s supply without insurance. For uninsured people, large name-brand pharmacies have coupon codes that significantly lower the cost of a 30-day supply to under $7.  

Lunesta Side Effects

As with most medications, there are associated risks you should consider before starting a new medication. The majority of the adverse effects associated with Lunesta are mild, but if you start to experience severe or bothersome side effects after starting the medication, call your healthcare provider immediately, 

Some of the most common side effects associated with Lunesta include: 

• Headache 
• Dry mouth
• GI upset, including nausea, diarrhea
• Drowsiness or dizziness 
• Increased anxiety or depression 
• Abnormal dreams 
• Hallucinations 
• Skin rash 

Lunesta Drug Warnings

There are a few serious adverse effects associated with taking Lunesta that should be discussed with your healthcare provider before starting the medication. 

Complex Sleep Behaviors

Lunesta can sometimes result in complex sleep behaviors, where the individual is not fully awake or conscious but is engaging in physical activities. Some examples of complex sleep behaviors include sleepwalking or even sleep-driving. 

As you can imagine, these complex sleep behaviors can be very dangerous and even potentially fatal for those involved. It is important to discontinue Lunesta if you experience any complex sleep behaviors after starting the medication. 

Dependency Warning

Lunesta (eszopiclone) is classified as a Schedule IV controlled substance by the U.S. Drug Enforcement Administration (DEA). This classification is due to the potential for abuse and dependence associated with the medication. 

In addition to dependence, long-term use of Lunesta carries an increased risk of behavioral changes like suicidal ideation and thoughts of self-harm. These changes may also include irritability, agitation, bizarre behavior, hallucinations, and dissociation or depersonalization. 

Lunesta might not be right for you if you have preexisting psychiatric conditions or a history of substance use disorder

Withdrawal Symptoms

If you are unhappy with your medication and thinking of discontinuing it, it is important to discuss this with your healthcare provider beforehand. They will tell you how to slowly taper off the medication safely to avoid adverse withdrawal symptoms. 

If you discontinue the medication after prolonged use of high daily doses (over 3 mg), you are often advised to come off the medication at a slower rate. It may also be suggested to use cognitive behavioral therapy (CBT) for insomnia while tapering the dose for a successful transition off of the medication.  

Lunesta Interactions

Several drugs interact with Lunesta, so you should carefully review your current medications and supplements with your healthcare provider before starting this medication. 

It is important to avoid drinking alcohol or using any other central nervous system (CNS) depressants due to the potential dangers of the enhanced negative side effects. 

Common drug interactions with Lunesta include: 

• Benzodiazepines 
• Other sleep aids, like Zolpidem
• Antihistamine medications, such as Hydroxyzine, Benadryl, or Zyrtec  
• Opioid pain medication
• Metoclopramide 
• Most cold and cough medicines 
• Muscle relaxants, like cyclobenzaprine 
• Recreational drugs, such as marijuana, Kratom

What is Doxepin?

Doxepin is a tricyclic antidepressant (TCA) medication commonly used to treat anxiety, depression, and insomnia. Doxepin can also be used topically to treat itching associated with eczema or neuropathic pain. 

TCAs work by blocking the reuptake or increasing the levels of serotonin and norepinephrine in the brain to improve mood. Doxepin has sedating effects, making it an effective choice for treating insomnia. 

Doxepin Forms and Doses

Doxepin is available in capsules, tablets, and as an oral solution for treating insomnia. In addition, Doxepin is available as a topical cream when prescribed for itching. 

Doxepin capsules are available in the following doses: 

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

Doxepin tablets are available in the following doses: 

• 3 mg 
• 6 mg 

The oral solution is available in 10 mg/mL dosing only and is typically reserved for the pediatric population and those who cannot tolerate swallowing oral medication. 

Conditions Doxepin Treats

Doxepin is a TCA antidepressant medication. It is most commonly used to treat depression, insomnia, and anxiety.  

Depression

TCA medications, such as Doxepin, are among the oldest medications used to treat depression. Depression can present itself in many different forms, and some may experience changes in their sleep patterns due to their depressive symptoms. 

Some common symptoms of depression include: 

• Loss of interest in pleasurable activities
• Low energy levels 
• Changes in appetite 
• Sleep disturbances, including insomnia or increased need for sleep
• Feelings of helplessness, hopelessness, or worthlessness

Insomnia

Doxepin is known to be a highly effective medication for the treatment of insomnia due to its sedating effects on the body. In addition, Doxepin is used to treat depression and anxiety, which could be beneficial for someone who has an underlying mood disorder or anxiety symptoms that may be contributing to insomnia as well.  

As mentioned above, insomnia can lead to serious problems in your everyday life due to the physical and psychological effects that sleep deprivation causes. It is important to talk to your healthcare provider if you are experiencing difficulty sleeping and cannot get a good night’s rest. 

Anxiety

Anxiety is another condition that can play a role in your inability to fall asleep and/or stay asleep. Racing, unwanted, or intrusive thoughts may keep you up at night, or you may find it challenging to “slow down your mind” while lying in bed.

Doxepin is effective in treating certain symptoms associated with anxiety, making this medication an excellent choice for someone who suffers from both anxiety and insomnia. 

Doxepin Costs

Doxepin is a relatively affordable medication covered by most commercial health insurance plans. The exact price of your medication will vary depending on insurance coverage, dosing, and which pharmacy you use. 

If you are uninsured, the use of coupon codes significantly reduces the cost of your medication and are found in most large pharmacies. The average retail price on a 30-day supply of Doxepin is roughly $33, but with the use of these coupons, the cost is lowered between $1-$8. 

Doxepin Side Effects

As with any medication, there are some common adverse effects that may occur when starting a new medication. If you begin to experience serious side effects, contact your healthcare provider or seek medical attention urgently. 

The common side effects associated with Doxepin include: 

• Headache 
• Increased heart rate 
• Dizziness upon standing
• Paresthesia, or sensation of “pins and needles” on the skin
• Chills
• Cold sweats
• Urinary retention 
• Blurred vision
• Muscle stiffness or spasms

It is important to seek out urgent medical care if you begin to experience any of the following serious side effects: 

• Chest pain or tightness
• Increasingly fast or irregular heartbeat
• Confusion and loss of consciousness 
• Signs of internal bleeding, such as black or tarry stools or frank blood in urine or stool
• Blurred vision 
• Seizures 

Doxepin Drug Warnings

Due to the side effect profile and potential risk of severe adverse effects when taking tricyclic antidepressants, they are no longer considered to be first-line agents for the treatment of anxiety and depression. 

Below we have listed a few important and potentially dangerous warnings to consider before starting any TCA antidepressant, including Doxepin. 

Serotonin Syndrome 

Serotonin is a rare yet serious and potentially life-threatening condition that occurs from dangerously high levels of serotonin in the body. This most commonly occurs when someone is on multiple medications that increase levels of serotonin. 

It is important to seek out immediate medical attention if you experience any of the following signs and symptoms: 

• Altered mental status: agitation, confusion, anxiety, delirium, coma 
• Autonomic dysfunction: high blood pressure, fast heart rate, sweating, overheating, nausea, vomiting, diarrhea
• Neuromuscular abnormalities: tremor, exaggerated reflexes, muscle rigidity, involuntary movements

Without urgent medical intervention, there are serious complications that may arise, including:

• Metabolic acidosis 
• Kidney failure 
• Respiratory failure 
• Breakdown of muscle 
• Seizures 
• Death 

Pregnancy and Breastfeeding on Doxepin

TCA antidepressant medication, such as Doxepin, is typically avoided during pregnancy and breastfeeding due to the following potential complications: 

• Spontaneous abortion
• Hypertension or preeclampsia 
• Preterm birth 
• Postpartum hemorrhage 
• Postnatal effects: withdrawal symptoms, hypoglycemia, respiratory illness, jaundice

Not a Controlled Substance

Unlike Lunesta, Doxepin is not classified as a controlled substance, meaning it is not habit-forming. Doxepin may be a suitable antidepressant for those with a history of substance abuse.

Doxepin Interactions

It is always important to disclose all medications you are currently taking to your healthcare provider, including all over-the-counter medications and supplements, before starting a new medication. 

There are a number of drug interactions with Doxepin, including: 

• Anticholinergic medications 
• Thyroid supplements 
• Certain antihypertensive medications, such as clonidine 
• MAOIs
• Other antidepressants, such as SSRIs
• Some antifungal drugs, such as terbinafine 
• Acid reflux or GERD medications like Cimetidine 
• St. John’s Wort

Should I Take Lunesta or Doxepin For Insomnia

Lunesta and Doxepin are two very different drugs, and each medication comes with its own risks and benefits to consider. Your healthcare provider will evaluate your current medications, medical history, and what insomnia looks like for you, including the severity of symptoms and their impact on daily life. 

It is also important to note that there are a number of effective medications in the treatment of insomnia, and everyone reacts differently. If you believe you would benefit from insomnia treatment or would simply like to learn more, Klarity Health can help.  

Start Insomnia Treatment Within 48 Hours With Healthcare Providers on Klarity Health

Whether it’s trouble falling asleep, staying asleep, or anything in between, the providers on Klarity Health can help you find the best sleep medication for your symptoms, if applicable. We’ll connect you with a licensed and experienced healthcare provider who will thoroughly discuss your symptoms to diagnose you accurately. 

Get treatment with an experienced healthcare provider in as little as 48 hours so you can be one step closer to the good night’s sleep you deserve.