Silenor vs Tofranil - What Is the Difference and Which One Should I Take?

Navigating depression can feel overwhelming, especially when first-line depression treatment hasn’t worked. Searching for effective antidepressant medicine takes some time, but… 

You’re not alone, and you deserve to get the treatment you need when you need it! Not weeks later. 

In this article, we’ll review Silenor and Tofranil, two antidepressant drugs that can be prescribed to treat major depressive disorder when first-line antidepressants like selective serotonin reuptake inhibitors (SSRIs) are not effective in reducing depression symptoms.

We’ll discuss—

• What class of antidepressants these two drugs belong to
• What symptoms each antidepressant is designed to treat
• Potential side effects of each antidepressant treatment
• Potential drug interactions for each antidepressant treatment
• The costs, doses, and formulations for each antidepressant
• Drug warnings for each antidepressant
• Plus, some frequently asked questions our mental health providers often receive!

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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.

Tofranil and Silenor Are the Same Class of Drugs (Tricyclics)

Tofranil (Imipramine) and Silenor (Doxepin) are tricyclics, a class of antidepressants developed in the 1950s. These medications are primarily prescribed to treat major depressive disorder (MDD) but also have other off-label uses, such as treating anxiety disorders or managing chronic pain.

Tricyclics are nonselective antidepressants meaning they affect much more serotonin receptors than other antidepressants like SSRIs or SNRIs, which are newer antidepressants that are selective.

What Are Tricyclics?

Tricyclics work by blocking the reuptake of certain neurotransmitters in the brain, which can help improve mood and reduce symptoms of depression. Tricyclics don’t work for everyone, but they can be an effective means of treatment for some people based on their health history and current diagnosis, such as treatment-resistant depression.

Tofranil and Silenor Are Both Used To Treat Major Depressive Disorder

Tofranil and Silenor are prescription medications used to treat major depressive disorder. Each drug has its own forms, doses, and side effects, and you should always consult your mental health provider before taking a new medication.  

Though Tofranil and Doxepin are in the same class of medication, it’s important to understand that they are different antidepressants and each will affect your mind and body differently.

Let’s compare these two antidepressant medications—

What Else Does Tofranil Treat?

Tofranil is primarily used to treat symptoms of MDD, but it may also be used off-label to treat other conditions. The FDA has an approval system where a series of tests determines whether or not a medication will be an effective treatment for a particular issue. Off-label use is when a medication isn’t approved for a certain issue, but it’s proven to be an effective treatment. 

Off-label Uses for Tofranil

Tofranil is FDA-approved to treat major depressive disorder. Off-label uses may include:

1. Anxiety disorders: Some healthcare providers might prescribe Tofranil for generalized anxiety disorder, panic disorder, or social anxiety disorder.
2. Neuropathic pain: Tofranil has been used to manage chronic neuropathic pain, such as diabetic neuropathy or post-herpetic neuralgia.
3. Fibromyalgia: Tofranil may help manage pain and improve sleep in fibromyalgia patients.
4. Migraine prophylaxis: Tofranil has been used as a preventive treatment for migraine headaches.
5. Irritable bowel syndrome (IBS): Tricyclic antidepressants like Tofranil may help manage abdominal pain and other IBS symptoms.
6. Chronic fatigue syndrome: Some healthcare providers might prescribe Tofranil to help alleviate symptoms of chronic fatigue syndrome.
7. Insomnia: Tofranil may be prescribed at low doses for patients who struggle with sleep.

What Else Does Silenor Treat?

Silenor is also primarily prescribed to treat MDD and anxiety. Since it increases the levels of certain chemicals in the brain responsible for regulating mood, it’s also used off-label to treat other conditions. 

Off-label Uses for Silenor

Off-label uses for Silenor may include:

1. Chronic urticaria: Silenor has antihistamine properties, so it has been used to treat chronic urticaria (hives) in some cases.
2. Neuropathic pain: Like other tricyclic antidepressants, Silenor may be prescribed for the management of neuropathic pain, such as diabetic neuropathy or post-herpetic neuralgia.
3. Migraine prophylaxis: Like Tofranil, Silenor has been used as a preventive treatment for migraine headaches.
4. Fibromyalgia: Some evidence suggests that Silenor may help manage pain and improve sleep for people with fibromyalgia.
5. Irritable bowel syndrome (IBS): Tricyclic antidepressants like Silenor can help manage IBS symptoms.
6. Pruritus: Silenor’s antihistamine properties may also make it useful for treating pruritus (itching) related to various skin conditions.
7. Chronic pain: Silenor may be prescribed for managing chronic pain conditions, such as chronic low back pain or chronic tension-type headaches.

Doses, Dosage Form, and Side Effects of Silenor

Silenor comes in different doses and forms that contribute to the overall cost of the medication. Depending on your recommended dose, you may experience common side effects, and it’s important to know how your body might respond. Additionally, silenor interacts with several drugs, so you should tell your care provider about any other medications you take.

Common Silenor Doses and Forms

Silenor is available in oral capsule, oral solution, and topical form. The recommended starting dose for adults is 75 mg daily, divided into three smaller doses and taken at bedtime. Your dose may increase gradually, up to a maximum of 300 mg per day. 

Common Silenor Side Effects

Silenor can cause several common side effects. These side effects are usually mild and may disappear as your body adjusts to the medication.

Common Silenor side effects include:

• Drowsiness
• Dizziness
• Dry mouth
• Blurred vision
• Constipation
• Difficulty urinating
• Nausea and vomiting
• Stomach pain
• Weight gain
• Changes in taste

However, if these side effects persist or if you experience any severe side effects, such as worsening depression, suicidal ideation, difficulty breathing, or swelling of the face, lips, tongue, or throat, you should contact your care provider right away.

Common Silenor Drug Interactions

Silenor can interact with other medications and substances, such as alcohol and certain herbal supplements. There are also 661 drugs that Silenor interacts with, including 134 major interactions, 502 moderate interactions, and 25 minor interactions. 

Of the most frequently checked medications, Silenor has major interactions with Cymbalta, Flexeril, Lexapro, Topamax, and Zoloft. 

Moderate interactions include:

• Abilify
• Adderall
• Ambien
• Benadryl
• Klonopin
• Lamictal
• Lyrica
• Norco
• Seroquel
• Synthroid
• Xanax
• Zyrtec

How Much Does Silenor Cost?

The cost of Silenor depends on the pharmacy you use, your recommended dose, and if you have insurance. You can expect to pay anywhere from $4.26 to $42.15 monthly for 30 capsules of 75 mg. Talk to your provider about using the generic form Silenor to save money.

Doses, Dosage Form, and Side Effects of Tofranil

Like Silenor, Tofranil also comes in several doses and forms and has its own set of side effects. It also interacts with a series of other medications, so you must tell your care provider about any other medicines you’re taking.

Common Tofranil Doses and Forms

There are several doses and forms of Tofranil available, including tablets, capsules, and a liquid form. Common doses are between 10 and 200 mg daily, with the typical dose starting at 75 mg. Your care provider will determine the right dose based on your symptoms and other factors, like your health history. 

Common Tofranil Side Effects

Tofranil can cause some side effects. You must contact your mental health provider if these side effects persist or become severe.

Common side effects include:

• Weight gain or loss
• Dry mouth
• Vision issues
• Headache
• Drowsiness
• Constipation
• Nausea and vomiting
• Loss of appetite
• Diarrhea
• Stomach cramps
• Tingly feeling
• Weakness
• Lack of coordination
• Ringing in your ears
• Breast swelling
• Decreased sex drive
• Impotence
• Difficulty orgasming

If you experience any of the following serious side effects, contact your healthcare provider immediately.

• Easy bruising or bleeding
• Fever
• Sore throat
• Dark urine
• Yellowing eyes or skin
• New or worsening chest pain
• Irregular heartbeat
• Sudden numbness
• Purple or red spots under the skin
• Confusion
• New or worsening depression
• Suicidal ideation
• Seizures

Common Tofranil Drug Interactions

Tofranil interacts with 690 drugs, with 134 major interactions, 529 moderate interactions, and 27 minor interactions. Major interactions occur with 

• Cymbalta
• Celexa
• Lexapro
• Paxil
• Prozac
• Trazodone
• Zoloft

Moderate interactions include:

• Adderall
• Ambien
• Ativan
• Elavil
• Gabapentin
• Klonopin
• Lamictal
• Levothyroxine 
• Lisinopril
• Seroquel
• Synthroid
• Xanax

How Much Does Tofranil Cost?

The cost of Tofranil varies depending on your dose, pharmacy, and insurance coverage. The price ranges from $12.22 to $53.60 for 90 tablets at 25 mg. You should also consider asking about Imipramine, the generic form of Tofranil, as it’s often less expensive. 

Other Tricyclic Side Effects

While they can be effective for many people, tricyclic antidepressants can have other potentially harmful side effects. These adverse effects could include serotonin syndrome, pregnancy and breastfeeding complications.An increased risk of bleeding could also occur due to taking blood thinner medication like Warfarin

What is Serotonin Syndrome?

One potential side effect of tricyclic antidepressants is serotonin syndrome, which occurs when there’s too much serotonin in the body. Symptoms of serotonin syndrome include agitation, hallucinations, and rapid heartbeat. If you experience these symptoms, contact your care provider immediately.

Pregnancy and Breastfeeding on Tricyclics

Another potential concern with tricyclic antidepressants is using them during pregnancy and breastfeeding. Taking tricyclics while pregnant can lead to preterm birth, respiratory distress, neonatal convulsions, or low birth weight. It’s important to talk to your healthcare provider about the potential risks and benefits of taking a tricyclic antidepressant during pregnancy.

Increased Bleeding Risk With Tricyclics

Tricyclic antidepressants can also increase the risk of bleeding if you’re taking a blood thinner like Warfarin. If you are taking a tricyclic antidepressant and planning surgery or dental work, let your care provider know beforehand. You may need to stop taking the medication for a period of time before and after the procedure.

Black Box Warning With Antidepressants

The Food and Drug Administration (FDA) requires a black box warning on all antidepressants, including tricyclic antidepressants. This warning states that antidepressants may increase the risk of suicidal thoughts and behaviors in children, teenagers, and young adults. Monitor any changes in mood or behavior while taking a tricyclic antidepressant.

Klarity Health Can Help You Access Depression Treatment Online

If you have treatment-resistant depression and are looking to try new antidepressants like Silenor and Tofranil, Klarity Health can help. We make accessing online depression treatment easy!

Get started with online depression treatment in as little as 24 hours when you book an appointment on Klarity Health.* If your provider determines medication is needed for your care, get a prescription.