Doxepin for sleep: Uses, dosage precautions and more

Doxepin for Sleep
Medically reviewed by Richard Honaker M.D.

Key Takeaways

  • A tricyclic antidepressant, Doxepin, is increasingly used off-label for sleep disorders, especially insomnia. Prescribed in lower doses (3-6 mg), it enhances overall sleep continuity but requires caution due to potential side effects and interactions.
  • It is administered orally (Silenor) once daily, approximately 30 minutes before bedtime.
  • Doxepin use depends on medical history, age, and potential interactions with other medications.
  • Consult a doctor before starting Doxepin, especially if experiencing severe insomnia, having a medical history, or encountering concerns about interactions or side effects. Regular follow-ups are advised for assessment and adjustments.


A person with insomnia has trouble falling, remaining asleep, or getting a decent night’s Sleep. Doxepin, a tricyclic antidepressant, has garnered attention for its off-label application in treating sleep disorders. While initially designed for managing depression, its soothing properties make it a potential remedy for insomnia. Prescribed in lower doses (3-6 mg) for sleep-related issues, it enhances overall sleep continuity and reduces nighttime awakenings. However, caution is warranted due to potential side effects like drowsiness and interactions with other medications. Regular monitoring and follow-ups are essential to assess its efficacy and address emerging concerns, emphasizing the need for personalized approaches under healthcare professionals’ guidance to ensure safety and optimal outcomes.

How to use Doxepin for sleep?

Doxepin also known as Silenor for sleep, is available as an oral tablet. Typically, it is taken once daily, up to 30 minutes before bed. Doxepin shouldn’t be taken for three hours after eating. Pay close attention to the instructions on the label of your prescription and ask your doctor to explain anything you do not understand. Doxepin should be taken as prescribed. Take only what is necessary or more frequently than your doctor has instructed.

Odepin (Silenor) will likely make you highly drowsy immediately, which will last a while. After taking Doxepin, schedule a 7–8 hour bedtime and stay in bed. If you can’t stay asleep for seven to eight hours after taking Doxepin, don’t take the drug.

When using Doxepin for the first few days of treatment, you should start to sleep better. Contact your doctor if, after 7–10 days, your Sleep does not get better or if it worsens.

How much Doxepin can you take for sleep?

The recommended dosages of Doxepin for Sleep typically range from 3 to 6 mg. Lower doses are favoured when the primary goal is addressing sleep-related issues rather than its antidepressant properties. Administered about 30 minutes before bedtime, this dosage range has shown efficacy in promoting sleep onset and maintenance.

Off-label use of Doxepin dosage for sleep, 10 mg capsules once daily at bedtime, is known. Despite the tablet recommendation of 6 mg/day, experts may start with 10 mg due to product availability.

Individualized considerations

Dosage considerations for Doxepin should be individualized, considering factors such as overall health, age and the specific sleep disorder being addressed. Elderly individuals may require lower doses due to increased sensitivity to sedative effects. Additionally, potential interactions with other medications need careful assessment, emphasizing the importance of consultation with healthcare professionals to tailor the dosage according to each patient’s unique circumstances and needs.

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How long does Doxepin take to work?

The onset of action for Doxepin, when used for sleep-related issues, typically varies among individuals. Generally, individuals may start experiencing its sedative effects within 30 minutes to an hour after taking the medication. However, full therapeutic effects, including improved sleep continuity and reduced nighttime awakenings, may take several days to weeks of consistent use.

Is Doxepin suitable for everyone seeking better sleep?

Doxepin may not suit everyone seeking better Sleep, and its use should be approached cautiously. Several factors contribute to its appropriateness for individuals:

Medical history

Doxepin may have contraindications with certain medical conditions. Individuals with a history of heart problems, urinary retention, glaucoma, or seizures may need careful consideration and monitoring.

Age considerations

Elderly individuals may be more susceptible to the sedative effects of Doxepin, necessitating lower doses to avoid excessive drowsiness, falls, or other adverse reactions.

Individual response

People vary in how they respond to medications. Some may experience side effects like drowsiness, dry mouth, or blurred vision, while others may not. It’s essential to be aware of individual responses and report any concerns to a healthcare professional.

Interactions with other medications

Doxepin may interact with other medications, including antidepressants, antihistamines, and certain cardiovascular drugs. A thorough review of a person’s medication regimen is crucial to prevent adverse interactions.

Psychological health

Given that Doxepin is a tricyclic antidepressant, its primary indication is for managing depression and anxiety disorders. Individuals seeking better Sleep primarily due to psychological reasons may find Doxepin more appropriate than those with other underlying causes.

Pregnancy and Lactation

There is insufficient evidence to support the safety of Doxepin during lactation and pregnancy. Before using Doxepin, nursing or pregnant patients should speak with their healthcare professional.

After doxepin is administered late in the third trimester, the baby may experience adverse effects such as apnea, persistent crying, cyanosis, feeding difficulties, hyperreflexia, hypotonia, hypoglycemia, jitteriness, irritability, respiratory distress, seizures, temperature instability, tremor, and vomiting. It can be necessary to use a feeding tube, breathing support, or extended hospital stays. Additionally, one newborn who was exposed to doxepin in utero was found to have paralytic ileus. It is unknown how long-term exposure to tricyclic antidepressants (TCAs) during pregnancy can affect an infant’s behavior and neurodevelopment.

Individualized approach

A personalized evaluation by a medical expert should serve as the foundation for the choice to take Doxepin for improved Sleep. Essential considerations in assessing appropriateness include:

  • General health.
  • The degree of sleep problems.
  • Traditional medical illnesses.
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How does Doxepin differ from other sleep medications?

Doxepin differs from other sleep medications, including its classification, mechanism of action, and primary indications. Here are some key distinctions:

Tricyclic antidepressant (TCA) classification

Tricyclic antidepressants (TCAs), which included Doxepin in its initial formulation, were designed to treat anxiety and depression. Its usage for problems linked to sleep is regarded as off-label, setting it apart from drugs made expressly for insomnia.

Dual action

Unlike many other sleep medications that primarily target neurotransmitters like gamma-aminobutyric acid (GABA), Doxepin has a dual action. It affects serotonin and norepinephrine levels and has potent histamine-blocking properties. This double action contributes to its sedative effects.

Off-label use for sleep

While Doxepin is primarily indicated for anxiety and depression, it has gained recognition for its off-label use in treating various sleep disorders, including insomnia. Other sleep medications are typically designed and explicitly approved for sleep-related issues. It may be one of the best medications for anxiety and sleep. 

Low-dose formulation

Doxepin for Sleep is often prescribed in lower doses (3 to 6 mg) compared to its higher doses used for treating depression. This low-dose formulation helps to minimize potential side effects while maximizing its sedative effects.

Lack of rapid onset

Doxepin may not have the rapid action onset seen with other sleep medications. Its full therapeutic effects, such as improved sleep continuity, may take several days to weeks of consistent use.

Potential anticholinergic effects

Doxepin, like other TCAs, has anticholinergic effects, which can cause side effects like blurred vision, dry mouth and constipation. This sets it apart from certain newer sleep medications that may have a different side effect profile.

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Are there precautions to take before using the drug?

  • If you have an allergy to any of the substances in doxepin (Silenor) tablets, amoxapine, loxapine, other drugs, or any combination of these, do not use this medication. For an ingredient list, consult the Medication Guide or ask your pharmacist.
  • Inform your physician about any usage of monoamine oxidase (MAO) inhibitors, such as tranylcypromine (Parnate), isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), or if you have not taken one in the previous 14 days. Furthermore, inform your physician if you are taking methylene blue (Provayblue) or linezolid (Zyvox). Your doctor will probably advise against taking Doxepin. When starting an MAO inhibitor, you should wait at least 14 days after quitting Doxepin.
  • Inform your physician if you now have or have ever had urine retention (inability to empty your bladder entirely or at all) or untreated glaucoma. Your doctor could advise you not to take Doxepin.
  • Steer clear of Doxepin if you currently use excessive amounts of alcohol, have ever used illegal substances, or have misused prescription pharmaceuticals. 
  • Use caution when using this medication if you have or have ever had depression, mental illness, suicidal thoughts, sleep apnea (a disease in which breathing stops temporarily during sleep), kidney or liver problems, or any combination of these illnesses.
  • Doxepin should never be taken if you are nursing a baby, planning to get pregnant, or are already pregnant. 
  • After taking Doxepin (Silenor), avoid operating machinery, operating a vehicle, and engaging in any other risky activity at night. The following day, once you are sure of how this prescription will affect you, do not operate machinery or drive a car.

When should I see a doctor regarding Doxepin for sleep?

Always consult with your doctor before starting Doxepin for sleep, and you should seek medical advice under various circumstances:

Insomnia severity

If you experience doxepin not working for sleep-related issues (insomnia), which may be defined by difficulty falling or staying asleep or poor quality sleep, you should speak with a doctor. They can help determine whether Doxepin or other therapeutic modalities are appropriate for treating the underlying problems.

Prior medical conditions

If you have a history of medical conditions such as heart problems, glaucoma, or urinary retention, it’s essential to consult with a doctor before using Doxepin. Certain medical conditions may contraindicate or require dosage adjustments for the medication.

Medication interactions

Discussing potential interactions with your doctor is essential for taking other medications. Doxepin can interact with various drugs, including other antidepressants, antihistamines, and certain cardiovascular medications.

Side effects

You must contact your doctor promptly if you experience any side effects, adverse reactions, or concerns about the medication. This includes excessive drowsiness, blurred vision, dry mouth, or other unexpected reactions.

FAQs about Doxepin for sleep

Does Doxepin have any antidepressant properties, or is it just used for sleep?

Doxepin has antidepressant properties and is classified as a tricyclic antidepressant. While it was initially developed for treating depression and anxiety, lower doses are often prescribed off-label for sleep-related issues due to its sedativeness. The dual functionality of Doxepin makes it suitable for addressing both mood disorders and sleep disturbances.

Can Doxepin be used for sleep without a prescription?

No, Doxepin is a prescription medication, and it should not be used for sleep without the guidance and supervision of a healthcare professional. Self-prescribing or using Doxepin without a prescription can lead to serious safety risks, including potential side effects, drug interactions, and complications.

Can I take Doxepin for sleep if I have a history of mental health conditions?

Consult with a doctor before considering Doxepin for sleep if you have a history of mental health conditions. The medication’s primary indication is for depression and anxiety, and its use should be carefully evaluated in the context of your mental health history. Only use Doxepin under the guidance of a healthcare professional to ensure safety and effectiveness.

Can Doxepin be used as a long-term solution for sleep difficulties?

For insomnia, 3-6 mg of Doxepin per day for fewer than 4–8 weeks is the recommended dosage. Doxepin side effects might include many symptoms, though headache and drowsiness are the most common. An overdose or long-term use can be lethal and have significant repercussions.

Can I take over-the-counter sleep aids while using Doxepin?

Combining medications, even over-the-counter ones, can lead to interactions and potential adverse effects. Your doctor can advise you on your health status, current medications, and specific sleep issues to ensure using sleep aids in conjunction with Doxepin. Only self-prescribe or mix drugs with professional guidance to avoid potential complications.

Is doxepin a controlled substance?

FDA-approved in March 2010, doxepin (3 mg and 6 mg) is the second non-controlled substance insomnia medication, potentially valuable for patients with a substance abuse history.

Alternatives to doxepin for sleep?

Common alternatives to doxepin for sleep include zolpidem, eszopiclone, temazepam, zaleplon, and melatonin supplements.

How long does doxepin stay in your system?

The liver breaks down and excretes doxepin through urine. In 15 to 18 hours, the prescription is halfway removed from the system once the patient stops taking it. Conversely, the half-life of nordoxepin, a doxepin byproduct, is between 28 and 31 hours.

Your Doctors Online uses high-quality and trustworthy sources to ensure content accuracy and reliability. We rely on peer-reviewed studies, academic research institutions and medical associations to provide up-to-date and evidence-based information to the users.

  • Roth, Thomas, et al. “Efficacy and safety of doxepin 1 mg, 3 mg, and 6 mg in adults with primary insomnia.” Sleep 30.11 (2007): 1555-1561.
  • Wu, Junfeng, Fei Chang, and Hengbing Zu. “Efficacy and safety evaluation of citalopram and doxepin on sleep quality in comorbid insomnia and anxiety disorders.” Experimental and Therapeutic Medicine 10.4 (2015): 1303-1308.
  • Yeung, Wing-Fai, et al. “Doxepin for insomnia: a systematic review of randomized placebo-controlled trials.” Sleep medicine reviews 19 (2015): 75-83.
  • Krystal, Andrew D., et al. “Efficacy and safety of doxepin 3 and 6 mg in a 35-day sleep laboratory trial in adults with chronic primary insomnia.” Sleep 34.10 (2011): 1433-1442.

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