Doxepin and trazodone are commonly prescribed to individuals with sleep issues. While the tablet form of doxepin is FDA-approved for insomnia, trazodone is used off-label but can be effective for sleep when used as instructed by your healthcare provider.
Learn more about these drugs, including their efficacy and effects, in this doxepin vs. trazodone for sleep comparison.
Doxepin vs. Trazodone—Basic Information
Doxepin and trazodone are prescription-only medications primarily indicated for major depressive disorders, anxiety, and tension. Doxepin is a tricyclic antidepressant, while trazodone is a phenylpiperazine antidepressant.
Doxepin is sold under several brand names, including Silenor and Sinequan. Trazodone is also available under different brand names, such as:
- Trazodone D
- Oleptro
- Molipaxin
- Desyrel
- Desyrel Dividose
Trazodone and doxepin work by increasing the concentration of serotonin in the brain. Serotonin is a neurotransmitter that regulates your mood, hunger, body temperature, and sexual behavior. It also increases the level of melatonin—a hormone that regulates your sleep-wake cycle.
The medications also inhibit the production of hormones that promote wakefulness, such as histamine. According to clinical studies, low-dose doxepin can provide relief from sleep-maintenance insomnia. Research also shows that trazodone is effective in the treatment of primary and secondary insomnia, particularly sleep issues caused by depression. However, while both medications are FDA-approved, only doxepin is approved for insomnia—trazodone is used off-label in this case.
Trazodone and doxepin aren’t controlled substances, but you can only get them with your doctor’s prescription. Even though these drugs don’t carry the risk of addiction, misusing them or continuing to take them after your doctor has stopped treatment can cause psychological dependence.
Trazodone vs. Doxepin for Sleep—Dosage and Administration
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Doxepin is available in four forms:
- Tablet—FDA-approved for insomnia
- Capsule
- Solution
- Topical cream
Check out a breakdown of the available doses for each form in the table below:
Doctors typically prescribe the 6 mg tablet for patients with insomnia, but your healthcare provider might recommend starting with 3 mg depending on your specific sleep issues and response to the medication. Doxepin typically kicks in within 30 minutes and reaches peak concentration in the body after two hours.
Meanwhile, trazodone comes in three forms:
- Capsule
- Tablet
- Liquid
Check out the available doses for each form in the table below:
The typical starting dose for adults with insomnia is 25 mg in tablet form, but your doctor will review your health status before prescribing the appropriate dosage.
You should take doxepin or trazodone an hour before bedtime and set aside seven hours for sleep to let the drug’s sedative effects kick in and wear off naturally.
Duration of Effects
Doxepin’s sedative effects typically subside eight hours after administration, while trazodone’s effects last for 5–9 hours.
Doxepin has an average half-life of 15 hours. Half-life is the period your body needs to metabolize 50% of a drug, and it takes an average of 5.5 half-lives for a drug to be eliminated from your system. You can expect to feel the effects of doxepin up to 3–4 days after treatment discontinuation. If you take the drug as recommended, you should get better sleep within seven days of starting treatment.
Trazodone has a shorter average half-life of about 5–13 hours, so your body should metabolize it 2–3 days after stopping treatment.
Which Is Better for Sleep—Trazodone or Doxepin?
Both doxepin and trazodone can alleviate sleep problems, but their effectiveness depends on your specific sleep issue and response to these medications. Insomnia typically stems from several complex factors, so medications alone may not produce sustainable results. To reach a lasting solution, you should consult a sleep expert.
Getting an appointment with a specialist isn’t as simple as it sounds. With less than 1% of doctors trained in sleep medicine and about 50–70 million adults in the U.S. grappling with some form of insomnia, meeting with a sleep expert can be complicated.
The fantastic development is that you can use telemedicine platforms like Kick to connect with sleep medicine specialists within a day. Designed by Dr. Alex Dimitriu, a Stanford sleep expert, Kick’s sleep program lets you consult a specialist within 15 minutes and begin treatment almost immediately.
Kick—Healthy Sleep, Healthy You
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Kick’s sleep program is tailored to your specific sleep problems and health status. The program combines cognitive behavioral therapy for insomnia (CBT-i) coaching with gentle sleep drugs to help you reach an all-encompassing solution. Kick’s medications include:
- Doxepin
- Trazodone
- Cyclobenzaprine
- Hydroxyzine
- Gabapentin
- Ramelteon
Our drugs are fast-acting, helping you achieve the desired results as soon as possible. Your doctor will prescribe two trial prescriptions that you’ll rotate in the first two weeks to prevent developing psychological dependence on one drug. Our specialist will also monitor your progress regularly and adjust the dosage if necessary to quickly optimize the treatment.
How To Join Kick
Our sleep program has been receiving rave reviews on Trustpilot, demonstrating Kick’s commitment to helping patients achieve restorative sleep. To benefit from the program, follow these three simple steps:
- Go to the signup page to start your brief sleep visit
- Fill out the form with your medical history and specific sleep issues
- Provide your payment and delivery details
Your medication will be delivered to your doorstep or local pharmacy, making the process discreet and convenient. If our team decides you’re not the best candidate for the program, you won’t pay for the initial consultations as per our Doctor Guarantee.
Doxepin and Trazodone for Sleep—Potential Side Effects
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Doxepin and trazodone carry the risk of similar side effects, but patients who stick to their doctor’s instructions rarely experience them.
Common Side Effects
The common unwanted reactions to doxepin or trazodone include:
- Dry mouth—Drink plenty of water and chew gum to alleviate this side effect
- Drowsiness—Avoid driving or operating heavy machinery until the drowsiness subsides
- Dizziness—Get up slowly from lying or sitting positions to avoid feeling lightheaded
- Headache—Consult your doctor about safe pain relievers to alleviate headaches
- Nausea—Stay in a well-ventilated place and eat foods containing ginger to prevent feeling nauseous
- Blurred vision—Avoid tasks that require sharp focus until your vision clears
Rare Side Effects
The rare side effects of doxepin and trazodone differ in specific cases. Check out the table below for more details about the severe unwanted reactions to these medications:
Patients who experience unexplained body changes or persistent adverse reactions to trazodone or doxepin should contact their doctors immediately.
Doxepin vs. Trazodone—Who Should and Shouldn’t Use These Drugs?
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Adults (18+) experiencing sleeplessness caused by depression, anxiety, or tension can take doxepin or trazodone. Doctors also prescribe these drugs to patients with primary insomnia, depending on their health status.
Check out the table below for more details on who shouldn’t use these medications.
This list isn’t exhaustive, so you should inform your doctor about any medical conditions you have to help them determine whether these medications are safe for you.
Trazodone vs. Doxepin for Insomnia—Potential Interactions With Other Substances
Check out the potential interactions between doxepin and trazodone with food and other drugs in the table below:
Before taking doxepin or trazodone, inform your healthcare provider about the substances you use. Your doctor will evaluate the potential interactions and only prescribe doxepin or trazodone if the benefits outweigh the risks in your case.
Doxepin and Trazodone Alternatives
Depending on your health status and the underlying causes of your sleep issues, your doctor may recommend doxepin and trazodone alternatives, such as:
- Ativan
- Baclofen
- Belsomra
- Ambien
- Melatonin
- Valium
- Xanax
- Tramadol
- Benadryl
- Seroquel
- Zoloft
- Doxylamine
- Propranolol
- Hydroxyzine
- Gabapentin
- Cyclobenzaprine
- Mirtazapine
Trazodone vs. Doxepin—Quick Overview
Check out the basic facts about doxepin and trazodone in the table below:
You should only use doxepin and trazodone in the short term. If your sleep issues persist after discontinuing doxepin or trazodone, contact your doctor for personalized guidance.
Featured image source: Karolina Grabowska
