Rankings / Sleep & Recovery

Doxepin (low-dose)

Sleep & Recovery · H1 antagonist (low dose)

Tier B+

Reviewed by Read Off Label · Last reviewed · How we grade

cholinergicprescription
7.1 / 10
Tier B+
Ev 6 Bn 5 Sf 9

Bottom line

Read Off Label grades Doxepin (low-dose) as B+ (7.1/10) based on moderate evidence, moderate benefit magnitude, and a low-risk safety profile.

Low-dose doxepin is studied for sleep-maintenance insomnia, including in older adults; its adverse-effect profile differs from Z-drugs, benzodiazepines, and first-generation antihistamines, especially at low versus antidepressant doses.

Studied, labeled, or reported-use context: 3-6 mg PO 30 min before bed — Rx; not individualized guidance.

What the evidence says

Low-dose doxepin is studied for sleep-maintenance insomnia, including in older adults; its adverse-effect profile differs from Z-drugs, benzodiazepines, and first-generation antihistamines, especially at low versus antidepressant doses. Silenor is expensive; compounded low-dose tablets from liquid form of higher-dose doxepin are often used.

Mechanism

At very low doses (3-6 mg) a selective histamine H1 antagonist with minimal anticholinergic or antidepressant activity; FDA-approved as Silenor 2010 for sleep maintenance insomnia

Studied, labeled, or reported dose & route

3-6 mg PO 30 min before bed

This records doses and routes described in studies, approved labeling, clinical practice, or documented use. It is not individualized guidance and does not establish safety; context changes with indication, formulation, health history, monitoring, and other medicines.

Citations

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Common questions

What does the evidence show about Doxepin (low-dose)'s effects?
Read Off Label rates the evidence for Doxepin (low-dose) as Moderate and the benefit magnitude as moderate, producing an overall grade of B+ (7.1/10). Low-dose doxepin is studied for sleep-maintenance insomnia, including in older adults; its adverse-effect profile differs from Z-drugs, benzodiazepines, and first-generation antihistamines, especially at low versus antidepressant doses.
What safety findings are reported for Doxepin (low-dose)?
Doxepin (low-dose) has a low risk profile in the database. Low (next-morning residual sedation if dosed late or too high; anticholinergic effects only at higher antidepressant doses) Legal status: Rx.
What doses or routes are reported for Doxepin (low-dose)?
3-6 mg PO 30 min before bed This is context from studies, approved labeling, clinical practice, or documented use; it is not individualized guidance and does not establish safety.
How does Doxepin (low-dose) work?
At very low doses (3-6 mg) a selective histamine H1 antagonist with minimal anticholinergic or antidepressant activity; FDA-approved as Silenor 2010 for sleep maintenance insomnia

This is an independent synthesis of published research by a non-clinician. Scores are opinions supported by citations, not prescriptions. See the full disclaimer and methodology for how this score was produced and what it does and doesn't mean.