Is Doxepin (tricyclic antidepressant) 10mg effective and safe for short-term treatment of insomnia?

From the Guidelines

Doxepin 10mg is a viable option for short-term treatment of insomnia, as it has been shown to be effective and generally safe in improving sleep quality and duration, as noted in studies such as 1 and 1.

Key Points to Consider

• Doxepin works by blocking histamine H1 receptors, which helps induce and maintain sleep without significant next-day effects when used at low doses.
• The 10mg dose for insomnia minimizes anticholinergic side effects and morning grogginess compared to higher doses used for depression.
• Patients typically take it 30 minutes before bedtime, and improvement may be noticed within the first few nights.
• Common side effects include mild sedation, dry mouth, and occasionally dizziness.
• Doxepin should be used cautiously in elderly patients and those with certain medical conditions like narrow-angle glaucoma, urinary retention, or severe liver disease.

Important Considerations for Use

• It's best used as part of a comprehensive approach to insomnia that includes good sleep hygiene practices.
• While it can be effective for short-term use (typically 7-10 days), it's essential to address underlying causes of insomnia rather than relying solely on medication long-term.
• As highlighted in 1, low-dose doxepin has no black box warning for suicide risk, but the risk for suicidal ideation associated with its use as a hypnotic agent is unknown and cannot be excluded.
• The choice between doxepin and other sleep aids, such as nonbenzodiazepine BZRAs, should consider the potential benefits and harms, with doxepin being a preferable option due to its efficacy and safety profile at low doses, as discussed in 1.

From the Research

Efficacy of Doxepin 10mg for Sleep

• The efficacy of doxepin for insomnia has been studied in several trials, but the specific dose of 10mg is not commonly mentioned in the provided evidence 2, 3, 4, 5, 6.
• Low-dose doxepin (3-6mg) has been shown to be effective in improving sleep maintenance and sleep duration, but not sleep initiation 2, 5.
• A study comparing doxepin 6mg to zolpidem 5-10mg found that doxepin improved sleep efficiency and total sleep time, but had a higher incidence of adverse events 3.
• Another study found that low-dose doxepin (3-6mg) was effective in improving sleep quality and reducing wake after sleep onset, with a good tolerability profile 5.

Safety of Doxepin 10mg for Sleep

• The safety of doxepin 10mg for sleep is not well-established in the provided evidence, as most studies used lower doses (3-6mg) 2, 3, 4, 5, 6.
• Common side effects of low-dose doxepin include headache, somnolence, and dry mouth 2, 5, 6.
• A study comparing doxepin to trazodone and melatonin found that doxepin had a better tolerability profile than trazodone, but was associated with dry mouth 6.

Comparison to Other Sleep Aids

• Doxepin has been compared to other sleep aids, such as zolpidem, trazodone, and melatonin, in several studies 3, 6.
• A study found that doxepin improved executive function more effectively than zolpidem in patients with insomnia disorder 3.
• Another study found that trazodone was the most effective medication for enhancing sleep quality, but had a higher incidence of adverse events, while melatonin was a safer option with fewer side effects 6.