Doxepin (low-dose)
Sleep & Recovery · H1 antagonist (low dose)
Tier B+
What this is
Underused — safe option for older adults for sleep maintenance insomnia where anticholinergic-driven cognitive harm from other agents (Z-drugs, benzos, diphenhydramine) is a concern. 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
Dose & route
3-6 mg PO 30 min before bed
Citations
- https://pubmed.ncbi.nlm.nih.gov/22851860/
- https://pubmed.ncbi.nlm.nih.gov/19955219/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC3230972/
- https://clinicaltrials.gov/study/NCT02353299
- https://pubmed.ncbi.nlm.nih.gov/41189302/
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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.