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Doxepin vs. Tofranil – What Is the Difference and Which One Should I Take?


Doxepin vs. Tofranil - What Is the Difference and Which One Should I Take?

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Navigating depression can feel overwhelming, especially with so many treatment options available. You’re not alone, and you deserve to get the treatment you need when you need it. 

In this article, we’ll review doxepin and Tofranil, two medications that can help treat major depressive disorder. Armed with this new knowledge, you’ll be able to advocate for yourself and have an informed discussion with your mental health provider.

At Klarity, we believe in providing easy access to depression-trained care providers so that you can find relief from your symptoms as soon as possible. Take our brief self-evaluation, and we’ll match you with a licensed provider in your state within 48 hours. 

This article discusses suicide, suicidal ideation, and self-harm. If you or someone you know is experiencing suicidal thoughts or is in crisis, contact the Suicide Prevention Lifeline immediately at 800-273-8255.

Tofranil and Doxepin Are the Same Class of Drugs (Tricyclics)

Tofranil (Imipramine) and doxepin (Silenor) are tricyclics, a class of antidepressants developed in the 1950s. These medications are primarily prescribed to treat major depressive disorder (MDD) but can also have other off-label uses. 

What Are Tricyclics?

Tricyclics work by blocking the reuptake of certain neurotransmitters in the brain, which can help improve mood and reduce symptoms of depression. Tricyclics don’t work for everyone, but they can be an effective means of treatment for some people based on their health history and current symptoms.

Tofranil and Doxepin Are Both Used To Treat Major Depressive Disorder

Tofranil and doxepin are prescription medications used to treat major depressive disorder. Each drug has its own forms, doses, and side effects, and you should always consult your mental health provider before taking a new medication.  

What Else Does Tofranil Treat?

Tofranil is primarily used to treat symptoms of MDD, but it may also be used off-label to treat other conditions. The FDA has an approval system where a series of tests determines whether or not a medication will be an effective treatment for a particular issue. Off-label use is when a medication isn’t approved for a certain issue, but it’s proven to be an effective treatment. 

Off-label Uses for Tofranil

Tofranil is FDA-approved to treat major depressive disorder. It may be prescribed off-label to treat conditions such as chronic pain, anxiety disorders, and attention deficit hyperactivity disorder (ADHD). 

What Else Does Doxepin Treat?

Doxepin is also primarily prescribed to treat MDD and anxiety. Since it increases the levels of certain chemicals in the brain responsible for regulating mood, it’s also used off-label to treat other conditions. 

Off-label Uses for Doxepin

Doxepin is also sometimes used to treat insomnia, as it has a sedative effect that can help people fall asleep and stay asleep. It can also be prescribed to alleviate nerve pain.

Doses, Dosage Form, and Side Effects of Doxepin

Doxepin comes in different doses and forms that contribute to the overall cost of the medication. Depending on your recommended dose, you may experience common side effects, and it’s important to know how your body might respond. Additionally, doxepin interacts with several drugs, so you should tell your care provider about any other medications you take.

Common Doxepin Doses and Forms

Doxepin is available in oral capsule, oral solution, and topical form. The recommended starting dose for adults is 75 mg daily, divided into three smaller doses and taken at bedtime. Your dose may increase gradually, up to a maximum of 300 mg per day. 

Common Doxepin Side Effects

Doxepin can cause several common side effects. These side effects are usually mild and may disappear as your body adjusts to the medication. 

Common doxepin side effects include:

  • Drowsiness
  • Dizziness
  • Dry mouth
  • Blurred vision
  • Constipation
  • Difficulty urinating
  • Nausea and vomiting
  • Stomach pain
  • Weight gain
  • Changes in taste

However, if these side effects persist or if you experience any severe side effects, such as worsening depression, suicidal ideation, difficulty breathing, or swelling of the face, lips, tongue, or throat, you should contact your care provider right away.

Common Doxepin Drug Interactions

Doxepin can interact with other medications and substances, such as alcohol and certain herbal supplements. There are also 661 drugs that doxepin interacts with, including 134 major interactions, 502 moderate interactions, and 25 minor interactions. 

Of the most frequently checked medications, doxepin has major interactions with Cymbalta, Flexeril, Lexapro, Topamax, and Zoloft. 

Moderate interactions include:

  • Abilify
  • Adderall
  • Ambien
  • Benadryl
  • Klonopin
  • Lamictal
  • Lyrica
  • Norco
  • Seroquel
  • Synthroid
  • Xanax
  • Zyrtec

How Much Does Doxepin Cost?

The cost of doxepin depends on the pharmacy you use, your recommended dose, and if you have insurance. You can expect to pay anywhere from $4.26 to $42.15 monthly for 30 capsules of 75 mg. Talk to your provider about using the generic form Silenor to save money.

Doses, Dosage Form, and Side Effects of Tofranil

Like doxepin, Tofranil also comes in several doses and forms and has its own set of side effects. It also interacts with a series of other medications, so you must tell your care provider about any other medicines you’re taking.

Common Tofranil Doses and Forms

There are several doses and forms of Tofranil available, including tablets, capsules, and a liquid form. Common doses are between 10 and 200 mg daily, with the typical dose starting at 75 mg. Your care provider will determine the right dose based on your symptoms and other factors, like your health history. 

Common Tofranil Side Effects

Tofranil can cause some side effects. You must contact your mental health provider if these side effects persist or become severe.

Common side effects include:

  • Weight gain or loss
  • Dry mouth
  • Vision issues
  • Headache
  • Drowsiness
  • Constipation
  • Nausea and vomiting
  • Loss of appetite
  • Diarrhea
  • Stomach cramps
  • Tingly feeling
  • Weakness
  • Lack of coordination
  • Ringing in your ears
  • Breast swelling
  • Decreased sex drive
  • Impotence
  • Difficulty orgasming

If you experience any of the following serious side effects, contact your healthcare provider immediately.

  • Easy bruising or bleeding
  • Fever
  • Sore throat
  • Dark urine
  • Yellowing eyes or skin
  • New or worsening chest pain
  • Irregular heartbeat
  • Sudden numbness
  • Purple or red spots under the skin
  • Confusion
  • New or worsening depression
  • Suicidal ideation
  • Seizures

Common Tofranil Drug Interactions

Tofranil interacts with 690 drugs, with 134 major interactions, 529 moderate interactions, and 27 minor interactions. Major interactions occur with 

  • Cymbalta
  • Celexa
  • Lexapro
  • Paxil
  • Prozac
  • Trazodone
  • Zoloft 

Moderate interactions include:

  • Adderall
  • Ambien
  • Ativan
  • Elavil
  • Gabapentin
  • Klonopin
  • Lamictal
  • Levothyroxine 
  • Lisinopril
  • Seroquel
  • Synthroid
  • Xanax

How Much Does Tofranil Cost?

The cost of Tofranil varies depending on your dose, pharmacy, and insurance coverage. The price ranges from $12.22 to $53.60 for 90 tablets at 25 mg. You should also consider asking about Imipramine, the generic form of Tofranil, as it’s often less expensive. 

Other Tricyclic Side Effects

While they can be effective for many people, tricyclic antidepressants can have other potentially harmful side effects. These adverse effects could include serotonin syndrome, pregnancy and breastfeeding complications, and an increased risk of bleeding. 

What is Serotonin Syndrome?

One potential side effect of tricyclic antidepressants is serotonin syndrome, which occurs when there’s too much serotonin in the body. Symptoms of serotonin syndrome include agitation, hallucinations, and rapid heartbeat. If you experience these symptoms, contact your care provider immediately.

Pregnancy and Breastfeeding on Tricyclics

Another potential concern with tricyclic antidepressants is using them during pregnancy and breastfeeding. Taking tricyclics while pregnant can lead to preterm birth, respiratory distress, neonatal convulsions, or low birth weight. It’s important to talk to your healthcare provider about the potential risks and benefits of taking a tricyclic antidepressant during pregnancy.

Increased Bleeding Risk With Tricyclics

Tricyclic antidepressants can also increase the risk of bleeding. If you are taking a tricyclic antidepressant and planning surgery or dental work, let your care provider know beforehand. You may need to stop taking the medication for a period of time before and after the procedure.

Black Box Warning With Antidepressants

The Food and Drug Administration (FDA) requires a black box warning on all antidepressants, including tricyclic antidepressants. This warning states that antidepressants may increase the risk of suicidal thoughts and behaviors in children, teenagers, and young adults. Monitor any changes in mood or behavior while taking a tricyclic antidepressant.

Doxepin and Tofranil Frequently Asked Questions

What is Doxepin?

Doxepin is a tricyclic antidepressant prescription medication commonly used to treat symptoms of depression and anxiety. 

What is Tofranil?

Tofranil is another tricyclic antidepressant medication that treats symptoms of depression. 

Are Doxepin and Tofranil the same class of drug?

Yes, doxepin and Tofranil are tricyclic antidepressants, meaning they belong to the same class of drugs. While they are within the same drug class, they have their own unique side effects and warnings, and you should consult with a licensed professional before taking either one. 

What’s better for anxiety? Doxepin or Tofranil?

Doxepin is FDA-approved to treat anxiety, while Tofranil is not. Tofranil is used to treat some panic disorders in an off-label capacity, but that’s not its primary intended use. The right medication depends on your current symptoms and your care provider’s recommendations. 

What’s better for depression? Doxepin or Tofranil?

Both doxepin and Tofranil are tricyclic antidepressant medications commonly used to treat MDD. Tofranil is a first-choice medication when it comes to treating symptoms of depression, while doxepin is a second-choice medication due to its many side effects. Your mental health provider will recommend the best option for you.

Can I drive on antidepressants like Doxepin or Tofranil?

It is generally safe to drive while taking doxepin or Tofranil as long as you do not experience any side effects that could impair your ability to operate a vehicle. Before getting behind the wheel, you should wait until you’ve taken a few doses to understand how your body responds. 

Can I drink alcohol on Doxepin or Tofranil?

You should not drink alcohol while taking doxepin or Tofranil. Alcohol can interact with these medications, increasing the risk of adverse side effects and worsening symptoms of depression and anxiety. If you do choose to drink while taking doxepin or Tofranil, only do so in moderation and talk to your healthcare provider about any potential risks.

Does it matter what time of day I take Doxepin or Tofranil?

It is generally recommended that you take doxepin or Tofranil at the same time each day to help maintain a consistent level of the medication in your body. Both drugs can make you tired, so it’s best to take them before bed. 

How Klarity Helps You Access Depression Treatment

Klarity was founded on the principle that access to quality mental healthcare should be convenient and affordable. The licensed providers on Klarity work with you to understand your symptoms and help you find the right treatment so that you can live your life symptom-free. 

Starting at $25/Month, with no insurance requirement, you can get seen by a certified mental health provider in your state at your comfortable home today. Learn more about us and depression treatment today! 


Mayo Clinic Staff. “​​Tricyclic antidepressants and tetracyclic antidepressantsMayo Clinic

“Doxepin Side Effects”

Femi Aremu. “Doxepin, Oral Capsule” Healthline

“Doxepin Interactions”

“Doxepin” GoodRx

John P. Cunha. “Side Effects Center” RxList

“Tofranil Interactions”,tofranil.html

“Tofranil” RxList

IBM Micromedex. “Imipramine (Oral Route)” Mayo Clinic

“Generic Tofranil” GoodRx

“Serotonin Syndrome” Mayo Clinic

Beena N. Patel, Janalynn Beste, Jean C. Blackwell. “Antidepressant Use During Pregnancy” American Family Physician

Kelly A. Cochran, Larisa H. Cavallari, Nancy L. Shapiro, Jeffrey R. Bishop. “Bleeding Incidence with Concomittant Use of Antidepressants and Warfarin” National Library of Medicine

Patricia Weisser. “Imipramine (Tofranil): dosage, uses, side effects” ro

“Compare Tofranil-PM vs. doxepin” Iodine

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