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Lunesta vs. Doxepin?

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If you are not getting enough sleep at night, you are not alone. Lunesta vs. Doxepin?

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If you are not getting enough sleep at night, you are not alone. It is estimated that every year, nearly 70 million Americans are affected by insomnia symptoms, which is estimated to be about one-third of the adult population. 

Although insomnia is fairly common in the US, it is important to recognize that lack of quality sleep puts you at risk of compromising not only your physical health but your mental health as well. There are a number of factors that impact our sleep patterns and insomnia can look different from person to person. 

Luckily, there are many treatment options that target specific symptoms associated with sleep disturbances, as well as treat the underlying cause of your insomnia. In this article, we will discuss two popular medications that are used for the treatment of insomnia, Lunesta and Doxepin. 

This side-by-side comparison guide will allow you to learn the main similarities and differences between the two medications so that you can be better informed while discussing insomnia treatment options with your healthcare provider. 

If you are in need of a compassionate healthcare provider who is experienced in treating insomnia or other sleep disturbances, schedule an appointment on Klarity today. We will connect you with a licensed provider in your state within 48 hours, who will help you get started on an individualized insomnia treatment plan that works best for you. 

What is Lunesta?

Lunesta or eszopiclone is a unique drug and is considered a sedative-hypnotic medication. This medication works by activating and modulating the same receptors benzodiazepines and alcohol act upon, although it is not a benzodiazepine medication itself.  

These receptors are called GABA inhibitory receptors, and when activated, have the inverse effect of slowing down the signaling and activity within the brain, resulting in sedation and allowing the brain to enter a sleep state.  

Lunesta is only FDA-approved for the use of insomnia to help individuals fall asleep, as well as stay asleep throughout the night. 

Lunesta Forms and Doses

Lunesta or its generic equivalent, eszopiclone, are available in tablets only. When initially starting the medication, your healthcare provider will start you on the lowest dose of a 1 mg tablet, to be taken immediately before going to bed. 

The dose can be increased over time, as needed, but should not exceed 3 mg per day. Lunesta is considered to be a schedule-IV controlled substance due to its potential for abuse and dependence. After long-term continuous use, you will need to be slowly tapered off of the medication. 

Lunesta tablets are available in the following doses: 

  • 1 mg 
  • 2 mg 
  • 3 mg

Conditions Lunesta Treats

Lunesta is only FDA-approved and used for the treatment of insomnia, primarily for those who have problems with sleep onset or falling asleep and sleep maintenance or staying asleep throughout the night. 

Insomnia

Insomnia is a fairly common sleep disturbance or disorder and can also present differently from person to person. Some may experience difficulty falling asleep, while others may not be able to stay asleep, with frequent nighttime awakenings or an inability to enter a deep sleep state.  

Overall, the individual’s sleep pattern is disturbed, and they are not getting the good quality sleep that their body needs. Without adequate sleep, your body is not able to function properly, physically and cognitively. The effects of sleep deprivation can have detrimental effects on your personal and professional lives.

Some common secondary symptoms caused by insomnia include: 

  • Excessive daytime sleepiness
  • Lack of motivation or energy 
  • Difficulty concentrating  
  • Increased anxiety or depressive symptoms 
  • Irritability or agitation 
  • Increased appetite
  • Changes in memory 

Lunesta Costs

In comparison to Doxepin, Lunesta is a fairly expensive medication. The price of your medication will dramatically vary based on your dose, insurance coverage, and which pharmacy you use. 

The average retail price for name-brand Lunesta is roughly $586 for a month’s supply without the use of insurance. For those who are uninsured, large name-brand pharmacies have coupon codes available that significantly lower the cost of a 30-day supply to under $7.  

Lunesta Side Effects

As with most medications, there are associated risks and benefits that should be considered before starting a new medication. The majority of the adverse effects associated with Lunesta are mild, but if you start to experience severe or bothersome side effects after starting the medication, call your healthcare provider immediately, 

Some of the most common side effects associated with Lunesta include: 

  • Headache 
  • Dry mouth
  • GI upset, including nausea, diarrhea
  • Drowsiness or dizziness 
  • Increased anxiety or depression 
  • Abnormal dreams 
  • Hallucinations 
  • Skin rash 

Lunesta Drug Warnings

There are a few serious adverse effects that are associated with taking Lunesta, and should be discussed before starting the medication. 

Complex Sleep Behaviors

Lunesta is associated with a few serious adverse effects, such as complex sleep behaviors, where the individual is not fully awake or conscious but is engaging in physical activities. Some examples of complex sleep behaviors include sleepwalking or even sleep-driving. 

As you can imagine, these complex sleep behaviors can be very dangerous and even potentially fatal for those involved. It is important to discontinue Lunesta if you experience any complex sleep behaviors after starting the medication. 

Limit Long-Term Use

Lunesta is considered to be a schedule-IV controlled substance by the FDA because of the potential for abuse and dependence. This medication should be avoided in those who have a current or past history of substance abuse. 

With long-term use of Lunesta or other sedatives, there have been studies that show an increased risk of behavioral changes and abnormal thinking patterns. This may include irritability, agitation, bizarre behavior, hallucination, and dissociation or depersonalization. 

Due to these findings, it is important to screen patients for underlying or unrecognized psychiatric disorders before prescribing Lunesta or other sedatives and to avoid prescribing this class of medication to this particular population. 

Withdrawal Symptoms

If you are unhappy with your medication and thinking of discontinuing it, it is important to discuss this with your healthcare provider. They will advise you to slowly titrate off of the medication by reducing the dose by roughly 25% each week until you are completely off the medication. 

For those who are discontinuing the medication after prolonged use of high daily doses (over 3 mg), it is often advised that these individuals come off of the medication at a slower rate. It may also be suggested to use CBT or cognitive behavioral therapy for insomnia while tapering the dose for a successful transition off of the medication.  

Lunesta Interactions

There are a number of drugs that interact with Lunesta, and therefore, your medication listed should be carefully reviewed with your healthcare provider before starting a new medication. 

It is important to avoid drinking alcohol or use of any other central nervous system depressants due to the potential dangers of the enhanced effect of CNS depression. There are a number of medications that have CNS depressant action that can be overlooked, and therefore, your med list should be carefully reviewed by your prescribing provider. 

Common drug interactions with Lunesta include: 

  • Benzodiazepines 
  • Other sleep aids, like Zolpidem
  • Antihistamine medications, such as, Hydroxyzine, Benadryl, or Zyrtec  
  • Opioid pain medication
  • Metoclopramide 
  • Most cold and cough medicines 
  • Muscle relaxants, like cyclobenzaprine 
  • Recreational drugs, such as marijuana, Kratom

What is Doxepin?

Doxepin is a tricyclic antidepressant medication that is commonly used for the treatment of anxiety, depression, and insomnia. Doxepin can also be used topically to treat itching associated with eczema or neuropathic pain. 

TCAs work by blocking the reuptake or increasing the levels of serotonin and norepinephrine in the brain to improve mood while simultaneously slowing down activity. Doxepin has sedating effects, making it an effective choice of medication for the treatment of insomnia. 

Doxepin Forms and Doses

Doxepin is available in capsules, tablets, and an oral solution for the treatment of insomnia. In addition, Doxepin is available as a topical cream for when prescribed for itching. 

Doxepin capsules are available in the following doses: 

  • 10 mg 
  • 25 mg 
  • 50 mg 
  • 75 mg 
  • 100 mg 
  • 150 mg 

Doxepin tablets are available in the following doses: 

  • 3 mg 
  • 6 mg 

The oral solution is available in 10 mg/mL dosing only and is typically reserved for the pediatric population and those who cannot tolerate swallowing oral medication. 

Conditions Doxepin Treats

Doxepin is a TCA antidepressant medication that is most commonly used to treat the following conditions: 

Depression

TCA medications, such as Doxepin, are among the oldest medications used in the treatment of depression. Depression can present itself in many different forms, and some may experience changes in their sleep patterns due to their depressive symptoms. 

Some common symptoms of depression include: 

  • Loss of interest in pleasurable activities
  • Low energy levels 
  • Changes in appetite 
  • Sleep disturbances, including insomnia or increased need for sleep
  • Feelings of helplessness, hopelessness, or worthlessness

Insomnia

Doxepin is known to be a highly effective medication for the treatment of insomnia due to its sedating effects on the body. In addition, Doxepin is used to treat depression and anxiety, which could be beneficial for someone who has an underlying mood disorder or anxiety symptoms that may be contributing to insomnia as well.  

 As mentioned above, insomnia can lead to serious problems in your everyday life due to the physical and psychological impairment that sleep deprivation causes. It is important to talk to your healthcare provider if you are experiencing difficulty sleeping and are unable to get a good night’s rest. 

Anxiety

Anxiety is another condition that can play a role in your inability to fall asleep and/or stay asleep. Racing, unwanted, or intrusive thoughts may keep you up at night, or you may find that it is challenging to “slow down your mind” at nighttime while lying in bed.

Doxepin is effective in the treatment of certain symptoms associated with anxiety, making this medication an excellent choice for someone who suffers from both anxiety and insomnia. 

Doxepin Costs

Doxepin is a relatively affordable medication and is covered by the majority of commercial health insurance plans. The exact price of your medication will vary depending on insurance coverage, dosing, and which pharmacy you use. 

 If you are uninsured, the use of coupon codes significantly reduces the cost of your medication and are found in most large pharmacies. The average retail price on a 30-day supply of Doxepin is roughly $33, but with the use of these coupons, the cost is lowered between $1-$8. 

Doxepin Side Effects

As with any medication, there are some common adverse effects that may occur when starting a new medication. If you begin to experience serious side effects, contact your healthcare provider or seek medical attention urgently. 

The common side effects associated with Doxepin include: 

  • Headache 
  • Increased heart rate 
  • Dizziness upon standing
  • Paresthesia, or sensation of “pins and needles” on the skin
  • Chills
  • Cold sweats
  • Urinary retention 
  • Blurred vision
  • Muscle stiffness or spasms

It is important to seek out urgent medical care if you begin to experience any of the following serious side effects: 

  • Chest pain or tightness
  • Increasingly fast or irregular heartbeat
  • Confusion and loss of consciousness 
  • Signs of internal bleeding, such as black or tarry stools or frank blood in urine or stool
  • Blurred vision 
  • Seizures 

Doxepin Drug Warnings

Due to the side effect profile and potential risk of severe adverse effects when taking tricyclic antidepressants, they are no longer considered to be first-line agents for the treatment of anxiety and depression. 

Below we have listed a few important and potentially dangerous warnings to consider before starting any TCA antidepressant, including Doxepin. 

Serotonin Syndrome 

Serotonin is a rare yet serious and potentially life-threatening condition that occurs from dangerously high levels of serotonin in the body. This most commonly occurs when someone is on multiple medications that increase levels of serotonin. 

It is important to seek out immediate medical attention if you experience any of the following signs and symptoms: 

  • Altered mental status: agitation, confusion, anxiety, delirium, coma 
  • Autonomic dysfunction: high blood pressure, fast heart rate, sweating, overheating, nausea, vomiting, diarrhea
  • Neuromuscular abnormalities: tremor, exaggerated reflexes, muscle rigidity, involuntary movements

Without urgent medical intervention, there are serious complications that may arise, including:

  • Metabolic acidosis 
  • Kidney failure 
  • Respiratory failure 
  • Breakdown of muscle 
  • Seizures 
  • Death 

Pregnancy and Breastfeeding on Doxepin

TCA antidepressant medication, such as Doxepin, is typically avoided during pregnancy and breastfeeding due to the following potential complications: 

  • Spontaneous abortion
  • Hypertension or preeclampsia 
  • Preterm birth 
  • Postpartum hemorrhage 
  • Postnatal effects: withdrawal symptoms, hypoglycemia, respiratory illness, jaundice

Doxepin Interactions

It is always important to disclose all medications you are currently taking to your healthcare provider, including all over-the-counter medications and supplements, before starting a new medication. 

There are a number of drug interactions with Doxepin, including: 

  • Anticholinergic medications 
  • Thyroid supplements 
  • Certain antihypertensive medications, such as clonidine 
  • MAOIs
  • Other antidepressants, such as SSRIs
  • Some antifungal drugs, such as terbinafine 
  • Acid reflux or GERD medications like Cimetidine 
  • St. John’s Wort

Should I Take Lunesta or Doxepin For Insomnia

Lunesta and Doxepin are two very different drugs, and each medication comes with its own risks and benefits to consider before starting a new medication. There are a number of different factors that go into the selection process of finding the right insomnia medication for you. 

Some of these components include your current medications, current and past medical history, and what insomnia looks like for you, including the severity of symptoms and its impact on daily life. 

It is also important to note that there are a number of effective medications in the treatment of insomnia, and everyone reacts to medications differently. If you believe you would benefit from insomnia treatment or would simply like to learn more, head over to Klarity and take our free survey.  

Lunesta and Doxepin Frequently Asked Questions

Throughout the article, we went over a lot of information on two very different drugs. Although they are both used to treat insomnia by causing sedation, they have extremely different effects on the body and treat different symptoms of insomnia. 

We understand this can be confusing, and you may have additional questions. Below, we have included some of the most frequently asked questions about Lunesta vs. Doxepin. 

Are Lunesta and Doxepin the same class of drug?

No, they are both two very different drugs with regard to their mechanisms of action. Lunesta is a hypnotic-sedative drug that acts on GABA receptors to induce sedation and promote sleep. 

Doxepin is a TCA antidepressant medication that works by increasing the levels of serotonin and norepinephrine in the brain to improve mood and reduce anxiety. Doxepin is also an effective treatment method for insomnia due to its sedating effects. 

What’s better for Insomnia? Lunesta or Doxepin?

Depending on your particular insomnia symptoms, one medication may be better than the other. There are a number of different factors that help determine which treatment method may be best for you, and your healthcare provider will help navigate this process with you.

If you have symptoms of underlying depression or anxiety, which are contributing to your insomnia, Doxepin may be a more beneficial medication for you. Treating the underlying cause of your insomnia symptoms is the most effective treatment method for successful, long-term results. 

When comparing Lunesta vs. Doxepin, Lunesta is more effective for insomnia treatment in the short-term period of time. It is a stronger sedative than Doxepin but should not be taken for long periods of time. 

Can Lunesta cause depression? Can Doxepin?

While Doxepin is used to improve mood in the treatment of depression, there is a small risk associated with worsening depression when starting the medication. 

Lunesta, on the other hand, has a risk of developing new or worsening depression as a potential side effect. In addition, there have been rare incidents of behavioral changes and abnormal thinking associated with the continuous use of Lunesta. 

Can I drive on Lunesta or Doxepin?

Neither medication should be taken before operating a vehicle or heavy machinery. This is especially true for Lunesta, as it is a much more potent sedative and should only be used right before bedtime. 

Can I drink alcohol when taking Lunesta or Doxepin?

Alcohol should be avoided while taking either medication due to the compound sedative effects of both substances together and the increased risk of experiencing adverse effects. 

Of particular note, drinking alcohol while taking Lunesta can be extremely dangerous and even fatal in rare circumstances. Both alcohol and Lunesta are CNS depressants and should never be simultaneously consumed. 

In addition, the risk of experiencing complex sleep behaviors can be potentiated while simultaneously drinking alcohol and taking Lunesta, and these behaviors in themselves can be extremely dangerous for all involved. 

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

Yes, since both medications cause sedation and promote sleep, they should be taken at night before bedtime. 

Start Insomnia Treatment Within 48 Hours With Healthcare Providers on Klarity

Sleep is arguably one of the most important bodily functions that help to maintain a happy and healthy lifestyle. It is your body’s time to reset and recharge so that you’re able to perform at your best throughout the day.  

Whether it’s trouble falling asleep, staying asleep, or anything in between, the providers on Klarity can help. At Klarity, we connect you to a licensed and experienced healthcare provider who will thoroughly discuss your symptoms in order to give you an accurate diagnosis. They will then navigate through the different treatment options with you so that you can build an individualized treatment plan that works best for you. 

We believe that you should have access to affordable mental health care at the convenience of your own home, anytime you need it. No subscriptions or insurance necessary, and no hidden fees. 
Schedule an appointment today and have your first appointment with an experienced healthcare provider in as little as 48 hours to get you one step closer to the good nights sleep you deserve.

Sources: 

“Doxepin (systemic): Drug information” UpToDate. https://www.uptodate.com/contents/doxepin-systemic-drug-information?search=doxepin%20drug%20information&source=panel_search_result&selectedTitle=1~70&usage_type=panel&showDrugLabel=true&display_rank=1 

“Doxepin Hcl Coupons & Prices” SingleCare. https://www.singlecare.com/prescription/doxepin-hcl?q=Doxepin%20Hcl%20(Silenor) 

“Doxepin Prices and Coupons and Patient Assistance Programs” Drugs.com. https://www.drugs.com/price-guide/doxepin 

“Eszopiclone: Drug information” UpToDate. https://www.uptodate.com/contents/eszopiclone-drug-information?search=lunesta&source=panel_search_result&selectedTitle=1~25&usage_type=panel&kp_tab=drug_general&display_rank=1 

“Lunesta Coupons & Prices” SingleCare. https://www.singlecare.com/prescription/lunesta?utm_medium=paid-search&utm_source=google-sc&utm_campaign=1798572127&utm_adgroup=75028918011&utm_term=%2Bcost%20%2Bof%20%2Blunesta&utm_content=618378207568&matchtype=b&pos=&device=c&mkwid=s|dc_pcrid_618378207568_pkw_%2Bcost%20%2Bof%20%2Blunesta_pmt_b&segments=&gclid=Cj0KCQiAkMGcBhCSARIsAIW6d0CiJtSkZtUeUiyA0ky6clpR-Cgf6G4cb6voUvLfE4Q1b-e-CU9UdH8aAvowEALw_wcB 

“Lunesta Prices, Coupons and Patient Assistance Programs”  Drugs.com. https://www.drugs.com/price-guide/lunesta 

“Pharmacotherapy for insomnia in adults” UpToDate. https://www.uptodate.com/contents/pharmacotherapy-for-insomnia-in-adults?search=doxepin&source=search_result&selectedTitle=3~70&usage_type=default&display_rank=2 

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