Silenor

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epidural man

epidural man

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  1. Attending Physician
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The reps for Silenor (doxepin) were hear today, talking about this 'new' sleep aide. Apparently it works really well.

I asked the reps - "so tell me what the problems are with the drug."

....crickets.......(and blank stares)

I said - "come on guys, anything that is powerful enough to make physiologic changes in the body for good, is powerful enough to make physicologic changes for the bad. What are they? What is wrong with the drug? What do I need to look out for?"

Funny they couldn't speak about that...I guess they need to learn more about their product.

(On a side note, people that love politics are the same way...i loved asking a die hard Clinton fans to name 5 things that Bush did really well and good for the country, they would start to stutter and get defensive. Then I asked True Blue Bush fans, what they really liked about Clinton - their heads would start to explode....funny stuff..)

Anyway, has anyone used it? Thoughts? Good stuff? Bad stuff? I had never heard of it before today.
 
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It's listed as a TCA, so I'd guess the adverse effects are similar to amitriptyline or nortriptyline. Pitching it to you as a sleeping agent, they should've said the side effects are...sedation. 🙂

Hasn't this med been around for many years? Looks like they just got approval for treating insomnia last year. Clever thing is, the generic are capsules, and the lowest capsule dose is 10mg. With the Silenor doses (tablets) being 3mg or 6mg, it would've been great to just prescribe generic doxepin and have the patient (or pharmacist) cut them in half; but no...damn capsules! Wonder if a generic manufacturer can make 10mg tablets? If not, I'll just stick with nortriptyline at night for it's sedating side effects.
 
Doxepin is old, so this is a re-formulation. If the drug rep can't come up with the bad stuff on his drug, just wait for him to come around with his regional manager and feed it to the manager.

I frustrate drug reps all the time. It's become a form of entertainment. This past week, the Synvisc rep was in my office, seeing docs, asking to see me, as everyone else apparently gave him 10 minutes to "educate" them. I had my nurse go tell him "Yes, he uses it" and refused to see him.

The Cymbalta rep doesn't even ask to see me anymore, Since I kept asking her questions she didn't know the answer to. When she would get an answer, I'd ask another one.
 
I love when they present themselves and then state "I am here to educate you on our new product *****"....

dude, you ain't educating me on nothing ....
 
I've had 2-3 patients complain of "not remembering that they had sex" after taking the medication. Crazy.

From the website:
"After taking Silenor, patients may get up out of bed while not being fully awake and do an activity that they do not know they are doing, and not remember having done the next morning. Patients have a higher chance for doing these activities if they drink alcohol or take other medications that make them drowsy with Silenor. Reported activities include:

driving a car ("sleep-driving")
making and eating food
talking on the phone
having sex
sleep-walking"
 
epidural man said:
The reps for Silenor (doxepin) were hear today, talking about this 'new' sleep aide. Apparently it works really well.

I asked the reps - "so tell me what the problems are with the drug."

....crickets.......(and blank stares)

I said - "come on guys, anything that is powerful enough to make physiologic changes in the body for good, is powerful enough to make physicologic changes for the bad. What are they? What is wrong with the drug? What do I need to look out for?"

Funny they couldn't speak about that...I guess they need to learn more about their product.

(On a side note, people that love politics are the same way...i loved asking a die hard Clinton fans to name 5 things that Bush did really well and good for the country, they would start to stutter and get defensive. Then I asked True Blue Bush fans, what they really liked about Clinton - their heads would start to explode....funny stuff..)

Anyway, has anyone used it? Thoughts? Good stuff? Bad stuff? I had never heard of it before today.
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Anticholinergic side effects.

Not a great idea in CAD patients, arrhythmia patients, etc.

Toxic in overdose.

Why reformulate such an old school medication, apart from profit margin? Seems stupid to me.

This is interesting: check out Silenor versus Doxepin on Epocrates. Apparently, Silenor does not have the potential to cause ventricular arrhthymias and QT prolongation , while Doxepin does.

Someone want to explain this to me?
 
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onewithpain said:
TCAs as a class help you sleep but inhibit REM, so you can sleep all night and half the day and still be tired.
Click to expand...

Same with benzos.

Isn't it funny how few people complain about this problem though?
 
Silenor is approved at 3-6 mg compared to doxepin when used as an antidepressant at 150-300 mg. At a 100-fold lower dose, doxepin is actually quite specific for the H1 receptor (and is even used as a radiotracer molecule to visualize H1 receptors on PET), so it does make sense that you won't see the classic TCA anticholinergic and arrhythmogenic effects. Also, it's actually slow wave sleep (Stage 3-4), not REM, that is the restorative phase of sleep.

The real question is why would anyone use Silenor 6 mg, when a generic doxepin capsule can be found at 10 mg? A Silenor rep tried to convince me how safe it was at 6 mg, but that if you add those 4 more you're really asking for trouble.

Also, keep in mind it was only found to be effective and approved for sleep maintenance, not initiation. 10 mg does work as a weak but non-addictive, safe, and well-tolerated sleep aid for mild insomnia, in my experience.
 
Great discussion on TCAs and sleep! Anyone have any good articles for reference?
 
Encephalopathy said:
Silenor is approved at 3-6 mg compared to doxepin when used as an antidepressant at 150-300 mg. At a 100-fold lower dose, doxepin is actually quite specific for the H1 receptor (and is even used as a radiotracer molecule to visualize H1 receptors on PET), so it does make sense that you won't see the classic TCA anticholinergic and arrhythmogenic effects. Also, it's actually slow wave sleep (Stage 3-4), not REM, that is the restorative phase of sleep.

The real question is why would anyone use Silenor 6 mg, when a generic doxepin capsule can be found at 10 mg? A Silenor rep tried to convince me how safe it was at 6 mg, but that if you add those 4 more you're really asking for trouble.

Also, keep in mind it was only found to be effective and approved for sleep maintenance, not initiation. 10 mg does work as a weak but non-addictive, safe, and well-tolerated sleep aid for mild insomnia, in my experience.
Click to expand...

Silenor is to see if it works, Doxepin 10mg is for the Rx. Like Rybix and Ultram.
 
lobelsteve said:
Guess which one is sitting in the closet at work?
Click to expand...

Good point. i gave a patient a pack of 4 Silenor last week just to try them out and see if they work better than her elavil; then call up if they work and we'll call her in a script.
 
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