Nowadays, Many people have insomnia; it is widely spreading among all adults due to stress, workplace tension, health and financial issues, and poor lifestyle habits.Â
About 36./. of UK adults are facing sleeping trouble during the night. There are many ways to overcome insomnia: some healthy lifestyle patterns, Meditation, following some therapies, etc. Regarding medication there,
Doxepin and zolpidem are primarily used in the market. Let us understand in detail both the drug differences,Â
Zolpidem (Ambien) is an effective sedative-hypnotic for the short-term treatment of insomnia. It has a rapid onset of action and a short duration of action and elimination half-life, making it useful as a sleep aid. Zolpidem is a Schedule IV controlled substance as it has the potential for abuse.
It is indicated for short-term treatment of insomnia in adults Used for neurologic conditions, migraine headaches, and to relieve stress.Â
Zolpidem is an imidazopyridine compound that acts as an agonist at the benzodiazepine binding site of the GABA receptor. It binds to the GABA-A-containing alpha receptors and slows brain activity, thereby inducing sleep. Zolpidem has a rapid onset of action. It reduces sleep latency and increases sleep duration.
Doxepin (3 mg and 6 mg), which received FDA approval in March 2010, is just the second sleep aid that is not a controlled substance. As such, it may be helpful for individuals with a history of substance dependence.
Low-dose of Doxepin—3 mg and 6 mg - is effective for insomnia characterized by frequent or early morning awakenings and an inability to fall back asleep.
Low dose doxepin- used to treat individuals with sleep maintenance insomnia, characterized by recurrent or early-morning awakenings and difficulty falling back asleep, Indicated for depression and Anxiety.
Doxepin is a tricyclic medication with cholinergic, histaminergic, and alpha1-adrenergic receptor-blocking properties. Doxepin also prevents the reuptake of serotonin and norepinephrine.
Doxepin is hypothesized to have antidepressant properties because it prevents serotonin and norepinephrine from reabsorption at synaptic clefts.
Doxepin is a histamine antagonist that works primarily at the H1 receptor. Its affinity for the H1 receptor is around 100 times greater than monoamine transporters (serotonin and norepinephrine).
Activation of the H1 receptor is crucial in mediating arousal, and brain histamine are critical in sustaining awake. The blockade of the H1 receptor by Doxepin most likely contributes to the decline in wakefulness.
It is available in:
Doxepin has long been available in
| Zolpidem | Doxepin |
| Rapid or irregular heartbeat | Agitation |
| Nausea and vomiting | Blurred vision |
| Abdominal pain | Constipation |
| Diarrhea | Dizziness |
| Appetite loss | Drowsiness |
| Double vision | Dry mouth |
| Respiratory depression | Fatigue |
| Muscle cramps | Nausea and vomiting |
| Skin rashes | Weakness |
| Abnormal body movements | Headache |
| Confusion | Confusion |
| Loss of memory | Seizures |
| Hallucinations | Sweating |
| Depression | Sexual dysfunction |
While not significantly affecting sleep onset, Doxepin 3 mg and 6 mg enhances and sustains sleep maintenance and sleep duration into the final quarter of the night. Zolpidem increases total sleep time and sleep efficiency and decreases sleep latency. With Doxepin, next-day side effects do not occur. The most common side effects are headache and sleepiness/sedation.
Case studies have documented sleepwalking, sleep eating, sleep conversations, sleep driving, and sleep sex in adults. These behaviors are uncommon and occur in patients taking high doses of zolpidem who have underlying psychiatric disorders, medical conditions, or drug-drug interactions.
In elderly individuals, Doxepin seems to be well tolerated. Zolpidem has the danger of dependence. The usage of zolpidem decreases performance in elderly subjects. When it comes to lowering sleep onset latency, zolpidem outperforms Doxepin.
While not significantly affecting sleep onset, Doxepin 3 mg and 6 mg enhances and sustains sleep maintenance and sleep duration into the final quarter of the night. Zolpidem increases total sleep time and sleep efficiency and decreases sleep latency. With Doxepin, next-day side effects do not occur. The most common side effects are headache and sleepiness/sedation.
Case studies have documented sleepwalking, sleep eating, sleep conversations, sleep driving, and sleep sex in adults. These behaviors are uncommon and occur in patients taking high doses of zolpidem who have underlying psychiatric disorders, medical conditions, or drug-drug interactions.
In elderly individuals, Doxepin seems to be well tolerated. Zolpidem has the danger of dependence. The usage of zolpidem decreases performance in elderly subjects. When it comes to lowering sleep onset latency, zolpidem outperforms Doxepin.Â
A comparison between Doxepin, benzodiazepines, and nonbenzodiazepines suggests that Doxepin may be better than nonbenzodiazepines at improving sleep duration and maintenance. Doxepin is less effective than nonbenzodiazepines and benzodiazepines in lowering sleep onset latency.
In a 2008 trial, Scharf et al. investigated the Safety and effectiveness of 1, 3, and 6 mg of Doxepin in patients above the age of 65 years. A placebo or Doxepin was given randomly to 76 persons with primary insomnia for two nights. Patients who took any dose of Doxepin experienced objective and subjective improvements in sleep duration and maintenance of sleep, which lasted into the final hours of the night. At all three doses, there was an improvement in both total sleep time and sleep efficiency.
In a study by Krystal AD, side effects included nausea (4–5%), somnolence (8–9%), and dizziness (2%). There were no reports of complex sleep behaviors, memory impairment, or cognitive disorders in the doxepin-treated elderly patients.
In a different study by Scharf, 768 older insomniacs participated in a two-phase trial. The usual treatment was compared to 4 weeks of zolpidem (5 or 10 mg).
Using immediate zolpidem release (IR) at both 5 and 10 mg, subjective sleep onset latency, average time awake at night, and the number of awakenings (NOA) decreased while total sleep time (TST) increased.
Precaution is needed in consuming drugs while taking it states some information about the drug; every individual should know and be aware of the drug precautions. They can consult their doctor and also read the label given below the tablets.Â
Why should people know about drug interactions?
Drug interaction will help you know which drugs should be taken together and not so well in practice or the medication. Read out the label and follow the instructions.
  Avoid taking MAO inhibitors like
with Doxepin because it may lead to severe effects of drug interactions. Some drugs, like cimetidine and terbinafine, will make the doxepin work less effectively. Inform your doctor if you are using products that cause drowsiness, like opioid pain, cough relievers, or alcohol.
Selective serotonin reuptake inhibitors:
Ambien can interact with the SSRIs group of drugs but will increase the risk of Ambien causing side effects.
Benzodiazepines:
While interacting with Ambien. You may have a higher risk of side effects from both the group of drugs; if you take Ambien and benzodiazepine, it can increase the CNS side effects and show some symptoms.
Before interacting with certain herbs and supplements, you should consult a doctor.
Avoid interacting with alcohol. It will lead to severe drowsiness and worsen your condition
Doxepin could be considered as first-line therapy for adults and older people with sleep maintenance insomnia. Zolpidem is more effective than Doxepin in reducing sleep onset latency.
Furthermore, ultra-low-dose Doxepin has not been shown to cause physical dependence or tolerance or to be related to abuse potential, making it a possible alternative for those with a history of these problems.
