Drug Comparison
For educational purposes only — a decision-support tool, not a substitute for clinical judgment.
Side-by-side rubric across 96 psychiatric medications. Every rating traces to a verbatim primary-source quote — click any cell to see it.
How to read this tool ▾
Rating scale
– Favorable / lower than class baseline
± Minimal / equivocal
+ Low / uncommon
++ Moderate / common
+++ High / very common
++++ Very high / class-outlier
Frequency vs severity
F = frequency, S = severity. Each gets its own pill colored on the same traffic-light scale: green → blue → yellow → orange → red. Click any cell for incidence percentages and NNH.
Evidence tier
A Network meta-analysis / RCT / FDA label
B Cohort / registry / pooled label data
C Expert review / textbook / case series
Sourcing
Click any cell to see the verbatim source quote and citation. Missing data shows n/a.
Data depth
++ Graded — frequency + severity, primary-source traces
+ FDA label — §6 frequency only (dashed border). Click for sub-types.
Blank — not yet checked (not “absent”)
–±++++++++++ABCF = frequency · S = severity · Dashed border = FDA label only · Click cell for details
1 drug selected — Doxepin(click to collapse)
1/4 selected
Doxepin
Sinequan · Silenor
Tricyclic Antidepressant
FDA-approved indications
- Depression and/or anxiety
- Insomnia characterized by difficulty with sleep maintenance (Silenor 3-6 mg)
Off-label uses
- Chronic urticaria/pruritus
- Neuropathic pain
- Peptic ulcer disease (H1+H2 blockade)
MechanismTricyclic antidepressant with potent H1 antihistamine activity — used at full doses for depression and at ultra-low doses (Silenor) for insomnia
Half-life~15 hours (doxepin); ~31 hours (desmethyldoxepin, active metabolite)
Decision GuideWhen to pick each / when to consider an alternative
Doxepin
Consider when
- Sleep-maintenance insomnia needing a non-scheduled option — only TCA with FDA insomnia approval; best sleep efficiency in Lancet 2022 NMA
- Elderly insomnia — one of only 3 AGS-recommended pharmacologic options at ≤6 mg (alongside DORAs and ramelteon)
- Chronic urticaria or pruritus refractory to standard antihistamines — unique H1+H2 dual blockade among antidepressants
- Depression with prominent insomnia — antidepressant doses (75–300 mg) provide dual benefit via unmatched H1-mediated sedation
- +1 more
Consider an alternative when
- Daytime alertness critical — most sedating TCA at antidepressant doses (H1 Ki 0.17 nM; drowsiness is dose-limiting)
- Suicidal ideation or overdose risk — among the most lethal TCAs in overdose (toxicity index 2.6× amitriptyline reference)
- Elderly patient at antidepressant doses — AGS Beers-listed for strong anticholinergic properties above 6 mg/day
- Patient on CYP2D6 or CYP2C19 inhibitors — dual-CYP vulnerability raises exposure more than most TCAs
- +1 more
| Axis | Doxepin TCA |
|---|---|
| CNS | |
Sedation / somnolence | |
Seizure risk | |
| Metabolic | |
Weight gain | |
| Autonomic | |
Anticholinergic burden | |
Dry mouth (xerostomia) | |
Orthostatic hypotension | |
| Cardiac | |
QTc prolongation | |
| Sexual | |
Sexual dysfunction | |
| Interactions | |
CYP interactions / DDI profile | |