At the end of this form, you will be prompted to pay a fee based on your selected option. This fee covers 30 or 90 days of medication, depending on your preference. 

• $45 Fee: For 30 days of medication.
• $120 Fee: For 90 days of medication. 

If your last prescription was sent within the past 7 days (including weekends), we will issue a 25% partial refund to account for the adjustment within 2 business days. Please note, it may take 7-14 business days for the refund to appear on your credit card statement.

Check the dose range for your medication to ensure you are not already at the minimum dose. If you are at the minimum dose and it is still too strong or causing side effects, please please start over and request a medication change.

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Daridorexant 

Brand Name: Quviviq

Available Doses: 25 mg, 50 mg tablets.
Minimum / Maximum Dose: 25 mg to 50 mg at bedtime.

Because it works with your body's natural sleep-wake system rather than sedating the brain, it not only helps you fall asleep faster but also improves sleep continuity. When taken correctly, it generally does not cause next-day drowsiness or a "hangover" effect, making it one of the best options for improving sleep with minimal side effects. Additionally, it has a lower potential for dependence compared to traditional sleep medications.

However, if you've had two or more alcoholic drinks within three hours of bedtime, it’s important to skip your dose that night to avoid dizziness and other unwanted side effects. If you can commit to giving it time, Daridorexant is truly one of the most effective and side-effect-free sleep treatments available.

✔ Pros:

• Improves sleep onset & maintenance – Helps fall asleep faster and stay asleep longer.
• Enhances daytime functioning – Reduces next-day fatigue and grogginess.
• Non-addictive – Lower risk of dependence compared to benzodiazepines.
• Well-tolerated – Minimal side effects with proper use.

✖ Cons:

• Delayed effectiveness – May take several weeks to notice full benefits.
• Interaction with alcohol – Can increase dizziness and next-morning impairment.
• Possible sleep paralysis/hallucinations – Rare but documented side effects.

View All Side Effects Here

Certain drugs can increase side effects or pose risks:

• Strong CYP3A4 inhibitors (e.g., ketoconazole) – Avoid use as they can increase daridorexant levels.
• Alcohol – Avoid taking if you’ve had 2+ alcoholic drinks within 3 hours of bedtime.
• Other CNS depressants (e.g., opioids, sedatives) – Can enhance sedation and impair mental alertness.

Always inform your provider about your medications.

Pregnancy
There is insufficient safety data regarding daridorexant use in pregnancy. Animal studies suggest potential fetal harm at high doses, but human data is lacking. Due to these unknown risks, our policy does not support prescribing daridorexant if pregnancy occurs. Patients should consult their provider about safer alternatives for sleep.

Breastfeeding
It is unknown whether daridorexant is excreted in breast milk, but similar medications suggest a potential risk of sedation and respiratory depression in infants. Due to these concerns, our policy does not support the use of daridorexant while breastfeeding. Patients should discuss alternative treatment options with their provider.

Doxepin 

Brand Names: Sinequan, Silenor

Available Doses: 3 mg, 6 mg (for sleep); higher doses available for depression and anxiety
Minimum / Maximum Dose for Insomnia: 3 mg to 12 mg nightly

What is Doxepin?
Doxepin is a tricyclic antidepressant traditionally used to treat depression and anxiety. However, at very low doses, it is effective for sleep maintenance, helping people stay asleep through the night. It works by blocking histamine receptors, which reduces wakefulness without leaving you overly drowsy the next day.

The Doctors’ Insights
Doxepin is particularly useful for individuals who wake up frequently throughout the night but do not have trouble falling asleep. Unlike stronger sedative medications, it helps maintain sleep without significant next-day grogginess.

Because doxepin has minimal addiction potential and does not disrupt normal sleep cycles, it is considered a safer long-term option compared to many other sleep aids. However, proper timing and dosage are critical for effectiveness.

Doxepin should be taken on an empty stomach, at least three hours after your last meal, to ensure it works optimally. Some patients may need to adjust their dose based on response. When used correctly, doxepin can significantly reduce nighttime awakenings and improve overall sleep quality.

When is Doxepin Considered for Sleep?

• Best suited for individuals who struggle with frequent nighttime awakenings.
• A good alternative for those who want to avoid stronger sedatives with higher addiction potential.
• Typically used when other treatments, such as behavioral changes or other medications, have not been effective.

Most Common Side Effects

Very Common (>10% of users)

• Drowsiness or Fatigue – Can occur the next morning if the dose is too high.
• Dry Mouth – Staying hydrated or chewing sugar-free gum can help alleviate this.

Common (1–10% of users)

• Dizziness – More common in individuals sensitive to antihistamines or tricyclics.

Rare but Serious Side Effects

• Mood Changes – Some users may experience increased irritability or agitation.
• Suicidal Thoughts-- very rare (1/132) but possible risk with the use of any antidepressant in patients 29 and under. 
• Heart Rhythm Changes – Rare but possible; inform your doctor if you have any heart conditions.
• Allergic Reactions – Symptoms such as swelling, rash, or difficulty breathing require immediate medical attention.

View All Side Effects Here

Most Common Drug Interactions

Medications to Avoid or Use with Caution

• Alcohol and Sedatives – Combining doxepin with alcohol, benzodiazepines, or opioids can amplify drowsiness and dizziness.
• Other Antihistamines – Using diphenhydramine (Benadryl) or hydroxyzine with doxepin may increase side effects like dry mouth and sedation.
• Antidepressants or Antipsychotics – Combining these medications requires monitoring to avoid interactions such as serotonin syndrome.

Pregnancy and Breastfeeding

Pregnancy

• Doxepin is not recommended for use during pregnancy due to limited safety data and potential risks to fetal development. While some providers may weigh the risks and benefits in severe cases, our policy is not to prescribe doxepin if pregnancy occurs. Patients who are pregnant or planning to become pregnant should discuss alternative sleep treatments with their healthcare provider.

Breastfeeding

• Doxepin passes into breast milk and has been associated with reports of infant sedation, breathing difficulties, and poor feeding. Due to these potential risks, our policy does not support the use of doxepin while breastfeeding. Nursing mothers should explore safer alternatives with their medical provider. If a patient taking doxepin becomes pregnant or begins breastfeeding, discontinuation and alternative treatment options should be discussed immediately.

Hydroxyzine

Brand Name: Vistaril

Available Doses: 25 mg and 50 mg capsules or tablets.
Minimum / Maximum Dose: 25 - 100 mg at bedtime.

One of the key benefits of hydroxyzine is its fast-acting sedative effect, making it a reliable option for those who have difficulty initiating sleep. Additionally, it helps maintain sleep by reducing nighttime awakenings. Unlike some stronger medications, it does not disrupt normal sleep cycles, allowing for a more natural rest.

However, about 10% of patients report mild morning tiredness as the medication gradually leaves their system. This effect is typically dose-dependent and can often be minimized by adjusting the dosage or taking it earlier in the evening. When used correctly, hydroxyzine provides a safe, non-addictive alternative for improving sleep quality.

Pros:

✔ Non-addictive with no risk of dependence.
✔ Fast-acting sedative effects help with sleep onset.
✔ Available as a low-cost generic option.
✔ Versatile uses (anxiety, allergies, nausea, insomnia).

Cons:
✖ Can cause significant drowsiness, dizziness, and dry mouth.
✖ Not suitable for individuals with long QT syndrome or during pregnancy.
✖ May lead to confusion or oversedation in older adults.

• Central nervous system depressants (risk of excessive drowsiness): Benzodiazepines, opioids, alcohol, sleep aids.
• QT-prolonging drugs (risk of heart arrhythmias): Certain antibiotics, antipsychotics, antiarrhythmic.
• Antihistamines (risk of enhanced side effects): Diphenhydramine, promethazine.
• CYP3A4 inhibitors (may increase hydroxyzine levels): Some antifungals, antibiotics, HIV medications.

Always inform your provider about your medications to avoid potential interactions.

Uncommon Effects:
✖ About 5% of patients report mild confusion or dizziness.
✖ Rare cases of dry mouth, headache, or nausea.
✖ If side effects occur, notify your provider for adjustments.

View All Side Effects Here

Mirtazapine  

Brand Name: Remeron

Available Doses: 7.5 mg, 15 mg, 30 mg, and 45 mg tablets (including orally disintegrating forms). The 7.5mg tablets can be broken in half.
Minimum / Maximum Dose for Insomnia: 3.75 mg to 15 mg nightly

Mirtazapine stands out among sleep aids due to its dual benefits: enhancing sleep while improving mood. It is an excellent choice for individuals suffering from insomnia, depression, or anxiety-related sleep disturbances.

Its mechanism is unique—rather than functioning like traditional sedatives (e.g., benzodiazepines or Z-drugs), mirtazapine promotes sleep by increasing serotonin and norepinephrine while also blocking histamine receptors. This histamine-blocking effect induces deep sleep without suppressing natural REM cycles.

• Non-Addictive – Unlike controlled substances like benzodiazepines or Z-drugs (e.g., Ambien), mirtazapine has no risk of dependence.
• Effective for Sleep Maintenance – Helps with both falling asleep and staying asleep.
• Appetite-Stimulating – Can be beneficial for individuals experiencing stress-related weight loss.
• Minimal Cognitive Impairment – Less next-day sedation compared to other sleep medications at lower doses.
• Weight Gain Potential – Some users report increased appetite and weight gain.
• Grogginess in Some Users – May cause morning drowsiness, particularly at higher doses.

Who Should Consider It?

• Individuals with both depression and insomnia
• Those who have tried traditional sleep medications without success
• People looking for a long-term sleep aid that is not habit-forming

Common Side Effects

Very Common (>10% of users)

• Drowsiness (75%)
• Dry mouth (25%)
• Increased appetite (17%)
• Weight gain (12%)
• Constipation (13%)

Common (1–10% of users)

• Dizziness
• Nausea
• Increased cholesterol levels

Rare but Serious Side Effects

• Mood Changes – Can trigger mania or agitation in individuals with bipolar disorder.
• Suicidal Ideation -- possible with any antidepressant when used in patients 29 and under. 
• Blood Disorders – Rare risk of agranulocytosis (severe white blood cell depletion).
• Serotonin Syndrome – High risk when combined with other serotonergic drugs.
• QT Prolongation – Can cause dangerous heart rhythm changes, particularly when combined with other medications that affect heart rhythms.
• Seizures – Rare but reported, especially in individuals with epilepsy.
• Severe Allergic Reactions (DRESS Syndrome) – Symptoms include fever, rash, swollen lymph nodes, and multi-organ involvement.
• Seek immediate medical attention if any of these occur.

View All Side Effects Here

Mirtazapine can interact with several medications. Always inform your doctor about all medications and supplements you are taking.

Major Interactions (Avoid Combining)

• MAOIs (Monoamine Oxidase Inhibitors) – Can cause dangerous serotonin syndrome. Avoid for at least 14 days before or after taking MAOIs.
• Other Serotonergic Drugs – Includes SSRIs, SNRIs, tramadol, St. John’s Wort.
• Benzodiazepines & Alcohol – Can increase drowsiness and cognitive impairment.
• QT-Prolonging Medications – May increase risk of heart arrhythmias.

Moderate Interactions (Use with Caution)

• Warfarin (Blood Thinner) – May increase bleeding risk; monitor INR closely.
• Cimetidine (Heartburn Medication) – Can increase mirtazapine levels; dose adjustments may be needed.
• Seizure Medications (Carbamazepine, Phenytoin) – Can reduce mirtazapine levels, potentially making it less effective.

Mild Interactions

• Herbal Supplements – Valerian root, kava, and melatonin may enhance sedation.

Warnings & Precautions

• Suicidal Thoughts – Slightly increased risk in young adults when starting antidepressants.
• Caution in Older Adults – Increased risk of falls due to sedation and dizziness.
• Pregnancy & Breastfeeding – Use only if benefits outweigh risks. Consult your doctor.
• Driving & Machinery – Avoid until you understand how it affects you.

Pregnancy & Breastfeeding 

Pregnancy
Mirtazapine is not considered a first-line option during pregnancy due to uncertain long-term fetal effects. While some studies suggest a low risk of congenital abnormalities, others indicate potential concerns, including preterm birth or low birth weight. Our policy does not support prescribing mirtazapine if pregnancy occurs. Patients should consult their provider about alternative treatments.

Breastfeeding
Mirtazapine is excreted in breast milk in small amounts, with some case reports showing mild sedation and weight gain in breastfed infants. Due to uncertainty about long-term effects, our policy does not support the use of mirtazapine while breastfeeding. Patients should discuss safer options with their doctor.