GENERIC NAME: doxepin

BRAND NAME: Sinequan, Adapin

DRUG CLASS AND MECHANISM: Doxepin is an anti-depressant medication of the tricyclic class. Medications in this class are often referred to as tricyclic anti-depressants, or TCAs. Depression is an all-pervasive sense of sadness and gloom. In some patients with depression, abnormal levels of neurotransmitters (chemicals that the nerve cells use to communicate with each other) may be the cause of the depression. Nortriptyline elevates mood by raising the level of neurotransmitters in the brain.

PRESCRIPTION: yes

GENERIC AVAILABLE: yes

PREPARATIONS: Capsules: 10mg, 25mg, 50mg, 75mg, 100mg. 150mg.

STORAGE: Doxepin should be stored below 86°F (30°C) in a tight, light resistant container.

PRESCRIBED FOR: Doxepin is used to elevate the mood of patients with depression. Nortriptyline is also a sedative and is useful in depressed patients with insomnia, restlessness, and nervousness. It also has been found to be helpful for treating chronic pain and the pain of neuralgia.

DOSING: The dose of doxepin is tailored to the patient's needs. Sometimes, physicians will start with relatively low doses, such as 25mg, given three times a day, to reduce the risk of excessive sedation early in the course; doses then will be increased slowly. (It may take several weeks before the effects of a dose are maximal.) Other physicians prefer to give nortriptyline once daily, in which case it is generally given at bedtime to take advantage of its sedating properties. Elderly persons and patients with advanced liver disease may need lower doses.

DRUG INTERACTIONS: Doxepin exaggerates the effects of other medications and drugs that slow the brain's processes, such as alcohol, barbiturates, benzodiazepines (e.g. lorazepam, Ativan), and narcotics. Reserpine, given to patients taking TCAs, can have a stimulatory effect. Doxepin and other TCAs should not be used with monoamine oxidase inhibiting drugs, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane). High fever, convulsions and even death can occur when these drugs are used together

Cimetidine (Tagamet) can increase doxepin blood levels, possibly causing side effects.

PREGNANCY: There is very little information about the effects of doxepin on the fetus in pregnant women. Physicians may use doxepin it if its benefits are deemed to outweigh the unknown risks.

NURSING MOTHERS: It is not known if doxepin is secreted in breast milk.

SIDE EFFECTS: The most commonly encountered side effects associated with doxepin include rapid heart rate, blurred vision, urinary retention (difficulty urinating), dry mouth, constipation, weight gain or loss, and low blood pressure when going from sitting to standing orthostatic hypotension). Rash, hives, seizures, and hepatitis are rare side effects. Doxepin also can cause elevated pressure in the eyes of some patients with glaucoma. Overdose with doxepin can cause life threatening abnormal heart rhythms or seizures.

"If antidepressants are discontinued abruptly, symptoms may occur such as dizziness, headache, nausea, changes in mood, or changes in the sense of smell, taste, etc. (Such symptoms even may occur when even a few doses of antidepressant are missed.) Therefore, it is recommended that the dose of antidepressant be reduced gradually when therapy is discontinued."

Last Editorial Review: 12/31/1997

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