
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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