doxepin (Sinequan and Adapin are discontinued brand in the US; Silenor)

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    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

  • Medical and Pharmacy Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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What is doxepin, and how does it work (mechanism of action)?

Doxepin belongs to a class of drugs called tricyclic antidepressants (TCAs) that are used primarily to treat depression and anxiety. Other examples of TCAs include amitriptyline (Elavil), nortriptyline (Pamelor), desipramine (Norpramin), and several others. Depression is an all-pervasive sense of sadness and gloom. In some patients with depression, an imbalance in levels of neurotransmitters in the brain may be the cause of the depression. Neurotransmitters are chemicals that nerves use to communicate with each other. Neurotransmitters affected by doxepin include serotonin, norepinephrine, acetylcholine, and histamine. Doxepin may elevate mood by raising the levels of serotonin and norepinephrine. It also blocks the activity of acetylcholine and histamine. The FDA approved doxepin in March 1974.

What brand names are available for doxepin?

Silenor

Is doxepin available as a generic drug?

GENERIC AVAILABLE: Yes

Do I need a prescription for doxepin?

Yes

What are the side effects of doxepin?

The most common side effect of doxepin is drowsiness. Drowsiness improves as therapy continues. Other side effects associated with doxepin include:

Doxepin also can cause elevated pressure in the eyes of some patients withglaucoma. Doxepin may dilate pupils which may trigger an angle closure attack in a patient with angle closure glaucoma.

If antidepressants, including doxepin, are discontinued abruptly, symptoms may include:

Such symptoms of withdrawal may occur even when a few doses of antidepressant are missed. Therefore, it is recommended that the dose of antidepressant be reduced gradually when therapy is discontinued.

Antidepressants increased the risk of suicidal thinking and behavior in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of any antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidal thinking or behavior, and unusual changes in behavior.

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What is the dosage for doxepin?

The usual dose of doxepin for depression or anxiety is 25 to 300 mg daily administered at bedtime or in two or three divided doses. Doses greater than 300 mg daily are not more effective. Optimal improvement in depressive symptoms is seen after 2-3 weeks; anti-anxiety effects occur much sooner. Insomnia is treated with 3 to 6 mg daily taken 30 minutes before sleeping. Avoid taking doxepin with high fat meals because high fat meals increase the absorption of doxepin.

Which drugs or supplements interact with doxepin?

Tricyclic antidepressants , including doxepin, should not be taken with any of the monoamine oxidase inhibitor (MAOI) class of antidepressants (for example, isocarboxazid [Marplan], phenelzine [Nardil], tranylcypromine [Parnate], selegiline [Eldepryl], and procarbazine [Matulane]) or other drugs that inhibit monoamine oxidase such as linezolid [Zyvox] and intravenous methylene blue. Such combinations may lead to confusion, high blood pressure, tremor, hyperactivity, coma, and death. Doxepin should not be administered for at least 14 days after stopping.

Drug that affect heart rhythm such as amiodarone (Cordarone), bepridil (Vascor), and disopyramide (Norpace) should not be combined with doxepin since it also affects heart rhythm.

Cimetidine (Tagamet) increases the breakdown of doxepin by the liver and can increase doxepin blood levels, possibly causing side effects from doxepin.

Is doxepin safe to take if I'm pregnant or breastfeeding?

There are no adequate studies of doxepin use in pregnant women.

It is not known if doxepin is secreted in breast milk. There is one report of apnea (cessation of breathing) and drowsiness occurring in a nursing infant whose mother was taking doxepin.

What else should I know about doxepin?

What preparations of doxepin are available?

Capsules: 10, 25, 50, 75, 100, 150 mg; Liquid: 10 mg/ml

How should I keep doxepin stored?

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

Reference: FDA Prescribing Information

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See more info: doxepin on RxList
Reviewed on 8/7/2015
References
Reference: FDA Prescribing Information

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