Doxepin HydrochloridePronouncation: (DOX-uh-pin HIGH-droe-KLOR-ide)
Class: Antianxiety agent, Tricyclic compound, Topical antihistamine preparation
- Capsules 10 mg
- Capsules 25 mg
- Capsules 50 mg
- Capsules 75 mg
- Capsules 100 mg
- Capsules 150 mg
- Cream 5%
Moderately blocks reuptake of norepinephrine and weakly blocks reuptake of serotonin; also produces antihistaminic and anticholinergic activity.
T max is 2 to 8 days (steady-state).
Metabolized in the liver to desmethyldoxepin (active).
Urinary excretion; t ½ is 8 to 24 h (oral), 28 to 52 h (topical).
Indications and Usage
Treatment of psychoneurotic patients with depression and/or anxiety; depression and/or anxiety associated with alcoholism (not to be taken concomitantly with alcohol); depression and/or anxiety associated with organic disease (the possibility of drug interaction should be considered if the patient is receiving other drugs concomitantly); psychotic depressive disorders with associated anxiety including involutional depression and manic-depressive disorders; moderate pruritus with atopic dermatitis or lichen simplex chronicus (topical).
Neurogenic pain, peptic ulcer disease.
Hypersensitivity to tricyclic antidepressants; use during acute recovery phase after MI; glaucoma; risk of urinary retention; concomitant use with MAOI; dibenzoxepines may produce cross-sensitivity.
Dosage and AdministrationDepression and/or Anxiety
PO Initial dose 75 mg/day, increasing as tolerated (max, 300 mg/day). May be given every day or on a divided dosage schedule. If given every day, the max recommended dose is 150 mg/day.For Mild Cases with Organic Diseases
PO 25ߙto 50ߙmg/day.Pruritus
Topical Apply thin film 4 times daily with at least 3 to 4 h between applications. Not recommended for more than 8 days.
Store capsules below 86°F.
Drug InteractionsAlcohol/CNS depressants
CNS and respiratory depression may be potentiated.Cimetidine
May inhibit metabolism of doxepin, leading to increased concentrations.Clonidine
Concurrent use may lead to loss of BP control and possibly dangerous increases in BP.Guanethidine
Hypotensive action may be inhibited.MAOIs
Concurrent use may lead to severe seizures, hyperpyretic crisis, and fatal reactions. Generally, allow 7 to 10 days between discontinuation of 1 drug and start of another.SSRIs (eg, fluoxetine)
May increase serum concentrations of doxepin; effect may occur up to 5 wk after discontinuation of fluoxetine.Sympathomimetics (eg, dopamine, epinephrine)
Pressor response may increase or decrease; arrhythmias may occur.Type IC antiarrhythmics (eg, propafenone, flecainide)
May inhibit metabolism of doxepin, leading to increased concentrations.
Laboratory Test Interactions
None well documented.
Orthostatic hypotension; hypertension; fainting; tachycardia.
Dizziness; drowsiness; headache; confusion; weakness; tremors; convulsions; fatigue; disorientation; hallucinations; numbness; paresthesias; ataxia; extrapyramidal symptoms; tardive dyskinesia.
Skin rash; edema; photosensitization; pruritus.Topical use
Local burning or stinging; dry or tight skin.
Mydriasis; photophobia; blurred vision; tinnitus.
Nausea; constipation; dry mouth; paralytic ileus; vomiting; indigestion; taste perversion; diarrhea; anorexia; aphthous stomatitis.
Urinary retention; nocturia; altered libido; testicular swelling, gynecomastia (males); enlargement of breasts, galactorrhea (females).
Agranulocytosis; eosinophilia; purpura; thrombocytopenia; leukopenia.
Weight gain; syndrome of inappropriate secretion of antidiuretic hormone; raising or lowering of blood sugar levels.
Exacerbation of asthma.
Hyperthermia; alopecia; sweating; chills.
Category C (oral); Category B (topical).
Excreted in breast milk.
Not recommended for children younger than 12 yr of age.
Special Risk Patients
Use drug with caution in patients with history of seizures, urinary retention, urethral spasm, angle-closure glaucoma or increased IOP, CV disorders, hyperthyroidism (or those receiving thyroid medication), hepatic or renal function impairment, schizophrenia, or paranoia.
Capsule, 150 mg
The 150 mg capsule strength is intended for maintenance therapy only and is not recommended for initiation of treatment.
Use of cream can cause Type IV hypersensitivity reactions.
Use drug with caution in patients with suicidal tendencies; do not allow access to large quantities of drug.
For external use only; do not use ophthalmically, orally, or intravaginally. Because of absorption of drug, drowsiness often occurs.
If treatment is to be discontinued, or the dose reduced, gradually taper the dose and monitor patient for withdrawal symptoms. If significant withdrawal symptoms develop, reinstitute previous dosing schedule and attempt a less rapid tapering regimen after patient has stabilized.
Confusion, agitation, transient visual hallucinations, seizures, hyperactive reflexes, coma, cardiac arrhythmias, dilated pupils, hyperpyrexia, severe hypotension, CNS depression, ECG changes (QRS axis or width), disturbed concentration, stupor, drowsiness, muscle rigidity, vomiting, hypothermia.
- Advise patient to read patient information leaflet before starting therapy and with each refill.
- Advise patient that medication is usually started at a low dose and then gradually increased as tolerated until max benefit is obtained.
- Advise patient to take prescribed dose without regard to meals, but to take with food if stomach upset occurs.
- Advise patient not to change the dose or stop taking unless advised by health care provider.
- Inform patient that it may take 2 to 6 wk to note improvement in symptoms and to continue with prescribed therapy once improvement has been noted.
- Instruct patient to contact health care provider if symptoms do not appear to be getting better, are getting worse, or if bothersome adverse reactions (eg, unusual sweating, urination difficulty, drowsiness, dizziness, constipation, changes in sexual function) occur.
- Advise patient to take frequent sips of water, suck on ice chips or sugarless hard candy, or chew sugarless gum if dry mouth occurs.
- Instruct patient to avoid alcoholic beverages and other depressants while taking this medication.
- Advise patient that drug (oral and topical) may cause drowsiness, dizziness, or impair reflexes and to use caution while driving or performing other tasks requiring mental alertness until tolerance is determined.
- Instruct patient not to take prescription or OTC drugs or dietary supplements without consulting health care provider.
- Caution patient to avoid unnecessary exposure to UV light (sunlight, tanning booths) and to use sunscreen and wear protective clothing when exposed to UV light until tolerance is determined.