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Doxepin Disease Interactions

There are 27 disease interactions with doxepin:

Major

Anxiolytics/sedatives/hypnotics (applies to doxepin) depression

Major Potential Hazard, Moderate plausibility.

A variety of abnormal thinking and behavior changes have been reported to occur in association with the use of most anxiolytics, sedatives and hypnotics. Some of these changes include decreased inhibition, aggressiveness, agitation, and hallucinations. These drugs can cause or exacerbate mental depression and cause suicidal behavior and ideation. Therapy with these drugs should be administered cautiously in patients with a history of depression or other psychiatric disorders. Patients should be monitored for any changes in mood or behavior. It may be prudent to refrain from dispensing large quantities of medication to these patients.

References

  1. "Product Information. Ambien (zolpidem)." sanofi-aventis, Bridgewater, NJ.
  2. "Product Information. Placidyl (ethchlorvynol)." Abbott Pharmaceutical, Abbott Park, IL.
  3. "Product Information. Sonata (zaleplon)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  4. "Product Information. Equanil (meprobamate)." Wallace Laboratories, Cranbury, NJ.
  5. "Product Information. Aquachloral Supprettes (chloral hydrate)." Medisca, Plattsburg, NY.
View all 5 references
Major

Doxepin (applies to doxepin) anticholinergic effects

Major Potential Hazard, Moderate plausibility. Applicable conditions: Glaucoma/Intraocular Hypertension, Urinary Retention

The use of doxepin is contraindicated in patients with glaucoma, or a tendency to urinary retention. These disorders should be ruled out before starting treatment, especially in elderly patients.

Major

TCAs (applies to doxepin) anticholinergic effects

Major Potential Hazard, High plausibility. Applicable conditions: Glaucoma/Intraocular Hypertension, Urinary Retention, Gastrointestinal Obstruction

Tricyclic and tetracyclic antidepressants (TCAs) have anticholinergic activity, to which elderly patients are particularly sensitive. Tertiary amines such as amitriptyline and trimipramine tend to exhibit greater anticholinergic effects than other agents in the class. Therapy with TCAs should be administered cautiously in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. In patients with angle-closure glaucoma, even average doses can precipitate an attack. Glaucoma should be treated and under control prior to initiation of therapy with TCAs, and intraocular pressure monitored during therapy.

References

  1. Remick RA, Keller FD, Buchanan RA, Gibson RE, Fleming JA "A comparison of the efficacy and safety of alprazolam and desipramine in depressed outpatients." Can J Psychiatry 33 (1988): 590-4
  2. Settle EC "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry 59 Suppl 16 (1998): 25-30
  3. Gershon S "Comparative side effect profiles of trazodone and imipramine: special reference to the geriatric population." Psychopathology 17 (1984): 39-50
  4. Feighner JP, Cohn JB, Fabre LF, Jr Fieve RR, Mendels J, Shrivastava RK, Dunbar GC "A study comparing paroxetine placebo and imipramine in depressed patients." J Affect Disord 28 (1993): 71-9
  5. Claghorn JL, Feighner JP "A double-blind comparison of paroxetine with imipramine in the long-term treatment of depression." J Clin Psychopharmacol 13 (1993): S23-7
  6. Pedersen JH, Sorensen JL "Therapeutic effect and side effects in patients with endogenous depression treated with oral nortriptyline once a day." Neuropsychobiology 6 (1980): 42-7
  7. Hermesh H, Aizenberg D, Weizman A, Lapidot M, Munitz H "Clomipramine-induced urinary dysfunction in an obsessive-compulsive adolescent." Drug Intell Clin Pharm 21 (1987): 877-9
  8. Nelson JC, Jatlow PI, Bock J, Quinlan DM, Bowes MB "Major adverse reactions during desipramine treatment." Arch Gen Psychiatry 39 (1982): 1055-61
  9. Guy W, McEvoy JM, Ban TA, Wilson WH, Pate K "A double-blind clinical trial of mianserin versus amitriptyline: differentiation by adverse symptomatology." Pharmacotherapy 3 (1983): 45-51
  10. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  11. Ayd FJ, Jr "Long-term treatment of chronic depression: 15-year experience with doxepin HCl." J Clin Psychiatry 45 (1984): 39-46
  12. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  13. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  14. Rudorfer MV, Young RC "Anticholinergic effects and plasma desipramine levels." Clin Pharmacol Ther 28 (1980): 703-6
  15. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  16. Remick RA, Campos PE, Misri S, Miles JE, Van Wyck, Fleet J "A comparison of the safety and efficacy of buproprion HCL and amitriptyline HCL in depressed outpatients." Prog Neuropsychopharmacol Biol Psychiatry 6 (1982): 523-7
  17. Jenike MA, Baer L, Greist JH "Clomipramine versus fluoxetine in obsessive-compulsive disorder: a retrospective comparison of side effects and efficacy." J Clin Psychopharmacol 10 (1990): 122-4
  18. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  19. Warnes H, Lehmann HE, Ban TA "Adynamic ileus during psychoactive medication: a report of three fatal and five severe cases." Can Med Assoc J 96 (1967): 1112-3
  20. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  21. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  22. Pigott TA, Pato MT, Bernstein SE, Grover GN, Hill JL, Tolliver TJ, Murphy DL "Controlled comparisons of clomipramine and fluoxetine in the treatment of obsessive-compulsive disorder. Behavioral and biological results." Arch Gen Psychiatry 47 (1990): 926-32
  23. Judd FK, Moore K, Norman TR, Burrows GD, Gupta RK, Parker G "A multicentre double blind trial of fluoxetine versus amitriptyline in the treatment of depressive illness." Aust N Z J Psychiatry 27 (1993): 49-55
  24. Georgotas A, McCue RE, Hapworth W, et al "Comparative efficacy and safety of MAOIs versus TCAs in treating depression in the elderly." Biol Psychiatry 21 (1986): 1155-66
  25. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  26. Guillibert E, Pelicier Y, Archambault JC, Chabannes JP, Clerc G, Desvilles M, Guibert M, Pagot R, Poisat JL, Thobie Y "A double-blind, multicentre study of paroxetine versus clomipramine in depressed elderly patients." Acta Psychiatr Scand Suppl 350 (1989): 132-4
  27. Ritch R, Krupin T, Henry C, Kurata F "Oral imipramine and acute angle closure glaucoma." Arch Ophthalmol 112 (1994): 67-8
  28. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  29. Rosen J, Pollock BG, Altieri LP, Jonas EA "Treatment of nortriptyline's side effects in elderly patients: a double-blind study of bethanechol." Am J Psychiatry 150 (1993): 1249-51
  30. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  31. Ananth J, Assalian P, Links PS "Intolerable side effects of clomipramine." J Clin Psychopharmacol 2 (1982): 215-6
  32. Bryant SG, Fisher S, Kluge RM "Long-term versus short-term amitriptyline side effects as measured by a postmarketing surveillance system." J Clin Psychopharmacol 7 (1987): 78-82
  33. "Product Information. Asendin (amoxapine)" Lederle Laboratories, Wayne, NJ.
View all 33 references
Major

TCAs (applies to doxepin) cardiovascular disease

Major Potential Hazard, Moderate plausibility. Applicable conditions: Hyperthyroidism, Cerebrovascular Insufficiency, Dehydration, History - Cerebrovascular Disease, History - Myocardial Infarction, Hypotension, Arrhythmias

Tricyclic and tetracyclic antidepressants (TCAs) may cause orthostatic hypotension, reflex tachycardia, syncope, and dizziness, particularly during initiation of therapy or rapid escalation of dosage. Imipramine appears to have the greatest propensity to induce these effects, while secondary amines such as nortriptyline may do so less frequently. Tolerance to the hypotensive effects often develops after a few doses to a few weeks. Rarely, collapse and sudden death have occurred secondary to severe hypotension. Other reported adverse cardiovascular effects include tachycardia, arrhythmias, heart block, hypertension, thrombosis, thrombophlebitis, myocardial infarction, strokes, congestive heart failure, and ECG abnormalities such as PR and QT interval prolongation. Therapy with TCAs should be avoided during the acute recovery phase following myocardial infarction, and should be administered only with extreme caution in patients with hyperthyroidism, a history of cardiovascular or cerebrovascular disease, or a predisposition to hypotension. Close monitoring of cardiovascular status, including ECG changes, is recommended at all dosages. Many of the newer antidepressants, including bupropion and the selective serotonin reuptake inhibitors (SSRIs), are considerably less or minimally cardiotoxic and may be appropriate alternatives.

References

  1. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  2. Gross JS, Zwerin G "Left bundle branch block developing in a patient with sub-therapeutic nortriptyline levels: a case report." J Am Geriatr Soc 39 (1991): 1006-7
  3. Appelbaum PS, Kapoor W "Imipramine-induced vasospasm: a case report." Am J Psychiatry 140 (1983): 913-5
  4. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  5. Carpenter P, Gobel FL, Hulsing DJ "Desipramine cardiac toxicity." Minn Med 65 (1982): 231-4
  6. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  7. Ramanathan KB, Davidson C "Cardiac arrhythmia and imipramine therapy." Br Med J 1 (1975): 661-2
  8. Bluhm RE, Wilkinson GR, Shelton R, Branch RA "Genetically determined drug-metabolizing activity and desipramine- associated cardiotoxicity: a case report." Clin Pharmacol Ther 53 (1993): 89-95
  9. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  10. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  11. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  12. Rudorfer MV, Young RC "Desipramine: cardiovascular effects and plasma levels." Am J Psychiatry 137 (1980): 984-6
  13. Dunn FG "Malignant hypertension associated with use of amitriptyline hydrochloride." South Med J 75 (1982): 1124-5
  14. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  15. Robinson DS, Nies A, Corcella J, Cooper TB, Spencer C, Kefover R "Cardiovascular effects of phenelzine and amitriptyline in depressed outpatients." J Clin Psychiatry 43 (1982): 8-15
  16. Burrows GD, Vohra J, Hunt D, Sloman JG, Scoggins BA, Davies B "Cardiac effects of different tricyclic antidepressant drugs." Br J Psychiatry 129 (1976): 335-41
  17. Feighner JP, Cohn JB, Fabre LF, Jr Fieve RR, Mendels J, Shrivastava RK, Dunbar GC "A study comparing paroxetine placebo and imipramine in depressed patients." J Affect Disord 28 (1993): 71-9
  18. Roose SP, Dalack GW, Glassman AH, Woodring S, Walsh BT, Giardina EG "Is doxepin a safer tricyclic for the heart?" J Clin Psychiatry 52 (1991): 338-41
  19. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  20. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  21. Settle EC "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry 59 Suppl 16 (1998): 25-30
  22. Pedersen JH, Sorensen JL "Therapeutic effect and side effects in patients with endogenous depression treated with oral nortriptyline once a day." Neuropsychobiology 6 (1980): 42-7
  23. Roose SP, Glassman AH, Siris SG, Walsh BT, Bruno RL, Wright LB "Comparison of imipramine- and nortriptyline-induced orthostatic hypotension: a meaningful difference." J Clin Psychopharmacol 1 (1981): 316-9
  24. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  25. Van Sweden B "Rebound antidepressant cardiac arrhythmia." Biol Psychiatry 24 (1988): 363-4
  26. Laird LK, Lydiard RB, Morton WA, Steele TE, Kellner C, Thompson NM, Ballenger JC "Cardiovascular effects of imipramine, fluvoxamine, and placebo in depressed outpatients." J Clin Psychiatry 54 (1993): 224-8
  27. Young RC, Alexopoulos GS, Shamoian CA, Dhar AK, Kutt H "Heart failure associated with high plasma 10-hydroxynortriptyline levels." Am J Psychiatry 141 (1984): 432-3
  28. Strasberg B, Coelho A, Welch W, Swiryn S, Bauernfeind R, Rosen K "Doxepin induced torsade de pointes." Pacing Clin Electrophysiol 5 (1982): 873-7
  29. Linnoila M, Jobson KO, Gilliam JH, Paine RL "Effects of doxepin on blood pressure and heart rate in patients with primary major affective disorder ." J Clin Psychopharmacol 2 (1982): 433-4
  30. Christensen P, Thomsen HY, Pedersen OL, et al "Cardiovascular effects of amitriptyline in the treatment of elderly depressed patients." Psychopharmacology (Berl) 87 (1985): 212-5
  31. Kantor SJ, Glassman AH, Bigger JT, Jr Perel JM, Giardina EV "The cardiac effects of therapeutic plasma concentrations of imipramine." Am J Psychiatry 135 (1978): 534-8
  32. Georgotas A, McCue RE, Hapworth W, et al "Comparative efficacy and safety of MAOIs versus TCAs in treating depression in the elderly." Biol Psychiatry 21 (1986): 1155-66
  33. "Product Information. Asendin (amoxapine)" Lederle Laboratories, Wayne, NJ.
  34. Nelson JC, Jatlow PI, Bock J, Quinlan DM, Bowes MB "Major adverse reactions during desipramine treatment." Arch Gen Psychiatry 39 (1982): 1055-61
  35. Luchins DJ "Review of clinical and animal studies comparing the cardiovascular effects of doxepin and other tricyclic antidepressants." Am J Psychiatry 140 (1983): 1006-9
  36. Veith RC, Bloom V, Bielski R, Friedel RO "ECG effects of comparable plasma concentrations of desipramine and amitriptyline." J Clin Psychopharmacol 2 (1982): 394-8
  37. Faravelli C, Brat A, Marchetti G, Franchi F, Padeletti L, Michelucci A, Pastorino A "Cardiac effects of clomipramine treatment. ECG and left ventricular systolic time intervals." Neuropsychobiology 9 (1983): 113-8
  38. Roos JC "Cardiac effects of antidepressant drugs. A comparison of the tricyclic antidepressants and fluvoxamine." Br J Clin Pharmacol 15 Suppl 3 (1983): s439-45
View all 38 references
Major

TCAs (applies to doxepin) pheochromocytoma

Major Potential Hazard, Moderate plausibility.

Tricyclic and tetracyclic antidepressants (TCAs) may potentiate the effects of circulating catecholamines. Enhanced sympathetic activity can provoke hypertensive crises in patients with pheochromocytoma or other tumors of the adrenal medulla, such as some neuroblastomas. Therapy with TCAs should be administered cautiously in patients with these tumors.

References

  1. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  2. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  3. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  4. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  5. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  6. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  7. "Product Information. Remeron (mirtazapine)." Organon, West Orange, NJ.
  8. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  9. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  10. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  11. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  12. "Product Information. Asendin (amoxapine)" Lederle Laboratories, Wayne, NJ.
View all 12 references
Major

Tricyclic antidepressants (applies to doxepin) acute myocardial infarction recovery

Major Potential Hazard, Moderate plausibility.

The use of most tricyclic antidepressants is contraindicated in patients that are going through the acute recovery period after a myocardial infarction.

Major

Tricyclic antidepressants (applies to doxepin) cardiovascular disease

Major Potential Hazard, Moderate plausibility.

Tricyclic antidepressants should be used with extreme caution in patients with evidence of cardiovascular disease because of the possibility of fluctuations in the blood pressure, arrhythmias, conduction defects, tachycardia, myocardial infarction and stroke. This also applies to patients who have family history of sudden death, cardiac dysrhythmias, or conduction disturbances. In some cases a gradual dose titration is recommended.

Major

Tricyclic antidepressants (applies to doxepin) depression

Major Potential Hazard, Moderate plausibility.

Adult and pediatric patients with depression may experience worsening of their symptoms and may have the emergence of suicidal thoughts and behavior. Patients should be monitored appropriately and observed closely for worsening of their symptoms, suicidality or changes in their behavior, especially during the first few months of treatment, and at times of dose changes. Families and caregivers should be advised of the need for close observation and communication with the treating physician. Discontinuing the medication should be considered if symptoms are persistently worse, or abrupt in onset. It may be prudent to refrain from dispensing large quantities of medication to these patients.

Major

Tricyclic antidepressants (applies to doxepin) seizure disorders

Major Potential Hazard, Moderate plausibility. Applicable conditions: Alcoholism, CNS Disorder

Tricyclic antidepressants (TCAs), can lower the seizure threshold and trigger seizures. These drugs should be used with extreme caution in patients with a history of seizures, or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism. Daily dose restrictions might apply for specific antidepressants. Physicians are encouraged to get additional dosing recommendations on the manufacturer's prescribing information.

References

  1. Settle EC "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry 59 Suppl 16 (1998): 25-30
  2. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  3. Robinson ML "Epileptic fit after clomipramine." Br J Psychiatry 132 (1978): 525-6
  4. Flechter S, Rabey JM, Regev I, Borenstein N, Vardi J "Convulsive attacks due to antidepressant drug overdoses: case reports and discussion." Gen Hosp Psychiatry 5 (1983): 217-21
  5. Pascual J, Combarros O, Berciano J "Partial status epilepticus following single low dose of chlorimipramine in a patient on MAO-inhibitor treatment." Clin Neuropharmacol 10 (1987): 565-7
View all 5 references
Moderate

Anxiolytics/sedatives/hypnotics (applies to doxepin) glaucoma

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Glaucoma/Intraocular Hypertension, Urinary Retention

Some hypnotic drugs can have an anticholinergic effect and should be used with caution in patients with glaucoma, and trouble urinating due to retention or enlarged prostate.

Moderate

Anxiolytics/sedatives/hypnotics (applies to doxepin) liver disease

Moderate Potential Hazard, Moderate plausibility.

In general, anxiolytics, sedatives and hypnotics are extensively metabolized by the liver. Their plasma clearance may be decreased and their half-life prolonged in patients with impaired hepatic function. Therapy with these drugs should be administered cautiously in patients with liver disease (some are not recommended in severe liver impairment), and the dosage should be adjusted accordingly. Laboratory testing is recommended prior and during treatment.

Moderate

Anxiolytics/sedatives/hypnotics (applies to doxepin) renal/liver disease

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction

Some anxiolytics, sedatives and hypnotics are extensively metabolized by the liver, and excreted in the urine. Patients with impaired renal and/or hepatic function may be at greater risk for adverse effects, including central nervous system and respiratory depression, due to drug and metabolite accumulation. Therapy with these drugs should be administered cautiously in such patients, with careful dose selection usually starting at the low end of the dosing range.

References

  1. "Product Information. Equanil (meprobamate)." Wallace Laboratories, Cranbury, NJ.
Moderate

Doxepin (applies to doxepin) bipolar screening

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Bipolar Disorder, Depression

A major depressive episode can be the initial presentation of bipolar disorder. Patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder prior to initiating treatment with doxepin. This screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. It should be noted that doxepin is not approved for use in treating bipolar depression.

Moderate

TCAs (applies to doxepin) bone marrow suppression

Moderate Potential Hazard, Low plausibility. Applicable conditions: Bone Marrow Depression/Low Blood Counts

The use of tricyclic and tetracyclic antidepressants (TCAs) has rarely been associated with bone marrow suppression. Leukopenia, agranulocytosis, thrombocytopenia, anemia, eosinophilia, purpura, and pancytopenia have been reported with some TCAs. Patients with preexisting bone marrow suppression or blood dyscrasias receiving TCAs should be monitored closely during therapy for further decreases in blood counts.

References

  1. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  2. Hunt KA, Resnick MP "Clomipramine-induced agranulocytosis and its treatment with G-CSF." Am J Psychiatry 150 (1993): 522-3
  3. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  4. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  5. Souhami RL, Ashton CR, Lee-Potter JP "Agranulocytosis and systemic candidiasis following clomipramine therapy." Postgrad Med J 52 (1976): 472-4
  6. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  7. Magni G, Urbani A, Silvestro A, Grassetto M "Clomipramine-induced pancytopenia." J Nerv Ment Dis 175 (1987): 309-10
  8. Albertini RS, Penders TM "Agranulocytosis associated with tricyclics." J Clin Psychiatry 39 (1978): 483-5
  9. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  10. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  11. Gravenor DS, Leclerc JR, Blake G "Tricyclic antidepressant agranulocytosis." Can J Psychiatry 31 (1986): 661
  12. Wolf B, Conradty M, Grohmann R, Ruther E, Witzgall H, Londong V "A case of immune complex hemolytic anemia, thrombocytopenia, and acute renal failure associated with doxepin use." J Clin Psychiatry 50 (1989): 99-100
  13. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  14. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  15. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  16. Draper BM, Manoharan A "Neutropenia with cross-intolerance between two tricyclic antidepressant agents." Med J Aust 146 (1987): 452-3
View all 16 references
Moderate

TCAs (applies to doxepin) diabetes

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Mellitus

Both elevation and lowering of blood sugar levels have been reported with the use of some tricyclic antidepressants (TCAs). Rarely, these effects have also occurred with maprotiline, a tetracyclic antidepressant. Patients with diabetes should be monitored for worsening control of blood glucose when treated with these agents, particularly during dosage escalation or whenever dosage has been altered.

References

  1. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  2. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  3. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  4. Zogno MG, Tolfo L, Draghi E "Hypoglycemia caused by maprotiline in a patient taking oral antidiabetics." Ann Pharmacother 28 (1994): 406
  5. "Product Information. Asendin (amoxapine)" Lederle Laboratories, Wayne, NJ.
  6. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  7. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  8. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  9. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  10. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  11. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
View all 11 references
Moderate

TCAs (applies to doxepin) renal/liver disease

Moderate Potential Hazard, High plausibility. Applicable conditions: Renal Dysfunction

Tricyclic and tetracyclic antidepressants (TCAs) are known to undergo metabolism in the liver. Some of the metabolites, such as those of imipramine, clomipramine and desipramine, may be pharmacologically active. Many of the metabolites are also excreted by the kidney. There are very limited data concerning the use of TCAs in patients with renal and/or liver disease. Therapy with TCAs should be administered cautiously in patients with significantly impaired renal or hepatic function. Dosage adjustments may be necessary.

References

  1. Gram LF, Andreasen PB, Overo KF, Christiansen J "Comparison of single dose kinetics of imipramine, nortriptyline and antipyrine in man." Psychopharmacology (Berl) 50 (1976): 21-7
  2. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  3. Nelson JC, Jatlow PI "Nonlinear desipramine kinetics: prevalence and importance." Clin Pharmacol Ther 41 (1987): 666-70
  4. Ziegler VE, Biggs JT, Wylie LT, Rosen SH, Hawf DJ, Coryell WH "Doxepin kinetics." Clin Pharmacol Ther 23 (1978): 573-9
  5. Sandoz M, Vandel S, Vandel B, et al "Metabolism of amitriptyline in patients with chronic renal failure." Eur J Clin Pharmacol 26 (1984): 227-32
  6. Brosen K, Gram LF "First-pass metabolism of imipramine and desipramine: impact of the sparteine oxidation phenotype." Clin Pharmacol Ther 43 (1988): 400-6
  7. Jorgensen A, Hansen V "Pharmacokinetics of amitriptyline infused intravenously in man." Eur J Clin Pharmacol 10 (1976): 337-41
  8. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  9. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  10. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  11. "Product Information. Asendin (amoxapine)" Lederle Laboratories, Wayne, NJ.
  12. Virtanen R, Scheinin M, Iisalo E "Single dose pharmacokinetics of doxepin in healthy volunteers." Acta Pharmacol Toxicol (Copenh) 47 (1980): 371-6
  13. Alexanderson B "Pharmacokinetics of nortriptyline in man after single and multiple oral doses: the predictability of steady-state plasma concentrations from single-dose plasma-level data." Eur J Clin Pharmacol 4 (1972): 82-91
  14. Linnoila M, Insel T, Kilts C, Potter WZ, Murphy DL "Plasma steady-state concentrations of hydroxylated metabolites of clomipramine." Clin Pharmacol Ther 32 (1982): 208-11
  15. Ciraulo DA, Barnhill JG, Jaffe JH "Clinical pharmacokinetics of imipramine and desipramine in alcoholics and normal volunteers." Clin Pharmacol Ther 43 (1988): 509-18
  16. Schulz P, Turner-Tamiyasu K, Smith G, Giacomini KM, Blaschke TF "Amitriptyline disposition in young and elderly normal men." Clin Pharmacol Ther 33 (1983): 360-6
  17. Lieberman JA, Cooper TB, Suckow RF, et al "Tricyclic antidepressant and metabolite levels in chronic renal failure." Clin Pharmacol Ther 37 (1985): 301-7
  18. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  19. Midha KK, Hubbard JW, McKay G, et al "Stereoselective pharmacokinetics of doxepin isomers." Eur J Clin Pharmacol 42 (1992): 539-44
  20. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  21. Gram LF, Overo KF "First-pass metabolism of nortriptyline in man." Clin Pharmacol Ther 18 (1975): 305-14
  22. Henry JF, Altamura C, Gomeni R, Hervy MP, Forette F, Morselli PL "Pharmacokinetics of amitriptyline in the elderly." Int J Clin Pharmacol Ther Toxicol 19 (1981): 1-5
  23. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  24. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  25. Dawling S, Crome P, Braithwaite R "Pharmacokinetics of single oral doses of nortriptyline in depressed elderly hospital patients and young healthy volunteers." Clin Pharmacokinet 5 (1980): 394-401
  26. Dawlilng S, Lynn K, Rosser R, Braithwaite R "The pharmacokinetics of nortriptyline in patients with chronic renal failure." Br J Clin Pharmacol 12 (1981): 39-45
  27. Faulkner RD, Pitts WM, Lee CS, Lewis WA, Fann WE "Multiple-dose doxepin kinetics in depressed patients." Clin Pharmacol Ther 34 (1983): 509-15
View all 27 references
Moderate

TCAs (applies to doxepin) schizophrenia/bipolar disorder

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Mania

Tricyclic antidepressants (TCAs) may aggravate symptoms of psychosis in schizophrenic patients, particularly those with paranoid symptomatology. Depressed patients, usually those with bipolar disorder, may experience a switch from depression to mania or hypomania. These occurrences have also been reported rarely with the tetracyclic antidepressant, maprotiline. Therapy with these agents should be administered cautiously in patients with schizophrenia, bipolar disorder, or a history of mania.

References

  1. Vallada HP, Gentil V "Musical hallucinations triggered by clomipramine?" Br J Psychiatry 159 (1991): 888-9
  2. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  3. Holmes VF, Fricchione GL "Hypomania in an AIDS patient receiving amitriptyline for neuropathic pain." Neurology 39 (1989): 305
  4. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  5. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  6. Hemmingsen R, Rafaelsen OJ "Hypnagogic and hypnopompic hallucinations during amitriptyline treatment." Acta Psychiatr Scand 62 (1980): 364-8
  7. Cruz R "Clomipramine side effects." J Am Acad Child Adolesc Psychiatry 31 (1992): 1168-9
  8. "Product Information. Asendin (amoxapine)" Lederle Laboratories, Wayne, NJ.
  9. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  10. Hardoby W "Imipramine and suicidal thoughts ." Am J Psychiatry 149 (1992): 412-3
  11. Godwin CD "Case report of tricyclic-induced delirium at a therapeutic drug concentration." Am J Psychiatry 140 (1983): 1517-8
  12. van Kammen DP, van Scheyen JD, Murphy DL "Platelet monoamine oxidase activity and clomipramine-induced mania in unipolar depressed patients." Biol Psychiatry 15 (1980): 565-73
  13. Nelson JC, Jatlow PI, Bock J, Quinlan DM, Bowes MB "Major adverse reactions during desipramine treatment." Arch Gen Psychiatry 39 (1982): 1055-61
  14. Norman TR, Judd F, Holwill BJ, Burrows GD "Doxepin and visual hallucinations." Aust N Z J Psychiatry 16 (1982): 295-6
  15. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  16. Peet M "Induction of mania with selective serotonin re-uptake inhibitors and tricyclic antidepressants." Br J Psychiatry 164 (1994): 549-50
  17. Harper G "Suicidality with clomipramine." J Am Acad Child Adolesc Psychiatry 31 (1992): 369-70
  18. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  19. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  20. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  21. Kupfer DJ, Carpenter LL, Frank E "Possible role of antidepressants in precipitating mania and hypomania in recurrent depression." Am J Psychiatry 145 (1988): 804-8
  22. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  23. Rampling D "Aggression: a paradoxical response to tricyclic antidepressants." Am J Psychiatry 135 (1978): 117-8
  24. Preskorn SH, Simpson S "Tricyclic-antidepressant-induced delirium and plasma drug concentration." Am J Psychiatry 139 (1982): 822-3
View all 24 references
Moderate

TCAs (applies to doxepin) tardive dyskinesia

Moderate Potential Hazard, Moderate plausibility.

Tricyclic and tetracyclic antidepressants (TCAs) have anticholinergic activity, to which elderly patients are particularly sensitive. Tertiary amines such as amitriptyline and trimipramine tend to exhibit greater anticholinergic effects than other agents in the class. As with other drugs that possess anticholinergic activity, TCAs may aggravate tardive dyskinesia or induce previously suppressed symptoms. Patients with tardive dyskinesia requiring therapy with TCAs should be monitored for exacerbation of the condition.

References

  1. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  2. Lee HK "Dystonic reactions to amitriptyline and doxepin ." Am J Psychiatry 145 (1988): 649
  3. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  4. Dekret JJ, Maany I, Ramsey TA, Mendels J "A case of oral dyskinesia associated with imipramine treatment." Am J Psychiatry 134 (1977): 1297-8
  5. Woogen S, Graham J, Angrist B "A tardive dyskinesia-like syndrome after amitriptyline treatment." J Clin Psychopharmacol 1 (1981): 34-6
  6. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  7. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  8. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  9. Sandyk R "Persistent akathisia associated with early dyskinesia." Postgrad Med J 60 (1984): 916
  10. Gersten SP "Tardive dyskinesia-like syndromes with clomipramine ." Am J Psychiatry 150 (1993): 165-6
  11. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  12. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  13. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  14. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  15. Schatzberg AF, Cole JO, Blumer DP "Speech blockage: a tricyclic side effect." Am J Psychiatry 135 (1978): 600-1
  16. Nelson JC, Jatlow PI, Bock J, Quinlan DM, Bowes MB "Major adverse reactions during desipramine treatment." Arch Gen Psychiatry 39 (1982): 1055-61
  17. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  18. Finder E, Lin K-M, Ananth J "Dystonic reaction to amitriptyline." Am J Psychiatry 139 (1982): 1220
View all 18 references
Moderate

Tricyclic antidepressants (applies to doxepin) acute alcohol intoxication

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Alcoholism

Tricyclic antidepressants can enhance the response to alcohol. In patients who may use alcohol excessively, it should be borne in mind that the potentiation may increase the danger inherent in any suicide attempt or overdosage.

Moderate

Tricyclic antidepressants (applies to doxepin) bipolar disorder screening

Moderate Potential Hazard, Moderate plausibility.

A major depressive episode can be the initial presentation of bipolar disorder. Patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder prior to initiating treatment with a tricyclic antidepressant. This screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. It should be noted that tricyclic antidepressants are not approved for use in treating bipolar depression.

Moderate

Tricyclic antidepressants (applies to doxepin) glaucoma

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Glaucoma (Narrow Angle)

Tricyclic antidepressants as other type of antidepressants have an effect on pupil size causing dilation. This effect can potentially narrow the eye angle resulting in increased intraocular pressure and angle closure glaucoma, especially in predisposed patients. These drugs should be used with caution in patients with anatomically narrow angle or history of glaucoma. Doxepin hydrochloride capsules are contraindicated in patients with glaucoma.

Moderate

Tricyclic antidepressants (applies to doxepin) hyper/hypoglycemia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Mellitus

There have been reports of both elevation and lowering of blood sugar levels in patients receiving tricyclic antidepressants. These drugs should be used with caution in patients with hypoglycemia, hyperglycemia or diabetes. Monitoring sugar levels is recommended.

Moderate

Tricyclic antidepressants (applies to doxepin) liver/renal disease

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction, Liver Disease

In general, tricyclic antidepressants should be used with caution in patients with liver or renal disease, as these drugs are metabolized and excreted through the liver and kidneys. Dose selection, especially in the elderly patients that might have liver or renal dysfunction, should usually be limited to the smallest effective total daily dose. Some tricyclic antidepressants such as clomipramine and nortriptyline have occasionally been associated with elevations in SGOT (AST) and SGPT (ALT), and other hepatic adverse events such as jaundice. Although serious liver injury has only been reported rarely, therapy with these drugs should be administered cautiously in patients with preexisting liver disease and periodic monitoring of liver enzyme levels is recommended.

References

  1. Larrey D, Rueff B, Pessayre D, Danan G, Algard M, Geneve J, Benhamou JP "Cross hepatotoxicity between tricyclic antidepressants." Gut 27 (1986): 726-7
  2. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
Moderate

Tricyclic antidepressants (applies to doxepin) neutropenia

Moderate Potential Hazard, Moderate plausibility.

The use of some tricyclic antidepressants has been associated with neutropenia (ANC < 500/mm3) and agranulocytosis (ANC < 500/mm3). Leukocyte and differential blood counts should be performed in patients that develop fever and sore throat during treatment. Therapy should be discontinued if there is evidence of pathologic neutrophil depression.

Moderate

Tricyclic antidepressants (applies to doxepin) schizophrenia

Moderate Potential Hazard, Moderate plausibility.

Some tricyclic antidepressants have shown to cause activation or exacerbation of psychosis in schizophrenic patients. A dosage reduction might be required.

Moderate

Tricyclic antidepressants (applies to doxepin) thyroid disorders

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Hyperthyroidism

Most tricyclic antidepressants should be administered with caution in hyperthyroid patients or those receiving thyroid medication as they may develop arrhythmias when these drugs are given.

Moderate

Tricyclic antidepressants (applies to doxepin) urinary retention

Moderate Potential Hazard, Moderate plausibility.

Due to their anticholinergic properties, tricyclic antidepressants should be administered with caution in patients with history of urinary retention. Particularly doxepin hydrochloride capsules are contraindicated in patients with tendency to urinary retention.

Doxepin drug interactions

There are 639 drug interactions with doxepin

Doxepin alcohol/food interactions

There is 1 alcohol/food interaction with doxepin

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.