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doxepin (Sinequan)

Generic Name: doxepin (Sinequan) (DOX e pin)
Brand Name:

What is doxepin (Sinequan)?

This medication guide provides information about the use of doxepin (Sinequan or other generic names) to treat depression or anxiety. Silenor is another brand of doxepin that is not covered in this medication guide.

Doxepin is a tricyclic antidepressant that affects chemicals in the brain that may be unbalanced.

Doxepin (Sinequan or other generic name) is used to treat symptoms of depression and/or anxiety associated with alcoholism, psychiatric conditions, or manic-depressive conditions.

Doxepin may also be used for purposes not listed in this medication guide.

What is the most important information I should know about doxepin (Sinequan)?

You should not take doxepin if you have glaucoma or problems with urination. Do not use if you are allergic to doxepin or to similar antidepressants.

Do not use this medicine if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine.

Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.

Do not give this medicine to anyone under 18 years old without the advice of a doctor. Doxepin is not approved for use in children.

What should I discuss with my healthcare provider before taking doxepin (Sinequan)?

You should not use doxepin if you are allergic to it, or if you have:

  • glaucoma;

  • urination problems; or

  • an allergy to similar antidepressants such as amitriptyline, amoxapine, clomipramine, desipramine, imipramine, nortriptyline, protriptyline, or trimipramine.

Do not use doxepin if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

To make sure doxepin is safe for you, tell your doctor if you have:

  • sleep apnea (breathing stops during sleep);

  • diabetes (doxepin may raise or lower blood sugar); or

  • bipolar disorder (manic-depression).

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using doxepin. Your family or other caregivers should also be alert to changes in your mood or symptoms.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether doxepin passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Do not give this medicine to anyone under 18 years old without the advice of a doctor. Doxepin is not approved for use in children.

How should I take doxepin (Sinequan)?

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Measure doxepin oral concentrate (liquid) with the special dose-measuring dropper provided. Do not use a regular table spoon. If you do not have a dose-measuring dropper, ask your pharmacist for one.

Empty the measured dose from the medicine dropper into a small glass (4 ounces) of water, milk, orange juice, grapefruit juice, tomato juice, prune juice, or pineapple juice. Do not use grape juice or a carbonated soft drink to mix doxepin oral concentrate. Stir the mixture and drink all of it right away. Do not save it for later use.

Do not stop using doxepin suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to avoid withdrawal symptoms when you stop using doxepin.

It may take up to 3 weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve.

Store at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of doxepin can be fatal.

What should I avoid while taking doxepin (Sinequan)?

Do not drink alcohol. Doxepin can increase the effects of alcohol, which could be dangerous.

Doxepin may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Doxepin (Sinequan) side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

  • blurred vision, tunnel vision, eye pain or swelling, seeing halos around lights;

  • a light-headed feeling, like you might pass out;

  • skin rash, bruising, severe tingling, numbness, pain, muscle weakness;

  • tremors, restless muscle movements in your eyes, tongue, jaw, or neck;

  • confusion, hallucinations, unusual thoughts, seizure (convulsions); or

  • painful or difficult urination, urinating less than usual.

Common side effects may include:

  • drowsiness;

  • vision changes;

  • nausea, vomiting, diarrhea, indigestion, loss of appetite;

  • dry mouth, mouth sores, taste problems;

  • breast swelling (in men or women); or

  • decreased or increased sex drive.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Side Effects (complete list)

Doxepin dosing information

Usual Adult Dose for Anxiety:

Initial dose: 75 mg orally once a day
Maintenance dose: 75 to 150 mg orally once a day or in divided doses; patients with very mild disease may be adequately controlled with 25 to 50 mg per day
Maximum dose: 150 mg/day

Comments:
-More severely ill patients may require higher doses with a gradual increase to 300 mg/day; additional therapeutic benefit is rarely obtained with doses greater than 300 mg/day.
-Dosages may be increased or decreased following initial dose at appropriate intervals and based on individual patient response.
-The anti-anxiety effect is apparent before the antidepressant effect; may take 2 to 3 weeks for optimal antidepressant effect to be seen.
-The 150 mg capsule is intended for maintenance therapy and should not be used for initiation of treatment.

Uses: For the treatment of psychoneurotic patients with depression and/or anxiety; for the treatment of depression and/or anxiety associated with alcoholism; for the treatment of depression and/or anxiety associated with organic disease; and for the treatment of psychotic depressive disorders with associated anxiety including involutional depression and manic-depressive disorders

Usual Adult Dose for Depression:

Initial dose: 75 mg orally once a day
Maintenance dose: 75 to 150 mg orally once a day or in divided doses; patients with very mild disease may be adequately controlled with 25 to 50 mg per day
Maximum dose: 150 mg/day

Comments:
-More severely ill patients may require higher doses with a gradual increase to 300 mg/day; additional therapeutic benefit is rarely obtained with doses greater than 300 mg/day.
-Dosages may be increased or decreased following initial dose at appropriate intervals and based on individual patient response.
-The anti-anxiety effect is apparent before the antidepressant effect; may take 2 to 3 weeks for optimal antidepressant effect to be seen.
-The 150 mg capsule is intended for maintenance therapy and should not be used for initiation of treatment.

Uses: For the treatment of psychoneurotic patients with depression and/or anxiety; for the treatment of depression and/or anxiety associated with alcoholism; for the treatment of depression and/or anxiety associated with organic disease; and for the treatment of psychotic depressive disorders with associated anxiety including involutional depression and manic-depressive disorders

Usual Adult Dose for Insomnia:

6 mg orally once a day; 3 mg once a day may be appropriate for some patients
Maximum dose: 6 mg/day

Comments: Dosages should be individualized based on the needs of each patient.

Use: For the treatment of insomnia characterized by difficulty with sleep maintenance; clinical trials in support of efficacy were up to 3 months duration

Usual Geriatric Dose for Insomnia:

3 mg orally once a day; may increase to 6 mg/day if clinically indicated
Maximum dose: 6 mg/day

Comments:
-Dosages should be individualized based on the needs of each patient.
-Sleep-promoting drugs may cause confusion and over-sedation in the elderly; a starting dose of 3 mg and evaluation prior to considering dose escalation is recommended.

Use: For the treatment of insomnia characterized by difficulty with sleep maintenance; clinical trials in support of efficacy were up to 3 months duration

What other drugs will affect doxepin (Sinequan)?

Taking doxepin with other drugs that make you sleepy or slow your breathing can increase these effects. Ask your doctor before taking doxepin with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Before taking doxepin, tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, or sertraline.

You must wait at least 5 weeks after stopping fluoxetine (Prozac) before you can take doxepin.

Other drugs may interact with doxepin, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your pharmacist can provide more information about doxepin (Sinequan).
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 12.01.

Date modified: December 03, 2017
Last reviewed: July 28, 2016

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