Doxepin

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Generic Name: Doxepin Brand Name(s): Generics only. No brands available. Avability: Rx Pregnancy Category: C (tablets), N (capsules and oral concentrate)

Uses

What is Doxepin used for?

Doxepin is used to treat mental/mood problems such as depression and anxiety. It may help improve mood and feelings of well-being, relieve anxiety and tension, help you sleep better, and increase your energy level. This medication belongs to a class of medications called tricyclic antidepressants. It works by affecting the balance of certain natural chemicals (neurotransmitters) in the brain.

How should I take Doxepin?

Take this medication by mouth, usually 1 to 3 times daily or as directed by your doctor. If you take it only once a day, take it at bedtime to reduce daytime sleepiness. The dosage is based on your medical condition and response to treatment.

To reduce your risk of side effects (such as drowsiness, dry mouth, dizziness), your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor’s instructions carefully.

Take this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time(s) each day. Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase.

It is important to continue taking this medication even if you feel well. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Also, you may experience symptoms such as mood swings, headache, and tiredness. To prevent these symptoms while you are stopping treatment with this drug, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details. Report any new or worsening symptoms right away.

This medication may not work right away. You may see some benefit within a week. However, it may take up to 3 weeks before you feel the full effect.

Tell your doctor if your condition persists or worsens (such as your feelings of sadness get worse, or you have thoughts of suicide).

How do I store Doxepin?

Doxepin is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Doxepin in the bathroom or the freezer. There may be different brands of Doxepin that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Doxepin down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Doxepin?

Before using this medication, tell your doctor or pharmacist your medical history, especially of: bleeding problems, breathing problems, liver problems, recent heart attack, problems urinating (such as due to enlarged prostate), overactive thyroid (hyperthyroidism), personal or family history of glaucoma (angle-closure type), personal or family history of mental/mood conditions (such as bipolar disorder, psychosis), family history of suicide, seizures, conditions that may increase your risk of seizures (such as other brain disease, alcohol/sedative withdrawal).

Doxepin may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.

The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using doxepin, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).

Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/”water pills”) or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using doxepin safely.

This drug may make you dizzy or drowsy or blur your vision. Alcohol or marijuana can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.

If you have diabetes, this drug may make it harder to control your blood sugar levels. Monitor your blood sugar levels regularly and tell your doctor of the results. Your doctor may need to adjust your diabetes medication, exercise program, or diet.

Older adults may be more sensitive to the side effects of this drug, especially dry mouth, dizziness, drowsiness, confusion, difficulty urinating, and QT prolongation.

During pregnancy, this medication should be used only when clearly needed. Since untreated mental/mood problems (such as depression, anxiety) can be a serious condition, do not stop using this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss with your doctor the benefits and risks of using this medication during pregnancy.

This medication passes into breast milk and may have undesirable effects on a nursing infant. Breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Doxepin during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Doxepin. According to the US Food and Drug Administration (FDA), Doxepin is pregnancy risk category:

  • C (tablets)
  • N (capsules and oral concentrate)

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Doxepin?

Drowsiness, dizziness, dry mouth, blurred vision, constipation, or trouble urinating may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water, or use a saliva substitute.

To prevent constipation, maintain a diet adequate in fiber, drink plenty of water, and exercise. If you become constipated while using this drug, consult your pharmacist for help in selecting a laxative.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if any of these rare but seriouspersistent heartburn, mental/mood changes (such as anxiety, agitation, confusion), shaking, severe stomach/abdominal pain.

Get medical help right away if you have any very serious side effects, including: severe dizziness, fast/irregular heartbeat, fainting, seizures, eye pain/swelling/redness, widened pupils, vision changes (such as seeing rainbows around lights at night).

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Doxepin?

Some products that may interact with this drug include: arbutamine, thyroid supplements, anticholinergic drugs (such as benztropine, belladonna alkaloids), central-acting drugs to treat high blood pressure (such as clonidine, guanabenz).

Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.

Other medications can affect the removal of doxepin from your body, thereby affecting how doxepin works. These drugs include cimetidine, St. John’s Wort, terbinafine, drugs to treat irregular heart rate (such as quinidine/propafenone/flecainide), antidepressants (such as SSRIs including paroxetine/fluoxetine/fluvoxamine). This is not a complete list.

Many drugs besides doxepin may affect the heart rhythm (QT prolongation in the EKG), including amiodarone, cisapride, dofetilide, pimozide, procainamide, quinidine, sotalol, macrolide antibiotics (such as erythromycin), among others. Therefore, before using doxepin, report all medications you are currently using to your doctor or pharmacist.

Tell your doctor or pharmacist if you are taking other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana, other drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).

Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain decongestants or ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

Doxepin may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Doxepin?

Doxepin may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Doxepin?

Doxepin may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Doxepin.

What is the dose of Doxepin for an adult?

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

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

Tablets: Initiate treatment with 3 mg orally once a day; monitor closely for adverse daytime effects

Dose Adjustments

Sleep Apnea:

-This drug has not been studied in patients with obstructive sleep apnea.

Recommendations:

-Due to the possibility of this drug to depress respiratory drive, precautions should be taken if prescribed to patients with compromised respiratory function.

-Use should be avoided in patients with severe sleep apnea.

Elderly:

-Capsules and Oral Concentrate: Dose selection should be cautious and initiated at the lower end of the dosing range due to increased risk of concomitant hepatic, renal, or cardiac dysfunction.

-This drug meets Beers Criteria; avoid doses of more than 6 mg/day in older adults.

What is the dose of Doxepin for a child?

The dosage has not been established in pediatric patients. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.

How is Doxepin available?

Doxepin is available in the following dosage forms and strengths:

  • Oral concentrate,
  • Oral capsule,
  • Oral tablet.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Doxepin, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: August 31, 2018 | Last Modified: August 31, 2018

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