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Doxepin Brand Names
- Prudoxin
- Silenor
- Sinequan
- Zonalon
What is Doxepin
Doxepin is an oral and topical tricyclic antidepressant (TCA) of the dibenzoxepin type; anticholinergic and sedative effects are common.
Doxepin is used for the treatment of depression and/or anxiety. In the treatment of depression, the drug is FDA-approved in adult patients, and while usual dosing for adolescents (e.g., age 13 years and older) is suggested within the product labels, the safety and efficacy in pediatric patients have not been established.
When used orally in low doses, doxepin is used for the treatment of insomnia characterized by difficulty with sleep maintenance; the drug improves many qualitative and subjective measures of sleep quality relative to placebo.
The topical formulation is used for the short-term (up to 8 days) management of moderate pruritus in adult patients with atopic dermatitis (eczema) or lichen simplex chronicus; significant doxepin plasma levels may be obtained with topical application.
Doxepin was first approved by the FDA in 1969. The FDA requires a boxed warning in antidepressant labels detailing the increased risk of suicidality in children, adolescents, and young adults.
A Patient Medication Guide (MedGuide) should accompany all prescriptions for antidepressants.
Mechanism of Action
The concise action of tricyclic antidepressants in the treatment of depression or anxiety is not fully understood, but it is believed that their most important effect is to enhance the actions of norepinephrine and serotonin by blocking the reuptake of various neurotransmitters at the neuronal membrane.
Doxepin most closely resembles amitriptyline in mechanism of action: both agents exert effects on norepinephrine and serotonin.
Recent evidence suggests that the upset of monoamine output seen in depressed patients may be regulated by long-term treatment with antidepressants due to their action on beta-adrenergic receptors.
This action on beta-receptors may be a better explanation than the reuptake theory of these agents’ antidepressant effects.
The exact mechanism by which doxepin exerts its effects in treating insomnia also has not been clearly established; however, it is thought to occur through antagonism of the H-1 receptor.
Indications
- anxiety
- atopic dermatitis
- depression
- eczema
- insomnia
- lichen simplex
For the treatment of major depression and/or anxiety, including psychotic depressive disorders with associated anxiety
Side Effects
- abdominal pain
- abnormal dreams
- agitation
- agranulocytosis
- alopecia
- anemia
- anorexia
- anxiety
- appetite stimulation
- arthralgia
- asthenia
- ataxia
- AV block
- back pain
- blepharospasm
- blurred vision
- bone fractures
- breast enlargement
- bronchospasm
- chest pain (unspecified)
- chills
- complex sleep-related behaviors
- confusion
- constipation
- contact dermatitis
- cough
- cycloplegia
- delirium
- depression
- diabetes mellitus
- diarrhea
- diplopia
- dizziness
- drowsiness
- dysarthria
- dysgeusia
- dyskinesia
- dysmenorrhea
- dyspepsia
- dyspnea
- dystonic reaction
- dysuria
- edema
- EEG changes
- ejaculation dysfunction
- elevated hepatic enzymes
- eosinophilia
- erythema
- fatigue
- fever
- flushing
- folliculitis
- galactorrhea
- gastroesophageal reflux
- glossitis
- goiter
- gynecomastia
- hallucinations
- headache
- heart failure
- hematoma
- hepatic failure
- hepatitis
- hyperbilirubinemia
- hyperglycemia
- hyperhidrosis
- hyperkalemia
- hypermagnesemia
- hypertension
- hyperthermia
- hyperthyroidism
- hypoglycemia
- hypokalemia
- hyponatremia
- hypothyroidism
- ileus
- impotence (erectile dysfunction)
- increased urinary frequency
- infection
- influenza
- insomnia
- jaundice
- laryngitis
- lethargy
- leukopenia
- libido decrease
- mania
- memory impairment
- migraine
- muscle cramps
- myalgia
- mydriasis
- myocardial infarction
- nasal congestion
- nausea
- nightmares
- nocturia
- ocular hypertension
- ocular pain
- orthostatic hypotension
- otalgia
- pallor
- palpitations
- paresthesias
- parotitis
- peripheral edema
- peripheral neuropathy
- petechiae
- pharyngitis
- photosensitivity
- PR prolongation
- pruritus
- pseudoparkinsonism
- psychosis
- purpura
- pyrosis (heartburn)
- QT prolongation
- rash
- restlessness
- rhinorrhea
- seizures
- serotonin syndrome
- SIADH
- sinus tachycardia
- sinusitis
- skin irritation
- ST-T wave changes
- stomatitis
- stroke
- suicidal ideation
- syncope
- testicular swelling
- thrombocytopenia
- tinnitus
- tongue discoloration
- torsade de pointes
- tremor
- urinary retention
- urticaria
- vasculitis
- ventricular tachycardia
- vomiting
- weight gain
- wheezing
- withdrawal
- xerophthalmia
- xerostomia
- yawning
Monitoring Parameters
- blood pressure
- ECG
- heart rate
- LFTs
- serum doxepin concentrations
- thyroid function tests (TFTs)
Contraindications
- abrupt discontinuation
- acute myocardial infarction
- agranulocytosis
- alcoholism
- anticholinergic medications
- bipolar disorder
- breast-feeding
- carbamazepine hypersensitivity
- cardiac arrhythmias
- cardiac disease
- children
- closed-angle glaucoma
- coadministration with other CNS depressants
- complex sleep-related behaviors
- congenital heart disease
- contact lenses
- diabetes mellitus
- driving or operating machinery
- electroconvulsive therapy (ECT)
- ethanol ingestion
- geriatric
- heart failure
- hepatic disease
- hyperthyroidism
- hypothyroidism
- ileus
- increased intraocular pressure
- leukopenia
- mania
- MAOI therapy
- myocardial infarction
- neonates
- occlusive dressing
- orthostatic hypotension
- pheochromocytoma
- pregnancy
- prostatic hypertrophy
- QT prolongation
- radiographic contrast administration
- schizophrenia
- seizure disorder
- seizures
- sleep apnea
- suicidal ideation
- sunlight (UV) exposure
- surgery
- thyroid disease
- tobacco smoking
- tricyclic antidepressant hypersensitivity
- urinary retention
Interactions
- Abarelix
- Abiraterone
- Acetaminophen; Butalbital
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Codeine
- Acetaminophen; Dextromethorphan
- Acetaminophen; Dextromethorphan; Doxylamine
- Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
- Acetaminophen; Dextromethorphan; Phenylephrine
- Acetaminophen; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Dichloralphenazone; Isometheptene
- Acetaminophen; Diphenhydramine
- Acetaminophen; Guaifenesin; Phenylephrine
- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Acetaminophen; Pentazocine
- Acetaminophen; Propoxyphene
- Acetaminophen; Pseudoephedrine
- Acetaminophen; Tramadol
- Acetazolamide
- Acetylcholine Chloride
- Acrivastine; Pseudoephedrine
- Albendazole
- Alfentanil
- Alfuzosin
- Alosetron
- Alprazolam
- Amantadine
- Ambenonium Chloride
- Amifampridine
- Amiodarone
- Amitriptyline; Chlordiazepoxide
- Amlodipine; Celecoxib
- Amobarbital
- Amoxapine
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Amphetamine
- Amphetamine; Dextroamphetamine
- Amphetamines
- Anagrelide
- Anticholinergics
- Apomorphine
- Apraclonidine
- Aprepitant, Fosaprepitant
- Aripiprazole
- Arsenic Trioxide
- Artemether; Lumefantrine
- Articaine; Epinephrine
- Asenapine
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Oxycodone
- Atazanavir
- Atazanavir; Cobicistat
- Atomoxetine
- Atropine
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Atropine; Difenoxin
- Atropine; Diphenoxylate
- Atropine; Edrophonium
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Azelastine
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- Azithromycin
- Baclofen
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- Benzphetamine
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- Bepridil
- Bethanechol
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- Brexpiprazole
- Brimonidine
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- Brimonidine; Timolol
- Brivaracetam
- Brompheniramine
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Dextromethorphan; Guaifenesin
- Brompheniramine; Dextromethorphan; Phenylephrine
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Brompheniramine; Pseudoephedrine
- Bupivacaine
- Bupivacaine Liposomal
- Bupivacaine; Lidocaine
- Buprenorphine
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- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbetapentane; Guaifenesin
- Carbetapentane; Guaifenesin; Phenylephrine
- Carbetapentane; Phenylephrine
- Carbetapentane; Phenylephrine; Pyrilamine
- Carbetapentane; Pseudoephedrine
- Carbetapentane; Pyrilamine
- Carbidopa; Levodopa
- Carbidopa; Levodopa; Entacapone
- Carbinoxamine
- Carbinoxamine; Dextromethorphan; Pseudoephedrine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbinoxamine; Phenylephrine
- Carbinoxamine; Pseudoephedrine
- Cariprazine
- Carisoprodol
- Celecoxib
- Cenobamate
- Ceritinib
- Cetirizine
- Cetirizine; Pseudoephedrine
- Cevimeline
- Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
- Chlophedianol; Guaifenesin; Phenylephrine
- Chlorcyclizine
- Chlordiazepoxide
- Chlordiazepoxide; Clidinium
- Chloroquine
- Chlorpheniramine
- Chlorpheniramine; Codeine
- Chlorpheniramine; Dextromethorphan
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Phenylephrine
- Chlorpheniramine; Pseudoephedrine
- Chlorpromazine
- Chlorthalidone; Clonidine
- Chlorzoxazone
- Cholinergic agonists
- Cimetidine
- Cinacalcet
- Ciprofloxacin
- Cisapride
- Citalopram
- Clarithromycin
- Clemastine
- Clobazam
- Clofazimine
- Clonazepam
- Clonidine
- Clorazepate
- Clozapine
- Cobicistat
- Cocaine
- Codeine
- Codeine; Guaifenesin
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- COMT inhibitors
- Conjugated Estrogens
- Conjugated Estrogens; Bazedoxifene
- Conjugated Estrogens; Medroxyprogesterone
- Crizotinib
- Cyclizine
- Cyclobenzaprine
- Cyproheptadine
- Dacomitinib
- Dantrolene
- Darifenacin
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- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Dasatinib
- Degarelix
- Delavirdine
- Desflurane
- Desloratadine; Pseudoephedrine
- Desmopressin
- Desvenlafaxine
- Deutetrabenazine
- Dexchlorpheniramine
- Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
- Dexmethylphenidate
- Dextroamphetamine
- Dextromethorphan
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Guaifenesin
- Dextromethorphan; Guaifenesin; Phenylephrine
- Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate
- Dextromethorphan; Guaifenesin; Pseudoephedrine
- Dextromethorphan; Promethazine
- Dextromethorphan; Quinidine
- Diazepam
- Dicyclomine
- Dienogest; Estradiol valerate
- Diethylpropion
- Diethylstilbestrol, DES
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Dimenhydrinate
- Diphenhydramine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Diphenhydramine; Phenylephrine
- Disopyramide
- Disulfiram
- Dofetilide
- Dolasetron
- Dolutegravir; Rilpivirine
- Donepezil
- Donepezil; Memantine
- Dopamine
- Doxylamine
- Doxylamine; Pyridoxine
- Dronabinol
- Dronedarone
- Droperidol
- Drospirenone; Estradiol
- Drospirenone; Ethinyl Estradiol
- Drospirenone; Ethinyl Estradiol; Levomefolate
- Duloxetine
- Edrophonium
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elagolix; Estradiol; Norethindrone acetate
- Elexacaftor; tezacaftor; ivacaftor
- Eliglustat
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Emtricitabine; Rilpivirine; Tenofovir alafenamide
- Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
- Encorafenib
- Enflurane
- Entacapone
- Entrectinib
- Ephedrine
- Epinephrine
- Eribulin
- Erythromycin
- Erythromycin; Sulfisoxazole
- Escitalopram
- Esketamine
- Eslicarbazepine
- Estazolam
- Esterified Estrogens
- Esterified Estrogens; Methyltestosterone
- Estradiol
- Estradiol Cypionate; Medroxyprogesterone
- Estradiol; Levonorgestrel
- Estradiol; Norethindrone
- Estradiol; Norgestimate
- Estradiol; Progesterone
- Estrogens
- Estropipate
- Eszopiclone
- Ethanol
- Ethinyl Estradiol
- Ethinyl Estradiol; Desogestrel
- Ethinyl Estradiol; Ethynodiol Diacetate
- Ethinyl Estradiol; Etonogestrel
- Ethinyl Estradiol; Levonorgestrel
- Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
- Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
- Ethinyl Estradiol; Norelgestromin
- Ethinyl Estradiol; Norethindrone
- Ethinyl Estradiol; Norethindrone Acetate
- Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
- Ethinyl Estradiol; Norethindrone; Ferrous fumarate
- Ethinyl Estradiol; Norgestimate
- Ethinyl Estradiol; Norgestrel
- Ethosuximide
- Etomidate
- Everolimus
- Ezogabine
- Fedratinib
- Felbamate
- Fenfluramine
- Fentanyl
- Fexofenadine; Pseudoephedrine
- Fingolimod
- Flavoxate
- Flecainide
- Fluconazole
- Flumazenil
- Fluoxetine
- Fluoxetine; Olanzapine
- Fluphenazine
- Flurazepam
- Fluvoxamine
- food
- Foscarnet
- Fospropofol
- Gabapentin
- Galantamine
- Gemifloxacin
- Gemtuzumab Ozogamicin
- Gilteritinib
- Givosiran
- Glasdegib
- Glycopyrrolate
- Glycopyrrolate; Formoterol
- Goserelin
- Granisetron
- Guaifenesin; Hydrocodone
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Guaifenesin; Phenylephrine
- Guaifenesin; Pseudoephedrine
- Guanabenz
- Guanfacine
- Guanidine
- Guselkumab
- Halofantrine
- Halogenated Anesthetics
- Haloperidol
- Halothane
- Histrelin
- Homatropine; Hydrocodone
- Hydantoins
- Hydrochlorothiazide, HCTZ; Methyldopa
- Hydrocodone
- Hydrocodone; Ibuprofen
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydromorphone
- Hydroxychloroquine
- Hydroxyzine
- Hyoscyamine
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Ibutilide
- Iloperidone
- Imatinib
- Indacaterol; Glycopyrrolate
- Inotuzumab Ozogamicin
- Iobenguane I 131
- Isoflurane
- Isoniazid, INH
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- Ketamine
- Ketoconazole
- Labetalol
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- Lamotrigine
- Lapatinib
- Lasmiditan
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- Lemborexant
- Lenvatinib
- Leuprolide
- Leuprolide; Norethindrone
- Levetiracetam
- Levocetirizine
- Levodopa
- Levofloxacin
- Levomethadyl
- Levomilnacipran
- Levorphanol
- Levothyroxine
- Levothyroxine; Liothyronine (Porcine)
- Levothyroxine; Liothyronine (Synthetic)
- Lidocaine
- Lidocaine; Prilocaine
- Linezolid
- Liothyronine
- Lisdexamfetamine
- Lithium
- Lofexidine
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- Long-acting beta-agonists
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- Loratadine; Pseudoephedrine
- Lorazepam
- Lorcaserin
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- Lumacaftor; Ivacaftor
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- Magnesium Salts
- Maprotiline
- Meclizine
- Mefloquine
- Melatonin
- Mepenzolate
- Meperidine
- Meperidine; Promethazine
- Mephobarbital
- Mepivacaine
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- Metaxalone
- Methadone
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