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Doxepin
Doxepin HCl is a tricyclic antidepressant (TCA) used to treat depression, anxiety disorders, and insomnia. It works by affecting the levels of neurotransmitters in the brain, such as serotonin and norepinephrine, which help regulate mood and sleep. Doxepin is often prescribed for its sedative properties at low doses to help manage sleep disorders, particularly in patients with difficulty staying asleep.
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Frequently Asked Questions
How long does it take for Doxepin to start working?
For depression and anxiety, it may take 2-4 weeks to see the full benefits. For insomnia, the sedative effects are usually noticeable within the first night of use.
Can I stop taking Doxepin suddenly?
No, stopping Doxepin abruptly can cause withdrawal symptoms such as nausea, headache, and irritability. Gradually tapering the dose under medical supervision is recommended.
Is Doxepin safe for long-term use?
Yes, Doxepin can be used for long-term management of depression, anxiety, and insomnia, but regular monitoring by a healthcare provider is necessary to ensure effectiveness and manage side effects.
Can I drink alcohol while taking Doxepin?
It is not recommended to drink alcohol while taking Doxepin, as it can increase drowsiness, dizziness, and the risk of accidental injury.
What should I do if I miss a dose of Doxepin?
If you miss a dose, take it as soon as you remember, unless it is close to your next scheduled dose. Do not double up on doses to make up for the missed one.
Comprehensive Drug Guide
How Does Doxepin Work?
Doxepin HCl works by inhibiting the reuptake of serotonin and norepinephrine, increasing the levels of these neurotransmitters in the brain. This helps alleviate symptoms of depression and anxiety. At lower doses, Doxepin exerts a sedative effect, making it useful for treating insomnia by promoting sleep and preventing early morning awakenings.
What is Doxepin Used For?
Doxepin is used to treat depression and anxiety disorders. It can also be used in lower doses to treat insomnia, especially in people who have trouble staying asleep.
Common Dosages
- Capsules: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg
- Tablets: 3 mg, 6 mg (for insomnia)
- Oral solution: 10 mg/mL
- Topical cream: 5%
Typical Dosing
- For depression and anxiety: The usual starting dose is 25-50 mg daily, which may be gradually increased to a maximum of 300 mg per day, based on response.
- For insomnia: The typical dose is 3 mg or 6 mg taken 30 minutes before bedtime.
- For pruritus: Apply the 5% topical cream to the affected area 3 to 4 times a day.
Typical Dosing
FDA Approved Indications
- Depression
- Anxiety disorders
- Insomnia
- Pruritus (itching, in topical cream form)
Off-Label Uses
Who Shouldn't Take Doxepin?
- Known hypersensitivity to doxepin or other TCAs
- Glaucoma
- Urinary retention
- Concurrent use of MAO inhibitors
Advice From The Pharmacist
- Take Doxepin exactly as prescribed and avoid increasing the dose without consulting your doctor.
- Doxepin can cause drowsiness and dizziness, especially at higher doses or when taken for insomnia. Avoid driving or operating heavy machinery until you know how it affects you.
- If you are taking Doxepin for sleep, take it 30 minutes before bedtime, and ensure you have enough time for a full night’s sleep (7-8 hours).
- Gradually taper the dose when discontinuing Doxepin to avoid withdrawal symptoms, especially after long-term use.
Side Effects of Doxepin
Common Side Effects
- Drowsiness
- Dry mouth
- Blurred vision
- Weight gain
Uncommon/Severe Side Effects
- Suicidal thoughts or behavior (especially in young adults)
- Severe allergic reactions (rash, swelling of the face or throat)
- Low blood pressure (dizziness, fainting)
Risks and Warnings of Doxepin
- Suicidal Thoughts: Antidepressants like Doxepin may increase the risk of suicidal thoughts in young adults, particularly when first starting treatment or changing doses. Close monitoring is recommended.
- Anticholinergic Effects: Doxepin can cause dry mouth, constipation, and blurred vision, which may be more pronounced in older adults.
- Heart Health: Doxepin can affect heart rhythm and should be used with caution in patients with preexisting heart conditions.
Interactions with Doxepin
Common Drug Interactions
- MAO inhibitors: Combining Doxepin with MAO inhibitors can result in severe, potentially life-threatening side effects. A two-week washout period is recommended when switching between these medications.
- CNS depressants: Combining Doxepin with alcohol or sedatives can increase drowsiness and the risk of accidental injury.
- Antihistamines: Using antihistamines with Doxepin may enhance anticholinergic side effects such as dry mouth and blurred vision.
Alternatives to Doxepin
- Amitriptyline: Another tricyclic antidepressant used for depression, anxiety, and insomnia.
- Mirtazapine (Remeron): An antidepressant with sedative effects, often used for sleep disorders and depression.
- Trazodone: A sedating antidepressant frequently prescribed for insomnia in addition to depression.
