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Zonalon

Zonalon (generic name: doxepin) is a topical tricyclic antidepressant used to treat pruritus (itching) associated with conditions such as eczema or atopic dermatitis. It helps alleviate itching by blocking histamine receptors in the skin, offering relief for moderate to severe itching. Though originally developed as an antidepressant, Zonalon is used primarily in its cream form for dermatological purposes.

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Frequently Asked Questions

How long does it take for Zonalon to relieve itching?
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Zonalon may begin to relieve itching within 30 minutes to 1 hour after application, though full effects may take longer depending on the severity of the condition.

Can Zonalon be used on the face?
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Zonalon can be used on the face but should be applied sparingly. Avoid contact with the eyes, mouth, and mucous membranes.

What should I do if I miss an application of Zonalon?
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If you miss a dose, apply it as soon as you remember. If it’s close to the time for your next dose, skip the missed dose and resume your regular schedule. Do not apply double doses.

Can Zonalon be used long-term?
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Zonalon is typically used for short-term relief of itching. Long-term use may lead to systemic absorption and side effects, so it should be used under the guidance of a healthcare provider.

Is Zonalon safe for children?
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Zonalon should be used with caution in children, and its safety has not been fully established in pediatric patients. Always consult a healthcare provider before using Zonalon in children.

Comprehensive Drug Guide

How Does Zonalon Work?

Zonalon works by blocking histamine receptors (H1 and H2) in the skin, which reduces the itching sensation. Doxepin, the active ingredient, also has anticholinergic effects, which further contribute to its anti-itch properties. These mechanisms help relieve the itch associated with certain skin conditions.

Common Dosages

  • 5% topical cream

Typical Dosing

  • Apply a thin layer of Zonalon cream to the affected area four times a day as needed for itching.
  • The total daily dose should not exceed 30 grams of cream.

Typical Dosing

FDA Approved Indications

  • Topical treatment of pruritus (itching) associated with eczema or atopic dermatitis.

Who Shouldn't Take Zonalon?

  • Hypersensitivity to doxepin or any other ingredients in the formulation.
  • Untreated narrow-angle glaucoma or urinary retention, as doxepin has anticholinergic effects that can worsen these conditions.

Advice From The Pharmacist

  • Apply Zonalon sparingly: Use only a small amount of cream, as systemic absorption can occur, especially when applied to large areas.
  • Avoid contact with the eyes, mouth, and mucous membranes, as this can cause irritation.
  • Wash hands after applying the cream to prevent accidental spread to other areas of the body.
  • Monitor for drowsiness: Since Zonalon is a tricyclic antidepressant, drowsiness is a common side effect. Avoid driving or operating heavy machinery if drowsiness occurs.
  • Do not use occlusive dressings (bandages) over the cream, as this can increase absorption and risk of side effects.

Side Effects of Zonalon

Common Side Effects

  • Drowsiness
  • Burning or stinging at the application site
  • Dry mouth
  • Dizziness
  • Blurred vision

Uncommon/Severe Side Effects

  • Systemic absorption leading to drowsiness or sedation, especially if applied to large areas.
  • Allergic reactions (rash, swelling, difficulty breathing)
  • Urinary retention in patients with preexisting conditions.

Risks and Warnings of Zonalon

  • Systemic Absorption: Zonalon may be absorbed into the bloodstream, leading to systemic side effects like drowsiness or sedation. Use caution when applying to large areas or broken skin.
  • Drowsiness: Zonalon can cause sedation, so patients should avoid activities that require full alertness, such as driving or operating machinery.
  • Anticholinergic Effects: Zonalon may worsen symptoms of narrow-angle glaucoma or urinary retention. Patients with these conditions should use Zonalon with caution.

Interactions with Zonalon

Common Drug Interactions

  • Other sedatives: Combining Zonalon with CNS depressants such as alcohol, benzodiazepines, or opioids can increase the risk of drowsiness or sedation.
  • MAO inhibitors: Zonalon should not be used in combination with monoamine oxidase inhibitors (MAOIs), as this can lead to serious drug interactions, including serotonin syndrome.

Alternatives to Zonalon

  • Hydrocortisone cream: A topical steroid used for reducing inflammation and itching in mild skin conditions.
  • Tacrolimus ointment (Protopic): A non-steroidal option for treating atopic dermatitis and pruritus.
  • Calamine lotion: A soothing topical agent often used for itching associated with minor skin irritations.
  • Antihistamines: Oral antihistamines like diphenhydramine can be used for systemic relief of itching.