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==Administration==
==Administration==
*Type: Insomnia; Tricyclic Antidepressants (TCAs)
*Type: Insomnia; [[Tricyclic antidepressant]] (TCAs)
*Dosage Forms: 10, 25, 50, 75, 100, 150; 10/mL
*Dosage Forms: 10, 25, 50, 75, 100, 150; 10/mL
*Routes of Administration: PO
*Routes of Administration: PO
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==Adult Dosing==
==Adult Dosing==
Depression
===[[Depression]]===
*150-300mg PO QHS
*150-300mg PO QHS
*start 25-75mg PO QHS; max 300mg/day
*start 25-75mg PO QHS; max 300mg/day
*taper gradually to dc
*taper gradually to discontinue


Anxiety
===[[Anxiety]]===
*150-300mg PO QHS
*150-300mg PO QHS
*start 25-75mg PO QHS; max 300mg/day
*start 25-75mg PO QHS; max 300mg/day
*taper gradually to dc
*taper gradually to discontinue


Insomnia
===[[Insomnia]]===
*10-50mg PO QHS
*10-50mg PO QHS


==Pediatric Dosing==
==Pediatric Dosing==
NA
 
===[[Depression]]===
 
*PO:
* Not recommended as first line medication; however some studies indicate it might be beneficial for patients with comorbid conditions.
 
*Children 7 to 11 years: Limited data available; efficacy results variable: 1 to 3 mg/kg/day in single or divided doses.
 
*Children ≥12 years and Adolescents: Initial: 25 to 75 mg/day at bedtime or in 2 to 3 divided doses; begin at the low end of range and gradually titrate; select patients may respond to 25 to 50 mg/day; maximum single dose: 150 mg; maximum daily dose: 300 mg/day.
 
** Note: Controlled clinical trials have not shown TCAs to be superior to placebo for the treatment of depression in children and adolescents


==Special Populations==
==Special Populations==
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*Allergy to class/drug
*Allergy to class/drug
*MI, acute recovery
*MI, acute recovery
*glaucoma
*glaucoma, increased IOP
*IOP increased
*urinary retention, prostatic hypertrophy, GI/GU obstruction
*urinary retention
*prostatic hypertrophy
*GI/GU obstruction
*avoid abrupt withdrawal
*avoid abrupt withdrawal
*caution in its <25yo
*caution if:
*caution in elderly pts
**age <25 years, elderly
*caution if cardiovascular dz
**cardiovascular disease
*caution if seizure disorder
**seizure disorder, parkinsons
*caution if thyroid dz
**thyroid disease, diabetes
*caution if diabetes mellitus
**asthma
*caution if asthma
**hepatic impairment
*caution if Parkinson dz
**schizophrenia, bipolar disorder, alcohol abuse, electroconvulsive therapy, suicide risk
*caution if hepatic impairment
**high environmental temperature
*caution if schizophrenia
*caution if bipolar disorder
*caution if electroconvulsive tx
*caution if alcohol abuse
*caution if suicide risk
*caution if high environmental temperature


==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
*hypotension, orthostatic
*syncope, orthostatic hypotension
*HTN
*ventricular arrhythmias, AV block, QT prolongation, torsades de pointes
*syncope
*seizures
*ventricular arrhythmias
*MI, HTN
*QT prolongation
*torsades de pointes
*AV block
*MI
*stroke
*stroke
*seizures
*extrapyramidal symptoms, tardive dyskinesia
*extrapyramidal sx
*ataxia
*ataxia
*tardive dyskinesia
*paralytic ileus
*paralytic ileus
*IOP elevation
*IOP elevation
*agranulocytosis
*agranulocytosis, leukopenia, thrombocytopenia
*leukopenia
*hallucinations, psychosis, worsening depression, hypomania/mania, suicidality
*thrombocytopenia
*hallucinations
*psychosis exacerbation
*hypomania/mania
*depression exacerbation
*suicidality
*SIADH
*SIADH
*hepatitis
*hepatitis
*angioedema
*angioedema
*psychosis, anticholinergic
*hyperthermia, heat stroke
*hyperthermia
*withdrawal symptoms if abruptly discontinued
*heat stroke
*withdrawal sx if abrupt dc


===Common===
===Common===
*drowsiness
*drowsiness, dizziness, confusion, weakness, tremor, paresthesias
*xerostomia
*nausea/vomiting, constipation, xerostomia
*dizziness
*constipation
*blurred vision
*blurred vision
*palpitations
*palpitations, tachycardia, diaphoresis, restlessness, insomnia, anxiety
*tachycardia
*urinary frequency, incontinence, retention
*incontinence
*increased appetite, weight gain
*appetite incr
*libido changes, impotence, gynecomastia,  galactorrhea
*nausea/vomiting
*diaphoresis
*weakness
*disorientation
*confusion
*restlessness
*insomnia
*anxiety/agitation
*urinary retention
*urinary frequency
*rash/urticaria
*pruritis
*weight gain
*libido changes
*impotence
*gynecomastia
*galactorrhea
*tremor
*hypo/hyperglycemia
*hypo/hyperglycemia
*paresthesia
*rash/urticarial, pruritus, photosensitivity
*photosensitivity


==Pharmacology==
==Pharmacology==
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==References==
==References==
<references/>
<references/>
[[Category:Pharmacology]]
[[Category:Pharmacology]] [[Category:Psychiatry]]

Revisión actual - 18:18 22 sep 2019

Administration

  • Type: Insomnia; Tricyclic antidepressant (TCAs)
  • Dosage Forms: 10, 25, 50, 75, 100, 150; 10/mL
  • Routes of Administration: PO
  • Common Trade Names: Silenor, Zonalon, Prudoxin

Adult Dosing

Depression

  • 150-300mg PO QHS
  • start 25-75mg PO QHS; max 300mg/day
  • taper gradually to discontinue

Anxiety

  • 150-300mg PO QHS
  • start 25-75mg PO QHS; max 300mg/day
  • taper gradually to discontinue

Insomnia

  • 10-50mg PO QHS

Pediatric Dosing

Depression

  • PO:
  • Not recommended as first line medication; however some studies indicate it might be beneficial for patients with comorbid conditions.
  • Children 7 to 11 years: Limited data available; efficacy results variable: 1 to 3 mg/kg/day in single or divided doses.
  • Children ≥12 years and Adolescents: Initial: 25 to 75 mg/day at bedtime or in 2 to 3 divided doses; begin at the low end of range and gradually titrate; select patients may respond to 25 to 50 mg/day; maximum single dose: 150 mg; maximum daily dose: 300 mg/day.
    • Note: Controlled clinical trials have not shown TCAs to be superior to placebo for the treatment of depression in children and adolescents

Special Populations

Renal Dosing

  • Adult: no adjustment

Hepatic Dosing

  • Adult: not defined, caution advised

Contraindications

  • Allergy to class/drug
  • MI, acute recovery
  • glaucoma, increased IOP
  • urinary retention, prostatic hypertrophy, GI/GU obstruction
  • avoid abrupt withdrawal
  • caution if:
    • age <25 years, elderly
    • cardiovascular disease
    • seizure disorder, parkinsons
    • thyroid disease, diabetes
    • asthma
    • hepatic impairment
    • schizophrenia, bipolar disorder, alcohol abuse, electroconvulsive therapy, suicide risk
    • high environmental temperature

Adverse Reactions

Serious

  • syncope, orthostatic hypotension
  • ventricular arrhythmias, AV block, QT prolongation, torsades de pointes
  • seizures
  • MI, HTN
  • stroke
  • extrapyramidal symptoms, tardive dyskinesia
  • ataxia
  • paralytic ileus
  • IOP elevation
  • agranulocytosis, leukopenia, thrombocytopenia
  • hallucinations, psychosis, worsening depression, hypomania/mania, suicidality
  • SIADH
  • hepatitis
  • angioedema
  • hyperthermia, heat stroke
  • withdrawal symptoms if abruptly discontinued

Common

  • drowsiness, dizziness, confusion, weakness, tremor, paresthesias
  • nausea/vomiting, constipation, xerostomia
  • blurred vision
  • palpitations, tachycardia, diaphoresis, restlessness, insomnia, anxiety
  • urinary frequency, incontinence, retention
  • increased appetite, weight gain
  • libido changes, impotence, gynecomastia, galactorrhea
  • hypo/hyperglycemia
  • rash/urticarial, pruritus, photosensitivity

Pharmacology

  • Half-life: 15.3 hours (doxepin); 31 hours (metabolite)
  • Metabolism: liver; CYP450 (1A2, 2C9/19, 2D6 substrate)
  • Excretion: urine
  • Mechanism of Action: exact MOA unknown; inhibits norepinephrine and serotonin reuptake; antagonizes central H1 receptors

See Also

References

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