Diferencia entre revisiones de «Doxepin»
| Línea 35: | Línea 35: | ||
*Allergy to class/drug | *Allergy to class/drug | ||
*MI, acute recovery | *MI, acute recovery | ||
*glaucoma | *glaucoma, increased IOP | ||
*urinary retention, prostatic hypertrophy, GI/GU obstruction | |||
*urinary retention | |||
*avoid abrupt withdrawal | *avoid abrupt withdrawal | ||
*caution | *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== | ==Adverse Reactions== | ||
Revisión del 02:52 29 sep 2016
Administration
- Type: Insomnia; Tricyclic Antidepressants (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
NA
Special Populations
- Pregnancy Rating: C
- Lactation risk: unsafe
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
- hypotension, orthostatic
- HTN
- syncope
- ventricular arrhythmias
- QT prolongation
- torsades de pointes
- AV block
- MI
- stroke
- seizures
- extrapyramidal sx
- ataxia
- tardive dyskinesia
- paralytic ileus
- IOP elevation
- agranulocytosis
- leukopenia
- thrombocytopenia
- hallucinations
- psychosis exacerbation
- hypomania/mania
- depression exacerbation
- suicidality
- SIADH
- hepatitis
- angioedema
- psychosis, anticholinergic
- hyperthermia
- heat stroke
- withdrawal sx if abrupt dc
Common
- drowsiness
- xerostomia
- dizziness
- constipation
- blurred vision
- palpitations
- tachycardia
- incontinence
- appetite incr
- 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
- paresthesia
- 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