Diferencia entre revisiones de «Doxepin»
| Línea 50: | Línea 50: | ||
==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
* | *syncope, orthostatic hypotension | ||
*ventricular arrhythmias, AV block, QT prolongation, torsades de pointes | |||
*seizures | |||
*ventricular arrhythmias | *MI, HTN | ||
* | |||
*MI | |||
*stroke | *stroke | ||
*extrapyramidal symptoms, tardive dyskinesia | |||
*extrapyramidal | |||
*ataxia | *ataxia | ||
*paralytic ileus | *paralytic ileus | ||
*IOP elevation | *IOP elevation | ||
*agranulocytosis | *agranulocytosis, leukopenia, thrombocytopenia | ||
*hallucinations, psychosis, worsening depression, hypomania/mania, suicidality | |||
*hallucinations | |||
*SIADH | *SIADH | ||
*hepatitis | *hepatitis | ||
*angioedema | *angioedema | ||
* | *hyperthermia, heat stroke | ||
*withdrawal symptoms if abruptly discontinued | |||
*withdrawal | |||
===Common=== | ===Common=== | ||
*drowsiness | *drowsiness, dizziness, confusion, weakness, tremor, paresthesias | ||
* nausea/vomiting, constipation, xerostomia | |||
*constipation | |||
*blurred vision | *blurred vision | ||
*palpitations | *palpitations, tachycardia, diaphoresis, restlessness, insomnia, anxiety | ||
*urinary frequency, incontinence, retention | |||
*increased appetite, weight gain | |||
*libido changes, impotence, gynecomastia, galactorrhea | |||
*urinary retention | |||
* | |||
*libido changes | |||
*hypo/hyperglycemia | *hypo/hyperglycemia | ||
* | *rash/urticarial, pruritus, photosensitivity | ||
==Pharmacology== | ==Pharmacology== | ||
Revisión del 02:58 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
- 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