Doxepin

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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 dc

Anxiety

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

Insomnia

  • 10-50mg PO QHS

Pediatric Dosing

NA

Special Populations

Renal Dosing

  • Adult: no adjustment

Hepatic Dosing

  • Adult: not defined, caution advised

Contraindications

  • Allergy to class/drug
  • MI, acute recovery
  • glaucoma
  • IOP increased
  • urinary retention
  • prostatic hypertrophy
  • GI/GU obstruction
  • avoid abrupt withdrawal
  • caution in its <25yo
  • caution in elderly pts
  • caution if cardiovascular dz
  • caution if seizure disorder
  • caution if thyroid dz
  • caution if diabetes mellitus
  • caution if asthma
  • caution if Parkinson dz
  • caution if hepatic impairment
  • 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

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

See Also

References

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