BP

Dothiepin hydrochloride (Dosulepin)

Proprietary

Prothiaden^® (Teofarma)
Dothiepin hydrochloride (non-proprietary, see BNF for details)

Group

Antidepressant – tricyclic

Uses/indications

Depression where sedation is required, e.g. postnatal depression

Type of drug

POM

Presentation

Capsules (25 mg), tablets (75 mg)

Dosage

Oral: 75 mg daily (divided or single) increased to 150–225 mg daily

Route of admin

Oral

Contraindications

Recent myocardial infarction, mania

Side effects

Dry mouth, sedation, blurred vision, cardiovascular disturbances, blood sugar changes
Interactions
Alcohol – avoid – enhanced sedative effect
Antidepressants – CNS excitation, hypertension with MAOIs – avoid for 2 weeks after stopping MAOI
Antiepileptics – convulsive threshold and tricyclic plasma concentration are lowered
Antihistamines – increased antimuscarinic and sedative effect, ventricular arrhythmias with terfenadine and astemizole
Antihypertensives – increases hypotensive effect
Contraceptives – antagonizes effect of antidepressants, but side effects increase the plasma concentration of tricyclics

Pharmacodynamic properties

Tricyclic antidepressant that acts to increase transmitter levels at central synapses; this produces a clinical antidepressant effect. The inhibition of the re-uptake of noradrenaline (norepinephrine) and 5-hydoxytryptamine (5HT) and the uptake of dopamine produces adaptive changes in the brain that enhance the antidepressant effects

Fetal risk

Higher fetal toxicity than SSRIs; tachycardia, irritability, muscle spasms and neonatal convulsions

Breastfeeding

Amount secreted too small to be harmful in short-term use; accumulation may cause sedation and respiratory depression