Doxepin Hydrochloride(dox’ e pin)
Apo-Doxepin (CAN), Prudoxin, Silenor, Sinequan, Zonalon
PREGNANCY CATEGORY C
PREGNANCY CATEGORY B (TOPICAL)
Drug Classes
Antidepressant
Antipruritic
TCA (tertiary amine)
Therapeutic Actions
Mechanism of action unknown; TCAs inhibit the reuptake of the neurotransmitters norepinephrine and serotonin, leading to an increase in their effects; anticholinergic at CNS and peripheral receptors; sedative.
Indications
Relief of symptoms of depression (endogenous depression most responsive); sedative effects may help depression associated with anxiety and sleep disturbance
Treatment of depression in patients with bipolar disorder, psychotic depressive disorders
Treatment of anxiety
NEW INDICATION: Treatment of insomnia characterized by difficulty in sleep maintenance (Silenor)
Treatment of pruritus in adults with atopic dermatitis, lichen chronicus (5% topical cream)
Unlabeled uses: Neuropathy, neurogenic pain
Contraindications and Cautions
Contraindicated with hypersensitivity to any tricyclic drug; concomitant therapy with an MAOI; recent MI; myelography within previous 24 hr or scheduled within 48 hr; lactation, pregnancy.
Use cautiously with EST; preexisting CV disorders (severe coronary heart disease, progressive heart failure, angina pectoris, paroxysmal tachycardia); angle-closure glaucoma, increased IOP, urinary retention, ureteral or urethral spasm; seizure disorders; hyperthyroidism; impaired hepatic, renal function; psychiatric patients (schizophrenic or paranoid patients may exhibit a worsening of psychosis); patients with bipolar disorder; patients with suicidal ideation (overdose may be fatal); elective surgery (TCAs should be discontinued as long as possible before surgery); geriatric patients (may be more sensitive to drug and adverse effects).
Available Forms
Capsules—10, 25, 50, 75, 100, 150 mg; oral concentrate—10 mg/mL; tablets—3, 6 mg; cream—30-g, 40-g tubes
Dosages
Adults
Mild to moderate anxiety or depression: Initially, 25 mg tid PO; individualize dosage. Usual optimum dosage is 75–150 mg/day; alternatively, total daily dosage, up to 150 mg, may be given at bedtime.
More severe anxiety or depression: Initially, 50 mg tid PO; if needed, may gradually
increase to 300 mg/day. Dose may be taken all at once at bedtime.
Mild symptomatology or emotional symptoms accompanying organic disease: 25–50 mg PO is often effective.
Insomnia: 3–6 mg PO 30 min before bedtime; use 3 mg in elderly patients and in those with hepatic impairment.
Pruritus: Apply cream four times/day at least 3–4 hr apart for 8 days. Do not cover dressing.
Pediatric patients
Not recommended for children younger than 12 yr.
