DOXEPIN

COMMON BRAND NAME(S): Silenor

GENERIC NAME(S): DOXEPIN HCL

 

Description: Doxepin is a tricyclic depressant that affects the chemicals in the brain and make it imbalanced.
Pharmacokinetics: 
Absorption: Readily absorbed from the GIT (oral).
Distribution: Widely distributed; crosses the blood-brain barrier; enters breast milk. Protein-binding: Extensive.
Metabolism: Extensively hepatic via demethylation to desmethyldoxepin, hydroxylation, N-oxidation.
Excretion: Urine (as metabolites); 8-24 hrs (elimination half-life).

Indications:

Doxxepin is recommended for the treatment of:

  • Psychoneurotic patients with depression and/or anxiety.
  • Depression and/or anxiety associated with alcoholism (not to be taken concomitantly with alcohol).
  • Depression and/or anxiety associated with organic disease (the possibility of drug interaction should be considered if the patient is receiving other drugs concomitantly).
  • Psychotic depressive disorders with associated anxiety including involutional depression and manic-depressive disorders.

Contraindications:

This drug should not be given to patients with hypersensitivity reactions from this drug.  This should not be given to patients with glaucoma or a tendency to urinary retention.

How to use doxepin

  • Take this medication by mouth, usually once nightly within 30 minutes before bedtime on an empty stomach, or as directed by your doctor.
  • Do not take it within 3 hours of a meal because the effect of the medication will be delayed.
  • Do not take this medication unless you are able to get a full night of sleep (7-8 hours) before you must be active again.
  • Tell your doctor if your condition persists or worsens after 7-10 days.

Clinical worsening and suicide risk: Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs.

Common side effects:

  • drowsiness or
  • nausea

Rarely, after taking this drug, people have gotten out of bed and driven vehicles while not fully awake (“sleep-driving”). People have also sleepwalked, prepared/eaten food, made phone calls, or had sex while not fully awake.

Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech).

Get medical help right away if you have any very serious side effects, including: eye pain/swelling/redness, vision changes (such as seeing rainbows around lights at night, blurred vision).

Precautions:

  • Allergy: Before taking doxepin, tell your doctor or pharmacist if you are allergic to it; or to other tricyclic antidepressants (such as amoxapine); or if you have any other allergies.
  • Medical History: Before using this medication, tell your doctor or pharmacist if you had: problems urinating (urinary retention), personal or family history of glaucoma (angle-closure type).
  • Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Pregnancy Risk:  During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

Breastfeeding:  This medication passes into breast milk and may have undesirable effects in a nursing infant. Therefore, breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

Interactions:

  • Some products that may interact with this drug include: cimetidine.
  • Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.
  • Tell your doctor or pharmacist if you also take drugs that cause drowsiness such as certain antihistamines (such as diphenhydramine), anti-seizure drugs (such as carbamazepine), medicine for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, narcotic pain relievers (such as codeine), psychiatric medicines (such as risperidone, amitriptyline, trazodone).

Overdose:

If overdose is suspected, contact a poison control center or emergency room immediately.

Symptoms of overdose may include: extreme drowsiness, hallucinations, fast/irregular heartbeat, fainting, slow/shallow breathing, seizures.

Notes

Do not share this medication with others.

This medication has been prescribed for your current condition only. Do not use it later for other conditions unless directed by your doctor. A different medication may be necessary in those cases.

Usually, insomnia is temporary and requires sleep medications only for a short time. If you require treatment for more than 7-10 days, laboratory and/or medical tests should be performed to find the cause of your sleep problem.

As you get older, your sleep pattern may naturally change and your sleep may be interrupted several times during the night. Talk to your doctor or pharmacist for ways to improve your sleep without medication, such as avoiding caffeine and alcohol close to bedtime, avoiding daytime naps, and avoiding going to bed too early each night.

Missed Dose

If you miss a dose, take it as soon as you remember if it is still near bedtime and you have trouble falling asleep. If it is already the next day, resume your usual dosing schedule that night at bedtime. Do not double the dose to catch up.

Storage

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Brands:

There are no brands containing this molecule.

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