Doxepin

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Information about Doxepin

Doxepin is a tricyclic antidepressant that widely used in the therapy of depression.


Liver safety of Doxepin

Doxepin can cause mild and transient serum enzyme elevations but is a rare cause of clinically apparent acute cholestatic liver injury.


Mechanism of action of Doxepin

Doxepin (dox' e pin) is a dibenzoxepine derived tricyclic antidepressant which acts by inhibition of serotonin and norepinephrine reuptake within synaptic clefts in the central nervous system, thus increasing brain levels of these neurotransmitters.

FDA approval information for Doxepin

Doxepin is indicated for therapy of depression or anxiety and was approved for this indication in the United States in 1969 and it is still widely used, with more than 2 million prescriptions being filled yearly.

Dosage and administration for Doxepin

Doxepin is available in generic forms and under the brand names of Sinequan in capsules of 10, 25, 50, 75, 100 and 150 mg as well as an oral solution. The recommended adult dose for depression is 25 to 75 mg daily in divided doses, increasing gradually to a maximum of 300 mg daily. Doxepin can also be given as a single nighttime dose (maximum dose of 150 mg).

Side effects of Doxepin

Common side effects include dizziness, headache, drowsiness, restlessness, confusion, gastrointestinal upset, nausea, increased appetite, weight gain, blurred vision, dry mouth, urinary retention, rash and hypersensitivity reactions. Rare but potentially severe adverse events include suicidal thoughts and behaviors and acute glaucoma.

The following are antidepressant subclasses and drugs

MAO Inhibitors Isocarboxazid, Phenelzine, Tranylcypromine

SNRIs Duloxetine, Levomilnacipran, Venlafaxine

SSRIs Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Vilazodone, Vortioxetine

Tricyclics Amitriptyline, Amoxapine, Clomipramine, Desipramine, Doxepin, Imipramine, Nortriptyline, Protriptyline, Trimipramine

Miscellaneous Bupropion, Flibanserin, Mirtazapine, Nefazodone, Trazodone

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Contributors: Prab R. Tumpati, MD