| name | Doxepin |
| classification | Tricyclic antidepressant (TCA) |
| pharmacokinetics | Doxepin is rapidly absorbed after oral administration, with peak plasma concentrations typically occurring within 2-4 hours. It is highly bound to plasma proteins (approximately 85-95%). Metabolism occurs primarily in the liver, with multiple metabolites produced. Elimination is primarily via hepatic metabolism, with a half-life ranging from 10 to 40 hours, depending on the specific formulation. This variability in half-life is important for dosing regimens and potential accumulation in some individuals. The longer half-life can lead to increased risk of drug interactions and adverse effects. |
| suggested dosage | Doxepin dosages are highly variable and are individualized based on the specific condition being treated. A starting dose of 25 mg to 50 mg at bedtime is often used for insomnia. However, dosage ranges can extend to 150 mg or even higher for depression. Dosage should be adjusted carefully under the guidance of a medical professional. |
| indications | | 1 | Treatment of major depressive disorder | | 2 | Treatment of chronic pain conditions, such as neuropathic pain | | 3 | Treatment of anxiety disorders | | 4 | Treatment of nocturnal enuresis (bedwetting) in children | | 5 | Treatment of pruritus (itching) | | 6 | Treatment of insomnia |
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| safety in pregnancy | Doxepin use during pregnancy is associated with potential risks to the developing fetus. Therefore, the use of doxepin during pregnancy is generally not recommended unless the potential benefits outweigh the risks. Close monitoring by a healthcare provider is crucial. Further research is necessary to define the precise risk profile across different trimesters. |
| safety in breastfeeding | Doxepin is excreted in breast milk. Therefore, breastfeeding mothers should carefully consider the potential risks and benefits of using doxepin. Potential adverse effects in the infant should be considered. Alternative treatments should be explored when possible. |
| side effects | | 1 | Sedation | | 2 | Dry mouth | | 3 | Constipation | | 4 | Blurred vision | | 5 | Urinary retention | | 6 | Orthostatic hypotension (dizziness, fainting when standing up) | | 7 | Weight gain | | 8 | Sexual dysfunction | | 9 | Cardiac arrhythmias (rare) | | 10 | Seizures (rare) | | 11 | Confusion, hallucinations, or other cognitive changes (more common in older adults) |
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| alternatives | |
| contraindications | | 1 | Known hypersensitivity to doxepin or other TCAs | | 2 | Severe cardiovascular disease (e.g., recent MI, severe heart block) | | 3 | Narrow-angle glaucoma | | 4 | Severe urinary retention | | 5 | Concurrent use with MAOIs (monoamine oxidase inhibitors) |
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| interactions | | 1 | Alcohol | | 2 | Other CNS depressants | | 3 | Certain antihistamines | | 4 | Some anticholinergics | | 5 | Some medications metabolized by the liver | | 6 | Some medications affecting cardiovascular function |
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| warnings and precautions | | 1 | Elderly patients are more susceptible to side effects, particularly sedation and cognitive changes. | | 2 | Caution is advised in patients with liver or kidney disease. | | 3 | Patients with a history of seizures should be monitored closely. | | 4 | Sudden discontinuation of doxepin may cause withdrawal symptoms. Dosage should be tapered gradually. |
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| additional informations | Doxepin is available in various formulations (e.g., immediate-release, sustained-release). Specific formulations may have different pharmacokinetic profiles and dosing recommendations. Always consult with a healthcare professional to discuss the appropriate dose and duration of therapy based on individual patient needs and characteristics. |
| patient details | | age | 25 years | | weight | 70 kg | | sex | male |
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