View source for Doxepin

==Administration==
*Type: Insomnia; [[Tricyclic antidepressant]] (TCAs)
*Dosage Forms: 10, 25, 50, 75, 100, 150; 10/mL
*Routes of Administration: PO
*Common Trade Names: Silenor, Zonalon, Prudoxin

==Adult Dosing==
===[[Depression]]===
*150-300mg PO QHS
*start 25-75mg PO QHS; max 300mg/day
*taper gradually to discontinue

===[[Anxiety]]===
*150-300mg PO QHS
*start 25-75mg PO QHS; max 300mg/day
*taper gradually to discontinue

===[[Insomnia]]===
*10-50mg PO QHS

==Pediatric Dosing==

===[[Depression]]===

*PO:
* Not recommended as first line medication; however some studies indicate it might be beneficial for patients with comorbid conditions.

*Children 7 to 11 years: Limited data available; efficacy results variable: 1 to 3 mg/kg/day in single or divided doses.

*Children ≥12 years and Adolescents: Initial: 25 to 75 mg/day at bedtime or in 2 to 3 divided doses; begin at the low end of range and gradually titrate; select patients may respond to 25 to 50 mg/day; maximum single dose: 150 mg; maximum daily dose: 300 mg/day.

** Note: Controlled clinical trials have not shown TCAs to be superior to placebo for the treatment of depression in children and adolescents

==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
*[[Lactation risk categories|Lactation risk]]: unsafe

===Renal Dosing===
*Adult: no adjustment

===Hepatic Dosing===
*Adult: not defined, caution advised

==Contraindications==
*Allergy to class/drug
*MI, acute recovery
*glaucoma, increased IOP
*urinary retention, prostatic hypertrophy, GI/GU obstruction
*avoid abrupt withdrawal
*caution if:
**age <25 years, elderly
**cardiovascular disease
**seizure disorder, parkinsons
**thyroid disease, diabetes
**asthma
**hepatic impairment
**schizophrenia, bipolar disorder, alcohol abuse, electroconvulsive therapy, suicide risk
**high environmental temperature

==Adverse Reactions==
===Serious===
*syncope, orthostatic hypotension
*ventricular arrhythmias, AV block, QT prolongation, torsades de pointes
*seizures
*MI, HTN
*stroke
*extrapyramidal symptoms, tardive dyskinesia
*ataxia
*paralytic ileus
*IOP elevation
*agranulocytosis, leukopenia, thrombocytopenia
*hallucinations, psychosis, worsening depression, hypomania/mania, suicidality
*SIADH
*hepatitis
*angioedema
*hyperthermia, heat stroke
*withdrawal symptoms if abruptly discontinued

===Common===
*drowsiness, dizziness, confusion, weakness, tremor, paresthesias
*nausea/vomiting, constipation, xerostomia
*blurred vision
*palpitations, tachycardia, diaphoresis, restlessness, insomnia, anxiety
*urinary frequency, incontinence, retention
*increased appetite, weight gain
*libido changes, impotence, gynecomastia,  galactorrhea
*hypo/hyperglycemia
*rash/urticarial, pruritus, photosensitivity

==Pharmacology==
*Half-life: 15.3 hours (doxepin); 31 hours (metabolite)
*Metabolism: liver; CYP450 (1A2, 2C9/19, 2D6 substrate)
*Excretion: urine
*Mechanism of Action: exact MOA unknown; inhibits norepinephrine and serotonin reuptake; antagonizes central H1 receptors

==See Also==

==References==
<references/>
[[Category:Pharmacology]] [[Category:Psychiatry]]