Tricyclic antidepressant used at higher doses for depression and anxiety, and at low doses (Silenor) for insomnia with sleep-maintenance difficulty.
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Dr. Steve Malen, PharmD
Dr. Steven Blikstein, PharmD
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Doxepin is a tricyclic antidepressant (TCA). At higher oral doses (75-300 mg/day), it inhibits reuptake of norepinephrine and serotonin and is used to treat depression and anxiety disorders. At very low doses (3-6 mg at bedtime, marketed as Silenor), it acts primarily as a potent histamine H1-receptor antagonist and is approved specifically for insomnia characterized by difficulty with sleep maintenance. Common side effects include drowsiness, dry mouth, constipation, blurred vision, and orthostatic hypotension; higher antidepressant doses carry greater anticholinergic burden and cardiac conduction effects. As with other antidepressants, doxepin carries a boxed warning for increased risk of suicidal thinking and behavior in children, adolescents, and young adults. It should not be used with or within 14 days of MAOIs, and is contraindicated in severe urinary retention or untreated narrow-angle glaucoma.
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Doxepin is a tricyclic antidepressant (TCA). At antidepressant doses, it inhibits reuptake of norepinephrine and serotonin; at very low doses (Silenor), it acts primarily as a potent histamine H1-receptor antagonist to promote sleep maintenance.
Boxed Warning: Antidepressants, including doxepin, may increase the risk of suicidal thinking and behavior in children, adolescents, and young adults, particularly during the early months of treatment or after dose changes. Patients should be monitored closely for worsening depression or unusual changes in behavior.
Common side effects include drowsiness, dry mouth, constipation, blurred vision, weight gain, and orthostatic hypotension. Higher antidepressant doses carry a greater anticholinergic burden and can affect cardiac conduction.
Precautions: Doxepin should not be used with or within 14 days of MAOIs, and is contraindicated in severe urinary retention or untreated narrow-angle glaucoma. Alcohol and other CNS depressants can increase sedation.