Details About Generic Salt ::  Doxepin

Main Medicine Class:: Antianxiety,Tricyclic antidepressant   

(DOX-uh-pin HIGH-droe-KLOR-ide)
Sinequan, Zonalon, Alti-Doxepin, Apo-Doxepin, Novo-Doxepin, Rho-Doxepin, Triadapin
Class: Antianxiety/Tricyclic antidepressant


Drugs Class ::

 Action Moderately blocks reuptake of norepinephrine and weakly blocks reuptake of serotonin; also produces antihistaminic and anticholinergic activity.

Indications for Drugs ::

 Indications Treatment of psychoneurotic patients with depression or anxiety; depression or anxiety associated with alcoholism (not to be taken concomitantly with alcohol); depression or anxiety associated with organic disease (the possibility of drug interaction should be considered if the patient is receiving other drugs concomitantly); psychotic depressive orders with associated anxiety including involutional depression and manic-depressive disorders. Unlabeled use(s): Neurogenic pain; peptic ulcer disease. Topical use: Pruritus.

Drug Dose ::



ADULTS: PO Initial dose: 75 mg/day, increasing as tolerated. Maximum daily dose: 150 mg for outpatients, 300 mg for inpatients. Maximum single daily dose: 150 mg given at bedtime. FOR MILD CASES WITH ORGANIC DISEASES: PO 25 to 50 mg/day.


ADULTS: Topical Apply thin film qid with ³ 3 to 4 hr between applications. Not recommended for > 8 days.

Contraindication ::

 Contraindications Hypersensitivity to tricyclic antidepressants; use during acute recovery phase after MI; angle-closure glaucoma; risk of urinary retention; concomitant use with monoamine oxidase (MAO) inhibitor; Dibenzoxepines may produce cross-sensitivity.

Drug Precautions ::


Pregnancy: Oral form: Safety not established. Lactation: Excreted in breast milk. Children: Not recommended for children < 12 yr. Special risk patients: Use drug with caution in patients with history of seizures, urinary retention, urethral spasm, angle-closure glaucoma or increased IOP, cardiovascular disorders, hyperthyroidism (or those receiving thyroid medication), hepatic or renal impairment, schizophrenia or paranoia. Topical use: For external use only; do not use ophthalmically, orally or intravaginally. Because of absorption of drug, drowsiness often occurs.


Drug Side Effects ::

 Adverse Reactions

CV: Orthostatic hypotension; hypertension; fainting; tachycardia; arrhythmias; MI; heart block, precipitation of CHF; stroke. CNS: Dizziness; drowsiness; headache; confusion; weakness; tremors; convulsions. EENT: Mydriasis; photophobia; blurred vision; increased IOP; unpleasant taste. GI: Nausea; constipation; dry mouth; paralytic ileus. GU: Urinary retention; nocturia; painful ejaculation; altered libido; impotence; dysmenorrhea. HEPA: Hepatitis. HEMA: Agranulocytosis; eosinophilia; purpura; thrombocytopenia; leukopenia. META: Increased appetite; weight gain; syndrome of inappropriate secretion of antidiuretic hormone. RESP Bronchospasms; dyspnea. OTHER: Hyperthermia. Topical use: Local burning or stinging; dry or tight skin. Results in significant plasma levels; drowsiness and other adverse effects are possible.

Drug Mode of Action ::  

 Action Moderately blocks reuptake of norepinephrine and weakly blocks reuptake of serotonin; also produces antihistaminic and anticholinergic activity.

Drug Interactions ::


Alcohol/CNS depressants: CNS and respiratory depression may be potentiated. Anticoagulants: Anticoagulant action may increase. Cimetidine: May inhibit metabolism of doxepin, leading to increased concentrations. Clonidine: Concurrent use may lead to dangerous increases in BP. Fluoxetine: May increase serum concentrations of doxepin; effect may occur up to 5 wk after discontinuation of fluoxetine. Guanethidine: Hypotensive action may be inhibited. MAO inhibitors: Concurrent use may lead to severe seizures, hyperpyretic crisis and fatal reactions. Generally, allow 7 to 10 days between discontinuation of one drug and start of other. Sympathomimetics (eg, dopamine, epinephrine): Pressor response may increase or decrease; arrhythmias may occur.

Drug Assesment ::


  • Obtain patient history, including drug history and any known allergies.
  • Assess BP (lying, standing) and pulse q 4 hr. If systolic BP drops significantly, withhold drug and notify physician.
  • Weigh patient weekly. Appetite may be increased.
  • Monitor ECG before and during therapy, especially in elderly patients or patients with current cardiac condition or history of cardiac disease.
  • Monitor blood studies: CBC, leukocytes and differential before and during therapy.
  • Monitor liver function studies: AST, ALT, bilirubin and serum phosphatase.
  • Monitor for urinary retention and constipation. Increase fluids and bulk in diet if constipation or urinary retention occurs.
  • Assess patient’s mental status: mood, sensorium, affect, suicidal tendencies, increased depression or panic.
  • Observe for signs of extrapyramidal syndrome especially in elderly patients: rigidity, dystonia, akathisia.
  • If drug is discontinued abruptly, observe patient for withdrawal symptoms: headache, nausea, vomiting, muscle pain, weakness.
  • If drowsiness or dizziness occurs, assist patient with ambulation. Use siderails for safety, especially with elderly patients.
  Confusion, agitation, hallucinations, seizures, status epilepticus, clonus, choreoathetosis, hyperactive reflexes, positive Babinski’s sign, coma, cardiac arrhythmias, renal failure, flushing, dry mouth, dilated pupils, hyperpyrexia

Drug Storage/Management ::


  • Administer with or after meals to decrease GI upset.
  • Have patient take capsule with full glass of water.
  • If patient is unable to swallow capsule, open capsule and mix contents with food or fluids.
  • Dilute concentrate with 120 ml of liquid (water, milk, fruit juice). Do not mix with carbonated beverages.
  • If oversedation occurs when divided doses are given during the day, administer total daily dose at bedtime.
  • Do not prepare or store bulk dilutions.
  • Store at room temperature in tight container and protect from sunlight.

Drug Notes ::

 Patient/Family Education

  • Warn patient of risk of seizure.
  • Emphasize that therapeutic effect may take up to 4 to 6 wk.
  • Advise patient to monitor dietary intake because increased appetite may lead to weight gain.
  • Instruct patient to increase fluid and bulk intake if constipation occurs.
  • Explain that if daytime drowsiness occurs, patient should ask physician about taking total dose at bedtime. Explain that sedative effect tends to disappear with prolonged therapy.
  • Caution patient not to stop taking drug abruptly since withdrawal symptoms may occur.
  • Emphasize importance of follow-up appointments and lab tests.
  • Instruct patient to report urinary retention to physician.
  • Advise patient to take sips of water frequently, suck on ice chips or sugarless hard candy or chew sugarless gum if dry mouth occurs.
  • Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
  • Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
  • Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
  • Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.

Disclaimer ::

The Information available on this site is for only Informational Purpose , before any use of this information please consult your Doctor .Price of the drugs indicated above may not match to real price due to many possible reasons may , including local taxes etc.. These are only approximate indicative prices of the drug.


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