Detailed Drug Information:

DRUG CLASS AND MECHANISM: Doxepin is an anti-depressantmedication of the tricyclic class. Medications in this class are oftenreferred to as tricyclic anti-depressants, or TCAs. Depression is anall-pervasive sense of sadness and gloom. In some patients withdepression, abnormal levels of neurotransmitters (chemicals that the nervecells use to communicate with each other) may be the cause of thedepression. Nortriptyline elevates mood by raising the level ofneurotransmitters in the brain.

PREPARATIONS: Capsules: 10mg, 25mg, 50mg, 75mg, 100mg. 150mg.

STORAGE: Doxepin should be stored below 86°F (30°C) ina tight, light resistant container.

PRESCRIBED FOR: Doxepin is used to elevate the mood of patientswith depression. Nortriptyline is also a sedative and is useful indepressed patients with insomnia, restlessness, and nervousness. It alsohas been found to be helpful for treating chronic pain and the pain ofneuralgia.

DOSING: The dose of doxepin is tailored to the patient's needs.Sometimes, physicians will start with relatively low doses, such as 25mg,given three times a day, to reduce the risk of excessive sedation early inthe course; doses then will be increased slowly. (It may take severalweeks before the effects of a dose are maximal.) Other physicians preferto give nortriptyline once daily, in which case it is generally given atbedtime to take advantage of its sedating properties. Elderly persons andpatients with advanced liver disease may need lower doses.

DRUG INTERACTIONS: Doxepin exaggerates the effects of othermedications and drugs that slow the brain's processes, such as alcohol,barbiturates, benzodiazepines (e.g. lorazepam, Ativan), and narcotics.Reserpine, given to patients taking TCAs, can have a stimulatory effect.Doxepin and other TCAs should not be used with monoamine oxidaseinhibiting drugs, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane). Highfever, convulsions and even death can occur when these drugs are usedtogether

Cimetidine (Tagamet) can increase doxepin blood levels, possibly causingside effects.

PREGNANCY: There is very little information about the effects ofdoxepin on the fetus in pregnant women. Physicians may use doxepin it ifits benefits are deemed to outweigh the unknown risks.

NURSING MOTHERS: It is not known if doxepin is secreted in breast milk.

SIDE EFFECTS: The most commonly encountered side effectsassociated with doxepin include rapid heart rate, blurred vision, urinaryretention (difficulty urinating), dry mouth, constipation, weight gain orloss, and low blood pressure when going from sitting to standing orthostatic hypotension). Rash, hives, seizures, and hepatitis are rareside effects. Doxepin also can cause elevated pressure in the eyes of somepatients with glaucoma. Overdose with doxepin can cause life threateningabnormal heart rhythms or seizures.

"If antidepressants are discontinued abruptly, symptoms may occur such as dizziness, headache, nausea, changes in mood, or changes in the sense of smell, taste, etc. (Such symptoms even may occur when even a few doses of antidepressant are missed.) Therefore, it is recommended that the dose of antidepressant be reduced gradually when therapy is discontinued."