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doxepin hydrochloride

DOXEPIN HYDROCHLORIDE

Manufacturer: Currax Pharmaceuticals LLC dba Cypress, Hawthorn, Macoven

Score: 141.0

Quick Summary

Doxepin hydrochloride is a tricyclic antidepressant used for the treatment of insomnia characterized by difficulty with sleep maintenance. The recommended dose is 6 mg once daily for adults and 3 mg once daily for the elderly, taken within 30 minutes of bedtime. Doxepin has high binding affinity to the H1 receptor and is extensively metabolized by hepatic enzymes. It is contraindicated in individuals with hypersensitivity to doxepin, untreated narrow angle glaucoma, or severe urinary retention. Common adverse reactions include somnolence, nausea, and upper respiratory tract infection. Special population considerations include use during pregnancy, nursing mothers, pediatric use, and geriatric use.

Key Clinical Findings and Indications

  • Treatment of insomnia characterized by difficulty with sleep maintenance
  • High binding affinity to the H1 receptor
  • Extensively metabolized by hepatic enzymes

Important Safety Information

Warning

May cause abnormal thinking and behavioral changes, suicide risk, and worsening of depression

Contraindications

  • Hypersensitivity to doxepin hydrochloride
  • Untreated narrow angle glaucoma
  • Severe urinary retention
  • Co-administration with Monoamine Oxidase Inhibitors (MAOIs)

Adverse Reactions

  • Somnolence
  • Nausea
  • Upper respiratory tract infection
  • Dizziness
  • Dry mouth

Dosing Recommendations

General Guidance

Total daily dose should not exceed 6 mg

Insomnia

Adult Dose

6 mg once daily

Pediatric Dose

Not evaluated

Insomnia in elderly

Adult Dose

3 mg once daily

Pediatric Dose

Not evaluated

Special Population Considerations

Pregnancy

  • Available data from published epidemiologic studies and postmarketing reports have not established an increased risk of major birth defects or miscarriage
  • Risks of poor neonatal adaptation with exposure to tricyclic antidepressants during pregnancy

Nursing Mothers

  • Doxepin may reduce fertility in females and males of reproductive potential
  • It is unknown if the effects are reversible

Pediatric Use

  • The safety and effectiveness of doxepin in pediatric patients have not been evaluated

Geriatric Use

  • A starting dose of 3 mg is recommended in this population
  • Evaluation prior to considering dose escalation is recommended