Doxepin
Doxepin: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. For violations of liver function
- 13. Use in the elderly
- 14. Drug interactions
- 15. Analogs
- 16. Terms and conditions of storage
- 17. Terms of dispensing from pharmacies
- 18. Reviews
- 19. Price in pharmacies
Latin name: Doxepinum
ATX code: N06AA12
Active ingredient: Doxepin (Doxepinum)
Producer: Teva Operations Poland LLC, Poland
Description and photo update: 18.10.2018
Doxepin is a drug from the group of tricyclic antidepressants.
Release form and composition
Dosage form - capsules (15 pcs. In blisters, 2 blisters in a carton).
Active ingredient: doxepin, in 1 capsule - 10 or 25 mg.
Excipients: sodium lauryl sulfate, lactose, corn starch, magnesium stearate.
Pharmacological properties
Pharmacodynamics
Doxepin is a derivative of dibenzoxepine and is a tricyclic antidepressant.
The drug weakens adrenergic transmission in the synapses of the central nervous system and blocks the reuptake of norepinephrine.
It has a sedative, antidepressant, anxiolytic and antiulcer effect. It has antiserotonin, anticholinergic and antihistamine effects, as well as antispasmodic activity, muscle relaxant, anticonvulsant and moderate peripheral vasodilatory effects.
The drug eliminates depression, depression, apathy, fear and inner tension, and improves mood. Effective for vegetative disorders of neurotic origin.
A moderate antidepressant effect (a distinct effect on mood) is observed 10-14 days after starting the drug. A persistent antidepressant effect appears within 2-3 weeks of regular capsule intake.
Does not inhibit monoamine oxidase, does not stimulate the central nervous system.
Pharmacokinetics
The drug is rapidly and completely absorbed from the gastrointestinal tract. The maximum concentration reaches in 1-3 hours. Equilibrium concentration (0.03-0.15 mg / ml) is observed after 2 weeks.
The substance is metabolized in the liver with the participation of P450 CYP2D6 to the pharmacologically active metabolite of dimethyldoxepine, then it is glucuronidated and excreted in the urine.
Doxepin is distributed throughout tissues and is found in the liver, heart, lungs, and brain.
The half-life is 28–52 hours.
The drug crosses the blood-brain and placental barrier into the milk of a nursing mother.
Indications for use
- psychoneurotic disorders accompanied by anxiety and / or depression;
- sleep disorders, anxiety and depression with neuroses, organic diseases of the central nervous system, alcoholism;
- psychotic depression (including involutional and reactive-depressive phases of manic-depressive psychosis).
In general therapeutic practice, Doxepin is used to treat the following diseases:
- dumping syndrome;
- chronic idiopathic urticaria;
- itchy skin;
- premenstrual syndrome;
- duodenal ulcer;
- chronic pain in cancer patients.
Contraindications
Absolute:
- age up to 12 years;
- atrioventricular block III degree;
- left bundle branch block;
- angle-closure glaucoma;
- adenoma of the prostate gland or conditions accompanied by urinary retention;
- severe dysfunction of the hematopoietic system, liver and kidneys;
- acute myocardial infarction;
- During pregnancy and breastfeeding;
- hypersensitivity to the drug.
Carefully:
- severe diseases of the cardiovascular system;
- emaciated patients;
- elderly age.
Instructions for the use of Doxepin: method and dosage
The capsules are taken orally. If the daily dose does not exceed 150 mg, the drug is taken once a day, if more than 150 mg, 2 times a day. For sleep disorders, most of the daily dose should be taken in the evening.
The dosage regimen of the drug is individual, depending on the type and severity of the disorder.
With moderate anxiety and / or depression, it is recommended to start treatment with a daily dose of 75 mg. Further, the dose is gradually increased, based on the data of the individual effect and the tolerability of the drug.
The average maintenance dose is 75–150 mg per day. With minimal disturbances, a dose of 25–50 mg may be sufficient. With significantly pronounced conditions, the daily dose may be increased to 300 mg.
The daily dose for children over 12 years old is 0.5 mg / kg.
The duration of the course of treatment is on average 2-3 weeks.
Side effects
- from the central and peripheral nervous system: extrapyramidal disorders, headache, disorientation, drowsiness, tinnitus, ataxia, dizziness, tremor, paresthesia, visual impairment, convulsions, hallucinations, tardive dyskinesia;
- on the part of the cardiovascular system: tachycardia, arterial hypotension, hypertension;
- from the digestive system: aphthous stomatitis, dry mouth, disturbances in taste, nausea, anorexia, constipation / diarrhea, vomiting; rarely, jaundice;
- from the endocrine system: rarely - syndrome of inadequate secretion of antidiuretic hormone, decrease or increase in blood sugar, weight loss; in women - galactorrhea, an increase in the mammary glands; in men - gynecomastia, testicular edema, increased or decreased libido;
- from the hematopoietic system: rarely - thrombocytopenia, agranulocytosis, leukopenia;
- allergic reactions: photosensitivity, eosinophilia, pruritus, skin rash, angioedema;
- others: rarely - aggravation of the course of bronchial asthma, general weakness, increased sweating, a feeling of flushed face, chills, urinary retention, alopecia.
Overdose
In case of an overdose, the following side effects may develop: pupil dilation, drowsiness, dry mouth, hallucinations, nausea, blurred vision, arrhythmias, tachycardia, severe arterial hypotension, respiratory depression, stupor, changes in the electrocardiogram (especially QRS) characteristic of intoxication with tricyclic antidepressants, muscle stiffness, convulsions, coma.
For the treatment of the condition, gastric lavage, ventilation of the lungs, correction of the function of the cardiovascular system should be performed. If necessary, administer physostigmine. Hemodialysis is ineffective.
special instructions
During the period of treatment, alcohol is prohibited.
You should not abruptly stop therapy, since withdrawal syndrome may develop. The drug should be withdrawn gradually.
Influence on the ability to drive vehicles and complex mechanisms
During treatment, one should refrain from engaging in activities that require an increased speed of motor and mental reactions.
Application during pregnancy and lactation
Doxepin is contraindicated for pregnant and lactating women.
Pediatric use
In pediatric practice, the drug is not used to treat children under 12 years of age.
With impaired renal function
The drug is contraindicated in severe renal impairment.
For violations of liver function
The drug is contraindicated in severe liver dysfunction.
Use in the elderly
Doxepin should be used with caution in old age.
Drug interactions
According to the instructions, Doxepin is contraindicated to prescribe concurrently with monoamine oxidase inhibitors (and within 2-3 weeks after their withdrawal), chlorpromazine, sulfopride and quinidine.
Caution should be exercised if the concomitant use of baclofen, digitalis glycosides is necessary.
Dextropropoxyphene may enhance the inhibitory effect of the drug on the central nervous system.
In patients with diabetes mellitus receiving tolazamide, doxepin may contribute to the development of severe hypoglycemia.
Cimetidine increases the concentration of doxepin in blood plasma, enhances its main effect and anticholinergic side effects.
Doxepin enhances the anticholinergic effects of anticholinergic drugs.
Ethanol increases concentration disorders, reduces the speed of psychomotor reactions.
With the simultaneous use of chlorpromazine, the risk of developing hyperpyrexia, lithium carbonate - neurotoxicity increases.
With the simultaneous use of doxepin in doses greater than 200–250 mg, a decrease or complete inhibition of the hypotensive effect of guanethidine or drugs with a similar mechanism of action is possible.
Analogs
Doxepin's analogs are: Azafen, Amitriptyline, Coaxil, Mirtazapine, Mianserin, Sinekvan, Trimipramine.
Terms and conditions of storage
Keep out of the reach of children, in a dry place at room temperature.
Shelf life is 4 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Doxepin
There are few reviews about Doxepin, which confirm its effectiveness in anxiety-hypochondriacal experiences and depression with a predominance of sleep disorders. However, given the non-selective effect on the metabolism of neurotransmitters, the drug causes many side effects, including patients complaining of the occurrence of adverse reactions that are not described in the instructions. In most cases, these phenomena disappear after dose reduction. In high doses and with prolonged use, Doxepin has a cardiotoxic effect.
Numerous side effects and negative interactions with many other drugs limit the use of tricyclic antidepressants in medical practice.
Price for Doxepin in pharmacies
At the moment, the drug is not available in the pharmacy chain, since its registration period has expired. In this regard, the prices for Doxepin are unknown.
In pharmacies, you can buy analogues with a similar mechanism of action, their cost is: Azafen - 172-193 rubles. per package, Amitriptyline - 48–55 rubles. per package, Mirtazapine - 513–778 rubles.
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
