Doxepin (HCl)

Doxepin (HCl) is a tricyclic antidepressant of the dibenzoxepine class, also having significant anxiolytic activity. Doxepin (HCl) is effective in treating depression and to treat nerve pain, and insomnia. Two to three weeks are required to observe the full effects of drug. Doxepin (HCl) is administered orally.

Brands
Adult Dose
Dose: 0.142 to 1.428 mg/kg
Single Dose: 0.78 (0.785)
Frequency: 8 hourly
Route: PO
Instructions: Maintenance
Neonatal
Paedriatic
Dose:
Single Dose:
Frequency:
Route:
Instructions: Not recommended in this age group
Characteristics
. It is of Synthetic origin and belongs to Dibenzoxepin. It belongs to Amine uptake inhibitor pharmacological group on the basis of mechanism of action and also classified in Psychotherapeutic Drugs and Antidepressant pharmacological group.The Molecular Weight of Doxepin (HCl) is 279.00. Its pKa is 8.
Contraindications
Doxepin (HCl) is contraindicated in conditions like Glucoma,Mania,Urinary retention.
Effects
The severe or irreversible adverse effects of Doxepin (HCl), which give rise to further complications include Heart failure.The signs and symptoms that are produced after the acute overdosage of Doxepin (HCl) include Cardiac arrhythmias, Convulsions, Coma, Hyperthermia, Blurred vision, Drowsiness, Dry mouth, Urinary retention, Respiratory depression, Mydriasis, Hypertension, Stupor, Decreased GI motility, Hyperreflexia.The symptomatic adverse reactions produced by Doxepin (HCl) are more or less tolerable and if they become severe, they can be treated symptomatically, these include Dizziness, Headache, Drowsiness, Tachycardia, Constipation, Insomnia, Dry mouth, Blurred vision, Rashes, Confusion, Extrapyramidal reactions, Hypotension, Agitation, Psychotic symptoms, Dry mouth, Confusion, dizziness.
Indications
Doxepin (HCl) is primarily indicated in conditions like Depressive illness, Mild anxiety, and can also be given in adjunctive therapy as an alternative drug of choice in Atopic dermatitis, Eczema, Insomnia, Lichen simplex, Migraine prophylaxis.
Interactions
Doxepin (HCl) is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementAdrenalineAlcoholBethanidine (Sulphate)Cimetidine (HCl)Cimetidine inhibit CYP450 thus inhibit metabolism of doxepin increases its serum concentration to toxic levelsl.ModerateMonitor patient response and tolerance.Dry mouth,blurred vission,constipation,altered heart beat,dizziness and urinary retention must be reported to physician.lClonidine (HCl)Debrisoquine (Sulphate)EphedrineGuanethidineLithiumMethyldopaMethylphenidate (HCl)Noradrenaline (Acid Tartrate)Phenylephrine (HCl)Phenylpropanolamine (HCl)Plasma Protein FractionRauwolfia ReserpineVORICONAZOLEVoriconazole may also increase the serum concentration of doxepin by decreasing its metabolism. Consider alternate therapy or monitor for QTc prolongationVortioxetineincreases the level of vortioxetinemonitor closely, use alternative These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.
Interfrence
Risks
Drug should not be given to Paediatrics, Pregnant Mothers, Geriatrics, and Neonates.If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.
Storage
Caps, Oral Soln Store Below 40°C. Protect from Sunlight and Moisture. Cream Store at room temperature, Between 15°C-30°C.
Warnings
It should be used with extreme caution in patients with a pre-existing seizure disorder because the seizure threshold may be lowered, diabetes mellitus, hepatic disease, pre-existing hematological disease, with respiratory depression, in patients with Parkinsons disease, in patients who have hyperthyroidism or are receiving thyroid drugs, with cardiac disease (because of the alterations inECG patterns). Patients with cardiovascular disease should be closely monitored and regular ECG tracings made. It should not be given to patients who are in the acute recovery phase following myocardial infarction; sudden death is possible. Therapy should be discontinued for several days prior to elective surgery because of the risk of hypertensive episodes. Patients may be more prone to sunburn during therapy with doxepin and suitable precautions should be taken (wearing long-sleeved clothing and applying sunblock). It is classified as a pregnancy category C drug. It should not be used during pregnancy, unless the possible benefits outweigh the risks to fetus. Following prolonged therapy in high doses, abrupt discontinuation of doxepin should be avoided because this can precipitate symptoms of cholinergic rebound. It should be used with caution in patients who have a history of alcoholism or who may use alcohol or other sedative medications because the depressant effects on the central nervous system can be potentiated. Bipolar disorder patients who are not concomitantly treated with an anticyclic medication are likely to switch from depression to mania, and some schizophrenic patients can experience exacerbation of psychosis.
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