Doxepin(Adapin, Sinequan, Asendin, Aventyl, Elavil, Endep, Norpramin, Pamelor, Surmontil, Tofranil, Vivactil)
Doxepin Pharmacology
Doxepin - Antidepressant
Doxepin is a psychotropic agent with antidepressant and anxiolytic properties. Doxepin also has sedative and anticholinergic effects, and, in the higher dosage range, it produces peripheral adrenergic blocking effects. Studies of electroencephalograms in humans have shown decreases in amplitude, and amplitude variability, also, the delta, theta and 24-35 CPS activities increased.
Doxepin Indications
Doxepin treatment of:
- Psychoneurotic patients with anxiety and/or depressive reactions. Anxiety neurosis associated with somatic disorders; alcoholic patients with anxiety and/or depression.
- Psychotic depression, including manic-depressive illness (depressed type) and involutional melancholia.
Doxepin Contraindications
Doxepin is contraindicated in individuals who have shown hypersensitivity to the drug or to other dibenzoxepin compounds.
It is not recommended for use Doxepin in children since safety and efficacy in this age group have not been established.
Because of its anticholinergic activity Doxepin should not be administered to patients with a history of glaucoma, increased intraocular pressure or urinary retention.
Tricyclic agents are generally contraindicated during the acute recovery phase following myocardial infarction and in the presence of acute congestive heart failure, as well as in patients with a history of blood dyscrasias and severe liver disease.
Doxepin should not be administered concomitantly with MAO inhibitors, since such a combination may cause a syndrome of intensive sympathetic stimulation. Drugs of this type should be discontinued at least 2 weeks before instituting therapy with doxepin.
Doxepin Precautions
Since drowsiness may occur with the use of Doxepin, patients should be advised against driving or engaging in activities requiring mental alertness and physical coordination until their response to the drug has been well established.
Patients should be warned that the effects of other drugs acting on the central nervous system, such as alcohol, barbiturates and other CNS depressants, may be potentiated by Doxepin.
Tricyclic antidepressants may also give rise to paralytic ileus, particularly in the elderly and in hospitalized patients. Therefore, appropriate measures should be taken if constipation occurs.
Doxepin should be used with caution in patients with impaired liver function or with a history of hepatic damage or blood dyscrasias. Periodic blood counts and liver function tests should be performed when patients receive doxepin in large doses or over prolonged periods.
Doxepin Overdose
Symptoms
Excessive drowsiness leading to minor alterations of consciousness and even unresponsiveness could be an early indication of excessive dosage. However, overdosage with doxepin is more likely to be manifested by increased psychomotor agitation and convulsions leading to apnea and coma. The ECG changes (broadening of QRS and T-wave abnormalities) tend to be a late finding and are not always accompanied by cardiovascular hemodynamic changes.
Treatment
In general, treatment of Doxepin overdosage should be symptomatic and supportive. Cardiac arrhythmias and CNS involvement pose the greatest threat with tricyclic antidepressant overdosage and may occur suddenly even when initial symptoms appear to be mild. Therefore, patients who may have ingested an overdosage of Doxepin, particularly children, should be hospitalized and kept under close surveillance.
Doxepin Dosage
The optimum daily dosage of Doxepin depends on the condition which is being treated and the response of the individual. Some patients respond promptly; others may not respond for 2 weeks or longer. An initial dosage of 25 mg 3 times daily may be used in most patients. This dosage should be increased as required by 25 mg increments at appropriate intervals until a therapeutic response is obtained. The usual optimum dosage range is 100 to 150 mg per day. In some patients, up to 300 mg per day may be required, but there is rarely any benefit to be obtained by increasing this dosage. In elderly patients it is advisable to proceed more cautiously with dosage increments and to initiate treatment with a lower dosage.
Once a satisfactory therapeutic response has been obtained, it is generally possible to reduce the dosage and still maintain this effect.
Doxepin Supplied
Each capsule contains: Doxepin HCl equivalent to 10, 25, 50, 75, 100 and 150 mg of Doxepin. Also contains cornstarch and magnesium stearate/sodium lauryl sulfate. Capsule shells also contain gelatin, sodium lauryl sulfate, sodium metabisulfate (25, 50, 75, 100 and 150 mg) and dyes FD & C Blue #1 (10, 25, 50, 100 and 150 mg), FD & C Red #2 (10 mg), FD & C Yellow #6 (10 mg), D & C Yellow #10 (10, 50, 75 and 100 mg) and FD & C Red #3. Tartrazine-free. Bottles of 100 and 500.
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