Doxepin

Generic Name: Doxepin
Brand Name: Sinequan

Indications
Sinequan is recommended for the treatment of:

• Psychoneurotic patients with depression and/or anxiety.
• Depression and/or anxiety associated with alcoholism (not to be taken concomitantly with alcohol).
• Depression and/or anxiety associated with organic disease (the possibility of drug interaction should be considered if the patient is receiving other drugs concomitantly).
• Psychotic depressive disorders with associated anxiety including involutional depression and manic-depressive disorders.

Dosage and Administration
Sinequan is available for oral administration 10mg, 25mg, 50mg, 75mg, 100mg and 150mg capsules. Sinequan Oral Concentrate is available in 120 mL bottles with an accompanying dropper calibrated at 5 mg, 10 mg, 15 mg, 20 mg, and 25 mg.

Normal Dosage:
For most patients with illness of mild to moderate severity, a starting daily dose of 75 mg is recommended. Dosage may subsequently be increased or decreased at appropriate intervals and according to individual response. The usual optimum dose range is 75 mg/day to 150 mg/day.
In more severely ill patients higher doses may be required with subsequent gradual increase to 300 mg/day if necessary. Additional therapeutic effect is rarely to be obtained by exceeding a dose of 300 mg/day.
In patients with very mild symptomatology or emotional symptoms accompanying organic disease, lower doses may suffice. Some of these patients have been controlled on doses as low as 25 - 50 mg/day.
The total daily dosage of SINEQUAN may be given on a divided or once-a-day dosage schedule. If the once-a-day schedule is employed, the maximum recommended dose is 150 mg/day. This dose may be given at bedtime. The 150 mg capsule strength is intended for maintenance therapy only and is not recommended for initiation of treatment.

Overdose: Overdose symptoms may include uneven heartbeats, extreme drowsiness, agitation, vomiting, blurred vision, confusion, hallucinations, feeling hot or cold, muscle stiffness, feeling light-headed, fainting, seizure (convulsions), or coma.

Drug Description
Sinequan (doxepin hydrochloride) is one of a class of psychotherapeutic agents known as dibenzoxepin tricyclic compounds. The molecular formula of the compound is C19H21NO•HCl having a molecular weight of 316. It is a white crystalline solid readily soluble in water, lower alcohols and chloroform.
Sinequan (doxepin HCl) is a dibenzoxepin derivative and is the first of a family of tricyclic psychotherapeutic agents. Specifically, it is an isomeric mixture of:
1-Propanamine, 3-dibenz [b, e] oxepin-11(6H) ylidene-N, N-dimethyl-, hydrochloride.

Side Effects
The most commonly encountered side effects associated with doxepin include rapid heart rate, blurred vision, urinary retention (difficulty urinating), dry mouth, constipation, weight gain or loss, and low blood pressure when going from sitting to standing orthostatic hypotension). Rash, hives, seizures, and hepatitis are rare side effects. Doxepin also can cause elevated pressure in the eyes of some patients with glaucoma. Overdose with doxepin can cause life threatening abnormal 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."

Precautions

• Avoid drinking alcohol. It can cause dangerous side effects when taken together with doxepin.
• Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures or anxiety can add to sleepiness caused by doxepin. Tell your doctor if you regularly use any of these medicines, or any other antidepressant.
• Doxepin can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
• Do not use this medication if you are allergic to doxepin, or if you have glaucoma or problems with urination.
• Do not use doxepin if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take doxepin before the MAO inhibitor has cleared from your body.
• Before taking doxepin, tell your doctor if you are allergic to any drugs, or if you have:
• bipolar disorder (manic-depression); or
• diabetes (doxepin may raise or lower blood sugar).
• You may have thoughts about suicide while taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.
• Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Drug Interactions

• Before taking doxepin, tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft).
• Before taking doxepin, tell your doctor if you are currently using any of the following drugs: cimetidine (Tagamet) or heart rhythm medications such as flecainide (Tambocor), propafenone (Rhythmol), or quinidine (Cardioquin, Quinidex, Quinaglute)

Accolate
Accupril
Aciphex
Actonel
Actos
Advair
Agenerase
Alesse
Allegra D
Altace
Amaryl
Ansaid
Arava
Atrovent
Avandamet
Avandia
Avapro
Azopt
Baclofen
Benoxyl
Betagan
Betaxolol
Boniva
Bumex
BuSpar
Cafergot
Captopril
Cardizem
Cardura
Casodex
Celebrex
Celexa
Cellcept
Cialis
Cimetidine
Cipro
Claritin
Cotazym
Cozaar
Daypro
Depen
Detrol
Diovan
Doxepin
Effexor
Elavil
Eltroxin
Etidronate
Evista
Exelon
Famotidine
Famvir
Feldene
Femara
Fenofibrate
Flexeril
Flomax
Flonase
Florinef
Floxin
Fosamax
Gabapentin
Glyburide
Gonal
Halog
Humatin
Hydralazine

Hydrea
Hytrin
Hyzaar
Imdur
Imipramine
Imitrex
Isoptin
Keppra
Ketorolac
Labetalol
Lamictal
Lamisil
Lanoxin
Lescol
Levitra
Levsin
Lipitor
Lopid
Lotensi
Macrobid
Maxalt
Metformin
Metoprolol
Mevacor
Minocin
Naproxen
Nexium
Norvasc
Paroxetine
Pentasa
Permax
Plaquenil
Plavix
Plendil
Pravachol
Prazosin
Premarin
Prevacid
Prinivil
Procan
Propanolol
Propecia
Protonix
Questran
Quibron
Qvar
Razadyne
Relafen
Remeron
Requip
Rifadin
Rythmol
Septra
Singulair
Synthroid
Tambocor
Tazorac
Topamax
Vasotec
Viagra
Wellburtin
Xenical
Yohimbine
Zestril
Zetia
Zocor
Zoloft