Apo-Doxepin

Brand Names: Apo-Doxepin

Common Name: doxepin HCl

What is this drug used for?

Doxepin belongs to the family of medications known as tricyclic antidepressants. It is used to treat depression, especially when anxiety is one of the symptoms. Doxepin is also used to treat people with alcoholism who also have anxiety or depression.

Tricyclic antidepressants work by increasing the amount of norepinephrine and serotonin neurotransmitters available in certain parts of the brain.

Your doctor may choose to use a medication for conditions other than the ones listed in these drug information articles. If you're unsure why you are taking this medication, contact your doctor.

Is there any reason not to take this drug?

Doxepin should not be taken by anyone who:

• is allergic to doxepin or any of the ingredients of the medication or any other dibenzoxepin compounds
• has glaucoma or increased eye pressure
• has urinary retention
• has just had a heart attack
• has acute congestive heart failure
• has blood disorders
• has severe liver disease
• has taken a MAO inhibitor (e.g., phenelzine, tranylcypromine) within the last 14 days
• is a child

What about possible side effects?

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor. Your health professional may be able to help you deal with some of the effects.

The following side effects may go away as your body becomes used to the medicine; check with your doctor if they continue or become bothersome.

More common:

• dizziness
• drowsiness
• dryness of mouth
• increased appetite (may include craving for sweets)
• nausea
• tiredness or weakness (mild)
• unpleasant taste in mouth
• weight gain

  Less common:

• diarrhea
• headache
• heartburn
• increased sweating
• trouble sleeping
• vomiting

Check with your doctor as soon as possible if any of the following side effects occur:

Less common:

• blurred vision
• confusion or delirium
• constipation (especially for seniors)
• decreased sexual ability
• difficulty speaking or swallowing
• eye pain
• fainting
• fast or irregular heartbeat (pounding, racing, skipping)
• hallucinations
• loss of balance control
• nervousness or restlessness
• numbness or tingling sensation in arms and legs
• problems urinating
• shakiness or trembling
• shuffling walk
• slowed movements
• stiffness of arms and legs

  Rare:

• anxiety
• breast enlargement (both males and females)
• hair loss
• inappropriate secretion of milk (females)
• increased sensitivity to sunlight
• irritability
• muscle twitching
• red or brownish spots on skin
• ringing, buzzing, or other unexplained sounds in the ears
• seizures
• skin rash and itching
• sore throat and fever
• swelling of face and tongue
• swelling of testicles
• trouble with teeth or gums
• weakness
• yellow eyes or skin

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

What if I am taking other drugs?

The following medications may affect how doxepin works or increase the risk of side effects:

• alcohol
• anticholinergic medications (e.g., atropine)
• barbiturates (e.g., phenobarbital)
• carbamazepine
• benzodiazepines (e.g., diazepam, lorazepam)
• cimetidine
• quinidine
• MAO inhibitors (e.g., phenelzine, moclobemide)
• methyldopa
• metoclopramide
• methylphenidate
• phenothiazines (e.g., chlorpromazine)
• pimozide
• propoxyphene
• SSRI antidepressants (e.g., fluoxetine, fluvoxamine)

Doxepin may affect how the following medications work:

• amphetamines
• guanethidine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. In many cases, interactions are intended or are managed by close monitoring. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than the ones listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Other information:

Heart disease: Tricyclic antidepressant drugs such as doxepin can cause abnormal heart rhythms, particularly when taken in high doses. Doxepin should be taken with caution by seniors as well as those who have a history of heart disease.

Liver function: Doxepin should be taken with caution by people with reduced liver function.

Mania: Doxepin may induce mania in people with a history of mania or bipolar disorder.

Occupational hazards: Since doxepin may cause drowsiness, avoid driving or engaging in activities requiring mental alertness and physical coordination until you determine your response to the medication.

Seizures: Doxepin should be taken with caution by anyone who has previously had seizures.

Withdrawal: Stopping doxepin treatment after having taken it for a long period of time may produce nausea, headache, and malaise. These symptoms are not indicative of addiction. Do not stop taking doxepin suddenly without first talking with your doctor.

Pregnancy: The safety of doxepin use during pregnancy has not been established. It should not be used by women who are or may become pregnant unless, in the opinion of their doctor, the potential benefits outweigh the possible risks.

Breast-feeding: The safety of doxepin use while breast-feeding has not been established. It should not be used by nursing women unless, in the opinion of their doctor, the potential benefits outweigh the possible risks.

Children: This medication is not recommended for use by children, as its safety and efficacy have not been established for this age group.

Special Instructions:

The recommended adult daily dose of doxepin ranges from 75 mg to 300 mg in three divided doses. The usual starting dose is 25 mg three times daily. The total dose can be taken at bedtime once the final dose is reached. Lower doses may be used by seniors.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be taken exactly as prescribed by the doctor. If you miss a dose, take it as soon as possible and continue on with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue on with your regular dosing schedule. Do not double doses.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

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