Generic Medicine Info
May be taken with or without food.
Mania, narrow-angle glaucoma, tendency to urinary retention. Severe liver impairment. Lactation. Concomitant use or within 14 days of discontinuing MAOIs.
Special Precautions
Patient with bipolar disorder; history of suicide-related events, epilepsy, risk factors of seizures (e.g. head trauma, brain damage, alcoholism), CV disease (e.g. recent MI, heart block, tachycardia, cardiac arrhythmia, conduction abnormalities), cerebrovascular disease, hypovolaemia, compromised respiratory function, sleep apnoea, decreased gastrointestinal motility, paralytic ileus, benign prostatic hyperplasia, xerostomia, visual problems, diabetes mellitus, hyperthyroidism. Patient undergoing elective surgery. Concomitant electroconvulsive therapy. Avoid abrupt withdrawal. Renal and mild to moderate hepatic impairment. Children and elderly. Pregnancy. CYP2D6 ultrarapid, intermediate and poor metabolisers. CYP2C19 ultrarapid, rapid and poor metabolisers. Patient Counselling This drug may cause drowsiness, if affected, do not drive or operate machinery. Topical: Avoid use of occlusive dressing. Monitoring Parameters Monitor ECG, heart rate and blood pressure in at risk patients; serum electrolytes (e.g. K, Na, magnesium), LFTs, blood glucose, weight and BMI at baseline, at periodic intervals and as clinically indicated. Closely monitor CNS status for signs of suicidal ideation, clinical worsening, and unusual behavioural changes especially at the start of therapy or when doses are increased or decreased; local skin reactions, excessive drowsiness or other systemic effects.
Adverse Reactions
Significant: Suicidal ideation and behaviour, precipitation of mania or hypomania, anticholinergic effects (e.g. constipation, dry mouth, blurred vision, urinary retention), CNS depression, bone fractures, mild pupillary dilation, orthostatic hypotension, QT prolongation, sleep-related activities (e.g. sleep-driving, cooking, eating or making phone calls while asleep), amnesia, hyponatraemia, syndrome of inappropriate antidiuretic hormone secretion (SIADH), withdrawal symptoms, contact sensitisation (topical). Blood and lymphatic system disorders: Rarely, eosinophilia, purpura, leucopenia, agranulocytosis, thrombocytopenia. Cardiac disorders: Tachycardia. Endocrine disorders: Extrapyramidal symptoms. Gastrointestinal disorders: Nausea, vomiting, indigestion, diarrhoea, taste disturbances. General disorders and administration site conditions: Fatigue, weakness, chills, facial oedema; application site reactions (e.g. burning, or stinging sensation, irritation). Immune system disorders: Urticaria. Investigations: Weight gain, increased or decreased blood sugar levels. Metabolism and nutrition disorders: Anorexia. Nervous system disorders: Drowsiness, tremors, paraesthesia, headache, dizziness. Rarely, convulsions. Psychiatric disorders: Insomnia, nightmares, confusion, disorientation, agitation. Reproductive system and breast disorders: Testicular swelling, gynecomastia. Respiratory, thoracic and mediastinal disorders: Nasopharyngitis. Skin and subcutaneous tissue disorders: Rash, sweating, pruritus, photosensitisation, alopecia. Vascular disorders: Flushing.
ROUTE(S) : Topical: B
Drug Interactions
Increased plasma concentrations with CYP2D6 inhibitors (e.g. quinidine, SSRIs). Increased risk of arrhythmias, hypo- or hypertension with anaesthetics, sympathomimetic agents (e.g. ephedrine, isoprenaline). May decrease antihypertensive effects of debrisoquine, bethanidine, guanethidine, clonidine. Increased rate of metabolism with barbiturates. Cimetidine may fluctuate steady-serum concentration of doxepin. May reduce effect of sublingual nitrates owing to dry mouth. Increased risk of severe hypoglycaemia with tolazamide.
CIMS Class
Antidepressants / Topical Antihistamines/Antipruritics
ATC Classification
D04AX01 - doxepin
N06AA12 - doxepin ; Belongs to the class of non-selective monoamine reuptake inhibitors. Used in the management of depression.
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