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Doxepin Medication: Uses, Dosage, Side Effects & More
Summary of Key Points
Doxepin is a prescription medication used to treat depression, anxiety, insomnia, and certain skin conditions. It belongs to a class of drugs known as tricyclic antidepressants (TCAs), which work by balancing chemicals in the brain. Doxepin can also help manage chronic pain and allergic reactions. Always consult your healthcare provider before starting or adjusting your dose. Our telemedicine providers are available to assist you with any questions or concerns.
Names of Medication
US Brand Names: Silenor, Zonalon
Generic Name: Doxepin
The generic name, Doxepin, refers to the active ingredient, regardless of the brand name under which it is sold.
Pharmacologic Category
Tricyclic Antidepressants (TCAs)
Antihistamines (for topical use)
Doxepin Dosage and Uses
Doxepin is prescribed for a variety of conditions, with the dosage and frequency tailored to the specific condition being treated. Always follow your healthcare provider’s instructions and consult them before making any changes to your treatment plan. Our telemedicine providers are available to assist you if needed.
Doxepin for Depression
The typical starting dose is 25-50 mg once daily, usually taken at bedtime. Depending on your response, the dose may be gradually increased to a maximum of 300 mg per day.
Doxepin for Anxiety
The usual dose is 25-50 mg once daily, typically at bedtime. Your doctor may adjust the dose based on your symptoms and how well you tolerate the medication.
Doxepin for Sleep Disorders (Insomnia)
For insomnia, the recommended dose is 3-6 mg once daily, taken approximately 30 minutes before bedtime.
Doxepin for Chronic Pain
Doxepin may be prescribed at doses ranging from 25-75 mg per day, depending on the severity of your pain and your response to treatment.
Doxepin for Allergic Rhinitis
The typical dose for allergic rhinitis is 10-25 mg once daily, depending on the severity of your symptoms.
Doxepin for Eczema and Psoriasis (Topical Use)
For skin conditions like eczema and psoriasis, apply a thin layer of the 5% cream to the affected area up to four times daily, as directed by your healthcare provider.
Doxepin for Fibromyalgia
The usual dose for fibromyalgia is 10-25 mg once daily, typically taken at bedtime. Your doctor may adjust the dose based on your symptoms and how well you respond to the treatment.
Doxepin for Post-traumatic Stress Disorder (PTSD)
The typical dose for PTSD is 25-50 mg once daily, usually taken at bedtime. Your doctor may adjust the dose as needed to manage your symptoms effectively.
Doxepin for Generalized Anxiety Disorder (GAD)
The usual dose for GAD is 25-50 mg once daily, typically at bedtime. The dose may be increased if necessary, depending on your response to the medication.
Dosage Forms and Strengths
Capsules: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg
Tablets (for insomnia): 3 mg, 6 mg
Topical Cream: 5% strength
Oral Solution: 10 mg/mL
Administration Instructions for Doxepin
Doxepin should be taken exactly as prescribed by your healthcare provider. Oral forms are typically taken once daily, usually at bedtime, to minimize daytime drowsiness. For the topical cream, apply a thin layer to the affected skin as directed. Be sure to avoid contact with your eyes, and wash your hands thoroughly after application. Do not stop taking Doxepin suddenly without consulting your doctor, as this may lead to withdrawal symptoms.
Doxepin Side Effects and Adverse Reactions
Like all medications, Doxepin can cause side effects. Some are common and mild, while others are rare but more serious. If you experience any severe side effects, contact your healthcare provider immediately. Our telemedicine providers are also available to help manage any concerns you may have.
Common Doxepin Side Effects
Common side effects include drowsiness, dry mouth, dizziness, blurred vision, and constipation. These effects are usually mild and may improve as your body adjusts to the medication.
Less Common Side Effects
Less common side effects include weight gain, difficulty urinating, low blood pressure, and an increased heart rate.
Serious Side Effects (Rare)
Serious side effects are rare but may include severe allergic reactions (such as rash, itching, or swelling), mood changes, confusion, hallucinations, seizures, or an irregular heartbeat. Seek medical attention immediately if you experience any of these symptoms.
Contraindications for Doxepin
Contraindications are specific conditions where a medication should not be used due to potential harm. Before starting Doxepin, ensure that none of the following apply to you, as they may make the medication unsafe.
Allergy to Doxepin or Other Tricyclic Antidepressants
If you are allergic to Doxepin or similar medications, taking it could trigger a severe allergic reaction, which may include symptoms like rash, swelling, or difficulty breathing.
Untreated Narrow-Angle Glaucoma
Doxepin can increase pressure in the eyes, potentially worsening this condition and leading to vision loss.
Urinary Retention
Doxepin may make it more difficult to urinate, which can be dangerous if you already have trouble emptying your bladder.
Recent Heart Attack (Myocardial Infarction)
Doxepin can affect heart rhythm and blood pressure, increasing the risk of complications after a heart attack.
Use of Monoamine Oxidase Inhibitors (MAOIs)
Taking Doxepin with MAOIs (a type of antidepressant) can cause a dangerous interaction, leading to high blood pressure and other severe side effects. You must wait at least 14 days after stopping an MAOI before starting Doxepin.
Doxepin Interactions with Other Medications
Doxepin can interact with other medications, increasing the risk of side effects or reducing the effectiveness of your treatment. Be sure to inform your healthcare provider about all medications you are taking, including over-the-counter drugs and supplements. Some common medications that may interact with Doxepin include:
Fluoxetine (Prozac)
Combining these medications may increase the risk of serotonin syndrome, a potentially life-threatening condition.
Cimetidine (Tagamet)
This medication can increase the levels of Doxepin in your body, raising the risk of side effects.
Clonidine (Catapres)
Doxepin may reduce the effectiveness of Clonidine, which is used to treat high blood pressure.
Warfarin (Coumadin)
Doxepin may increase the effects of blood thinners like Warfarin, raising the risk of bleeding.
Diazepam (Valium)
Taking Doxepin with sedatives like Diazepam can increase drowsiness and impair your ability to think clearly.
Doxepin in Pregnancy
Is it safe to take Doxepin during pregnancy?
Doxepin is classified as a Category C medication for use during pregnancy. This means that there is not enough research to definitively confirm its safety for pregnant women. While animal studies have shown potential risks to the fetus, there are no well-controlled studies in humans. If you are pregnant or planning to become pregnant, it is important to discuss the potential risks and benefits of Doxepin with your healthcare provider. They may recommend alternative treatments based on your individual needs and circumstances.
Doxepin while Breastfeeding
Is it safe to take Doxepin while breastfeeding?
Doxepin can pass into breast milk and may affect a nursing infant. Some reports have noted drowsiness, poor feeding, and breathing difficulties in infants exposed to Doxepin through breast milk. If you are breastfeeding, it is essential to consult your healthcare provider to determine whether Doxepin is the best option for you. They may suggest alternative treatments or advise you to closely monitor your baby for any potential side effects.
Estimated Cost of Doxepin Medication
The cost of a 30-day supply of Doxepin without insurance can vary depending on the pharmacy and dosage. With a GoodRx coupon, the estimated price for a 30-day supply of generic Doxepin (10 mg) typically ranges from $10 to $15. Prices may be higher for brand-name versions or higher dosages. It is always a good idea to check with your pharmacy for the most accurate pricing information.
Possible Alternatives to Doxepin
If Doxepin is not suitable for you, there are several alternative treatments and lifestyle changes that may help manage your condition. Always consult your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine appointment with one of our providers to explore these alternatives.
Depression: Other antidepressants, such as Sertraline (Zoloft) or Escitalopram (Lexapro), may be considered. Cognitive-behavioral therapy (CBT) and regular physical activity can also be effective in managing depression.
Anxiety: Medications like Buspirone (Buspar) or Benzodiazepines (e.g., Lorazepam/Ativan) may be alternatives. Mindfulness practices and therapy can also help alleviate anxiety symptoms.
Insomnia: Non-medication options, such as improving sleep hygiene, cognitive-behavioral therapy for insomnia (CBT-I), or melatonin supplements, may be beneficial. Medications like Trazodone or Zolpidem (Ambien) could also be considered.
Chronic pain: Alternatives include medications like Gabapentin (Neurontin) or Duloxetine (Cymbalta). Physical therapy and acupuncture may also provide relief.
Allergic rhinitis: Antihistamines like Loratadine (Claritin) or nasal corticosteroids such as Fluticasone (Flonase) may be more appropriate options.
Eczema: Topical corticosteroids or calcineurin inhibitors like Tacrolimus (Protopic) may be used. Regular moisturizing and avoiding known triggers can help manage symptoms.
Psoriasis: Treatments such as topical Vitamin D analogs or biologics like Adalimumab (Humira) may be considered. Light therapy is another option for some patients.
Fibromyalgia: Medications like Pregabalin (Lyrica) or Duloxetine (Cymbalta) may help. Regular exercise and stress management techniques are also beneficial.
Post-traumatic stress disorder (PTSD): Selective serotonin reuptake inhibitors (SSRIs) like Sertraline (Zoloft) or Paroxetine (Paxil) are commonly used. Therapy, particularly trauma-focused cognitive-behavioral therapy (CBT), is highly effective.
Generalized anxiety disorder (GAD): SSRIs like Escitalopram (Lexapro) or SNRIs like Venlafaxine (Effexor) may be alternatives. Relaxation techniques and therapy can also help manage symptoms.
Recent Updates on Doxepin Research
Recent studies have explored the use of low-dose Doxepin for treating insomnia, with promising results. Research suggests that doses as low as 3 mg to 6 mg can improve sleep without causing significant next-day drowsiness. This has led to the approval of low-dose Doxepin (Silenor) specifically for insomnia treatment. Additionally, ongoing studies are examining Doxepin’s potential benefits in treating chronic pain conditions, such as fibromyalgia, due to its effects on mood and pain perception.
As research continues, staying informed about new findings is essential. If you have questions about how these updates may affect your treatment, consider scheduling a telemedicine appointment with one of our providers for personalized advice.
