Doxepin

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Doxepin belongs to a group of medicines called tricyclic antidepressants. It has a calming effect and reduces mental and physical activity. When taken for a long time, Doxepin brightens the mood. That is why the active ingredient is used, among other things, for depressive illnesses, states of anxiety and restlessness as well as for sleep disorders. Here you can read everything you need to know about Doxepin.

This is how Doxepin works

Doxepin belongs to the group of tricyclic antidepressants. It has a mood-enhancing (antidepressant), anxiolytic (anxiolytic) and calming (sedative) effect.

The way Doxepin works is complex and not yet fully understood. We know that the active ingredient influences the metabolism of messenger substances in the brain. Above all, Doxepin prevents the messenger substances norepinephrine and serotonin ("happiness hormone") from being inactivated so that they can develop their effect for longer. In this way, the severity and duration of a depressive phase or anxiety disorder are positively influenced.

In addition to noradrenaline and serotonin, the active ingredient influences numerous other messenger substances and their binding sites (receptors). This diverse mode of action is also held responsible for any side effects of Doxepin.

Uptake, breakdown and excretion

Doxepin is given by mouth and is well absorbed into the body through the gastrointestinal tract. Part of the active ingredient is immediately converted in the liver into desmethyldoxepine, which is also effective.

Both active ingredients - doxepin and desmethyldoxepin - are easily soluble in fat and therefore reach the brain quickly. They are eventually broken down by the liver and then excreted in the urine and stool.

When is Doxepin used?

The areas of application (indications) of Doxepin are:

depressive illnesses
Anxiety syndromes
mild withdrawal symptoms from alcohol, drug or drug addiction
Restlessness, anxiety and sleep disorders in connection with depressive illnesses or mild withdrawal symptoms

While the mood-enhancing effect of Doxepin only sets in a few days to weeks after the start of treatment, the calming and sleep-promoting effect is evident from the first ingestion.

This is how doxepin is used

Doxepin tablets or capsules are swallowed whole with a glass of water before or after a meal or in the evening before going to bed. There is also an oral Doxepin solution for patients with swallowing problems.

For depressive illnesses and anxiety states, treatment is started with an intake in the evening; then the dose is gradually increased. To avoid a relapse, therapy with Doxepin should be continued for several months after the symptoms have subsided.

Doxepin is often given three times a day to treat withdrawal symptoms caused by alcohol, drug or drug addiction.

If a sleep-promoting effect is desired, the larger partial dose should be taken at night.

In elderly patients, lower doses of doxepin are often sufficient to achieve the desired treatment effect. This also reduces the risk of side effects.

In order to end the therapy with Doxepin, the dosage is slowly reduced ("tapering off"). This prevents withdrawal symptoms such as restlessness, sleep disorders, sweating, nausea and vomiting.

What are the side effects of Doxepin?

The most common Doxepin side effects are dry mouth, dry nose, disturbance of near-far adjustment of the eyes, sweating, tiredness, drowsiness, dizziness, low blood pressure, rapid heartbeat, irregular heartbeat, tremor (tremors), constipation, increase in liver enzyme activity and weight gain . These side effects occur in more than ten percent of patients.

One to ten percent of patients experience allergic skin reactions, itching, feeling thirsty, urination disorders, internal restlessness, states of confusion, loss of libido and / or impotence.

Doxepin can make you less responsive. As a result, your ability to drive and work with machines may be impaired during treatment.

Doxepin can make you less responsive (especially at the beginning of treatment). As a result, your ability to drive and work with machines may be impaired during treatment.

What should be considered when taking Doxepin?

Contraindications

Doxepin must not be used in the following cases:

Hypersensitivity to doxepin or related active substances (other dibenzoxepines)
acute delirium
acute urinary retention (inability to urinate)
Intestinal paralysis (paralytic ileus)

Interactions

If Doxepin and a large number of other active substances are taken at the same time, there may be interactions. Therefore, it is important for a patient to inform the prescribing physician of all medicines, including those that do not require a prescription, that they are taking.

Doxepin should not be taken together with other central depressant drugs, as they can mutually increase their effects. These include active ingredients that are used against depression, mental disorders or epilepsy.

Sleeping pills and sedatives, morphine-like painkillers, certain drugs against allergies (H1 antihistamines) and alcohol also have a central depressant effect and should therefore be avoided during treatment.

Doxepin must never be taken together with certain other antidepressants (monoamine oxidase inhibitors = MAO inhibitors), as this can lead to serious side effects.

Droperidol (medicine against nausea and vomiting after operations) must not be taken together with Doxepin, as this increases the risk of palpitations. The same applies to pimozide and sertindole, two active ingredients against psychoses.

Simultaneous administration of drugs against cardiac arrhythmias (amiodarone and quinidine) or against malaria (lumefantrine), of certain antibiotics or antihistamines (allergy drugs) can trigger increased cardiac arrhythmias.

Doxepin enhances the effect of sympathomimetics. These are active ingredients that have a stimulating effect on the part of the nervous system that is responsible for vital functions such as heartbeat, blood pressure and breathing. Examples of such active ingredients are adrenaline, etilefrine, dopamine and pseudoephedrine.

Doxepin can reduce the antihypertensive effects of certain antihypertensive agents (clonidine, reserpine, α-methyldopa and guanethidine). On the other hand, taking other high blood pressure drugs (such as beta blockers) or drugs at the same time may increase the antihypertensive effect.

Simultaneous treatment with cimetidine (a medicine for gastrointestinal disorders) can increase the side effects of doxepin.

Age restriction

Doxepin is approved for ages twelve and up. However, use between the ages of 12 and 18 is not recommended due to a lack of data on the effectiveness and safety of the treatment.

pregnancy and breast feeding period

Doxepin should not be taken during pregnancy as there is insufficient experience with it. Other active ingredients such as citalopram, sertraline and amitriptyline should be given preference here.

Since Doxepin passes into breast milk and can cause undesirable effects in infants, breastfeeding mothers should stop breastfeeding before starting treatment.

How to get medication with doxepin

Preparations with Doxepin require a prescription in Germany and are only available with a prescription in pharmacies. The active ingredient is not on the market in Austria or Switzerland.

How long has Doxepin been known?

Doxepin came on the market in 1970. It is derived from the tricyclic antidepressant imipramine, the mood-enhancing effect of which was discovered by the Swiss psychiatrist Roland Kuhn in 1957.

What else you should know about doxepin

Doxepin can significantly increase the skin's sensitivity to light, so that even short-term sun exposure can lead to sunburn-like skin reactions. Therefore, you should avoid exposure to the sun during treatment with Doxepin or ensure good protection from light.

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