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Doxepin (daak·suh·pn) belongs to a class of drugs called tricyclic antidepressants (TCAs). This class of drugs affects the brain chemicals serotonin and norepinephrine.
Tricyclic antidepressants manage and treat clinical depression, also known as major depressive disorder (MDD).
Doxepin is only available with a doctor’s prescription.
Doxepin is available in the following forms:
Capsules (the oral capsule form only comes as a generic drug)
Tablets (brand name Silenor)
Oral Concentrate (generic drug)
Topical Cream (brand name Prudoxin)
Doxepin is used mainly to treat depression and anxiety.
It is also used in low doses to treat insomnia (disordered sleep).
The topical form of doxepin is sometimes prescribed short-term in low doses to relieve itching and various forms of dermatitis (skin inflammation) because it works as an antihistamine.
Take doxepin exactly as prescribed by your doctor. Do not start or stop taking doxepin without consulting with your doctor. Do not take more or less than your prescribed dosage.
When used orally, doxepin can be taken with or without food.
For those with mild conditions, doxepin may be prescribed at 25–50mg per day.
The maximum dose is 150mg daily.
A maintenance dose of doxepin is usually 75–150mg, once a day. The 150mg form is unsuitable for initial treatment (that level is intended for maintenance therapy only). Your doctor will inform you if and when it is suitable to make any changes to your medication. For the treatment of insomnia in adults, an initial dose ranges from 3–6mg, once a day. The maximum dose is 6mg a day.
Using doxepin for the treatment of depression and anxiety is not recommended for children. The suitability of doxepin for the treatment of insomnia in children should be determined only by a doctor.
Doxepin liquid solution should be taken using the dropper (pipette) provided. It will be clearly marked to assist you with measuring the correct amount. Get one at your local pharmacy if a dropper isn’t included with your medication. A common household spoon is not accurate enough for measuring doxepin.
Dilute your liquid doxepin solution in 120ml (4 oz.) of water, milk, or juice before taking it. Do not add doxepin to carbonated drinks.
Only dilute and mix this solution directly before taking it. Do not prepare it ahead of time.
The tablet should not be taken within three hours of a meal. Otherwise, it may not work properly. In addition, it may make you drowsy, so it should be taken approximately 30 minutes before sleeping.
When taking the tablet form, plan on having a full night’s sleep as the medication may make you feel sedated if you wake up too soon.
When doxepin starts to work depends on the condition being treated. For the treatment of depression, symptoms may start to improve after two to three weeks of taking doxepin. For the treatment of anxiety, results may be sooner.
Remember that even if you are feeling well, you should not stop taking doxepin without direction from your prescribing doctor.
Several side effects may occur while taking doxepin. Common side effects include:
Changes in food taste
Increased or decreased sex drive
Increase in breast size
Yellowing of the eyes or skin
Unusual bruising or bleeding
Worsening depression with the following symptoms:
Worsened or new symptoms of anxiety
Agitated or restless feelings
Aggressive, violent, or angry actions
Acting on dangerous impulses
Mania (an extreme increase in talking and activity)
Other mood or behavioral changes
Incomplete bladder emptying
Sudden urge to urinate
Bloating or pain in the lower belly
Allergic reactions with the following symptoms:
Swelling of the face, throat, or tongue
These side effects are severe, and most require immediate medical attention. Contact your doctor or seek medical attention immediately if you experience these side effects.
Prolonged use of low-dose doxepin is generally safe, as long as you follow your doctor’s prescribed dosage.
Never take a double dose of doxepin to make up for a missed one. Consider setting a reminder to help you remember to take doxepin on schedule.
Symptoms of doxepin overdose can include the following:
Convulsions or seizures
Increase in pupil size
Lower than usual body temperature
Slow or shallow breathing
Even if some of these symptoms aren’t causing you immediate distress, they could indicate doxepin toxicity. Seek medical attention or call 911 immediately.
Before taking doxepin, these are some essential topics to discuss with your doctor:
Allergies you have or past allergic reactions to medications (especially doxepin).
Medications you currently take (prescribed or non-prescribed), including vitamins and supplements.
If you have taken monoamine oxidase inhibitors (MAOIs) in the past 14 days.
Other medical conditions particularly: bipolar disorder, glaucoma, and urinary problems.
Whether you are pregnant or trying to get pregnant.
Whether you are currently breastfeeding or planning to breastfeed.
Upcoming medical or dental procedures (or plans to have one).
Whether or not you consume alcohol, how much, and how frequently.
Do not suddenly stop taking doxepin without your doctor’s instruction to do so. The risk of withdrawal symptoms is higher in patients that have been using doxepin long-term.
Withdrawal symptoms may include:
Irritability or agitation
If you have concerns about continuing your use of doxepin, talk to your doctor. If they advise you to stop taking doxepin, they will likely prescribe you a gradually decreased dosage to help reduce or avoid withdrawal symptoms.
Doxepin for treatment of depression falls under US FDA pregnancy Category B. Reproductive studies of doxepin in animals did not show a risk to the fetus. However, there are no well-controlled human studies yet.
Taking doxepin while breastfeeding is not recommended. Doxepin is known to pass into breast milk and may cause unwanted effects on the nursing infant.
The use of doxepin is only recommended when the benefits outweigh the possible risks.
Doxepin can interact with both prescription and nonprescription drugs, as well as herbal supplements. These interactions can change how doxepin works, increasing the risk of side effects or preventing doxepin from working properly.
To reduce the possibility of dangerous interactions talk to your doctor about any medications you currently take (or might take) while on doxepin.
MAO inhibitors used to treat clinical depression or Parkinson’s disease, such as selegiline (Eldepryl, Emsam), phenelzine (Nardil), and isocarboxazid (Marplan, Marplon, Enerzer) should not be taken with doxepin. Together they overload the brain with serotonin, which can cause psychosis or even be fatal.
The drug cimetidine (Tagamet) can increase the amount of doxepin in the body.
Fluconazole (Diflucan), voriconazole (Vfend), and terbinafine (Lamisil) can increase the amount of doxepin in the body.
Quinidine (Cardioquin, Quinaglute) and dronedarone (Multaq) can have the opposite of the desired effect and increase irregular heartbeat symptoms.
Chronic kidney disease drugs like cinacalcet (Sensipar) increase the amount of doxepin in the body.
Combining tolazamide (generic) for type 2 diabetes while on doxepin can cause dangerously low blood sugar levels.
Drinking alcohol while taking doxepin can increase feelings of confusion or drowsiness.
Severe allergic reaction, also known as anaphylaxis is a possibility for those who take doxepin.
Symptoms of anaphylaxis include:
Swelling of the face and lips
Elevated heart rate
If you experience symptoms of a severe allergic reaction, seek immediate medical attention or call 911.
Doxepin gained US FDA approval in 1969 for the treatment of major depressive disorder (MDD).
After six controlled trials, low-dose doxepin was approved to treat insomnia in 2010.
Doxepin is not yet approved for the treatment of migraines or nerve pain, but it is sometimes prescribed off-label (therapeutically).
Avoid alcohol while on doxepin. Consuming alcohol can increase your risk of side effects.
Doxepin can make you drowsy. Avoid driving, using machinery, or doing activities that require full attention.
Doxepin may cause sun sensitivity (photosensitivity) so it is imperative to take protective measures to prevent burning, such as wearing sunscreen every day and avoiding direct exposure or tanning.
As with all medication, keep doxepin stored safely away from children.
Not all pharmacies stock doxepin. Call ahead if you need to refill your prescription.
Doxepin | Rx List
Doxepin capsules or oral solution | Good Rx
Doxepin (capsules, oral concentrate) | Drugs.com
Doxepin (Depression, anxiety) | MedlinePlus
Doxepin, oral capsule | Healthline
Doxepin (Oral route) | Mayo Clinic
Doxepin overdose | Mount Sinai
What is doxepin Hcl: Uses, warnings & interactions | Single Care
Sinequan (Doxepin) withdrawal and detox | The Recovery Village
Doxepin | StatPearls
Here at HealthMatch, we’ve done our best to ensure that the information provided in this article is helpful, up to date, and, most importantly, accurate.
However, we can’t replace the one-to-one advice of a qualified medical practitioner or outline all of the possible risks associated with this particular drug and your circumstances.
It is therefore important for you to note that the information contained in this article does not constitute professional medical or healthcare advice, diagnosis or recommendation of treatment and is not intended to, nor should be used to, replace professional medical advice. This article may not always be up to date and is not exhaustive of all of the risks and considerations relevant to this particular drug. In no circumstances should this article be relied upon without independent consideration and confirmation by a qualified medical practitioner.
Your doctor will be able to explain all possible uses, dosages, precautions, interactions with other drugs, and other potential adverse effects, and you should always talk to them about any kind of medication you are taking, thinking about taking or wanting to stop taking.
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