Doxepin Hcl (doxepin HCl)

Dosage of doxepin hydrochloride is expressed in terms of doxepin. There is a wide range of dosage requirements, and dosage must be carefully individualized. Initial dosages should be low and generally range from 30-150 mg daily, depending on the severity of the condition being treated. Dosage may be gradually adjusted to the level which produces maximal therapeutic effect with minimal toxicity and may range up to 300 mg daily. The manufacturers state that dosages exceeding 300 mg daily rarely produce additional therapeutic benefits. Hospitalized patients under close supervision may generally be given higher dosages than outpatients. Patients with very mild symptomatology or organic brain syndrome should usually be given lower than average dosages and may obtain satisfactory improvement with 25-50 mg of doxepin daily. The manufacturers state that appropriate dosage in geriatric patients should be selected with caution, usually initiating therapy at the low end of the dosage range since decreased hepatic, renal, or cardiac function occurs more frequently in these patients.

When doxepin is administered as a single daily dose, the maximum daily dose recommended by the manufacturers is 150 mg. Commercially available 150-mg capsules of doxepin are intended for maintenance therapy only and are not recommended for initial therapy. Maximum antidepressant effects may not occur for 2 or more weeks after therapy is begun, although anxiolytic effects may develop more rapidly.

After symptoms are controlled, dosage should be gradually reduced to the lowest level which will maintain relief of symptoms. To avoid the possibility of precipitating withdrawal symptoms, doxepin should not be terminated abruptly in patients who have received high dosages for prolonged periods.

Patients should be monitored for possible worsening of depression, suicidality, or unusual changes in behavior, especially at the beginning of therapy or during periods of dosage adjustment. (See Cautions: Precautions and Contraindications, in the Tricyclic Antidepressants General Statement 28:16.04.28.)

Doxepin hydrochloride is administered orally. Although doxepin has been administered in up to 3 divided doses throughout the day, it is long-acting and the entire daily dose may be administered at one time. Administration of the entire daily dose at bedtime may reduce daytime sedation.

Each dose of the oral concentrate should be diluted with approximately 120 mL of water, whole or skimmed milk, or orange, grapefruit, tomato, prune, or pineapple juice just prior to administration; the solution is physically incompatible with many carbonated beverages. For patients requiring doxepin therapy while on methadone maintenance, doxepin solution and methadone syrup can be mixed together with Gatorade(R), lemonade, orange juice, sugar water, Tang(R), or water, but not with grape juice. Bulk dilution and storage are not recommended by the manufacturers.

Doxepin is applied topically to the skin as an antipruritic. (See Doxepin Hydrochloride 84:08.)

No dosing information is available for this tab.

No dosing information is available for this tab.

There is no enhanced messaging for this drug.

There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

There are no moderate interactions for this drug.

There is no enhanced messaging for this drug.

There are no contraindication contraindications for this drug.

There are no severe contraindications for this drug.

There are no moderate contraindications for this drug.

There is no enhanced messaging for this drug.

There are no severe adverse reactions for this drug.

There are no less severe adverse reactions for this drug.

No enhanced messaging available.

No enhanced messaging available.

No enhanced messaging available.

Limited data indicate that doxepin and its active N-demethylated metabolite are distributed into milk. Sedation and serious respiratory depression were reported in a nursing infant whose mother was receiving 75 mg of doxepin daily; substantial concentrations of the active metabolite of the drug were detected in the infant's serum and urine. In addition, poor sucking and swallowing while nursing, drowsiness, muscle hypotonia, and vomiting were reported in a nursing infant whose mother was receiving 35 mg of doxepin daily. Because of the potential for serious adverse reactions to doxepin and/or its active metabolite in nursing infants, a decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the woman.

No enhanced messaging available.