Doxepin

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Side Effects

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Doxepin originally sold as Sinequan functions as an antihistamine and a tricyclic antidepressant depending on the dose. Small amounts may treat insomnia and itch while larger amounts provide relief for anxiety and depression. Off label, doxepin may prevent recurrences of migraine headache, control symptoms of irritable bowel and assist in treatment of chronic hives.

Approved in the late 1960s, doxepin has largely been supplanted by SSRIs, SNRIs and other classes of medicines for treatment of depression. All of the approved antidepressants offer approximately the same degree of relief from symptoms. The choice between agents relates to the side effect profile, doctor familiarity with the drug and unfortunately drug company advertising.

The initial dose of doxepin for depression is 75 mg at bedtime. Fatty meals delay absorption by about 3 hours but decrease clearance from the bloodstream by 40%. After several weeks, the dose may be adjusted to as high as 150 mg either at one time or in divided doses. Some will do well with a lower dose.

For sleep, as little as 1 mg may suffice although the recommended dose is up to 25 mg. Silenor, a brand name drug, provides doxepin in either 3 mg or 6 mg tablets. Unfortunately the price is exorbitant compared to the generic drug. Generic doxepin is available in capsules with as little as 10 mg or 25 mg and the liquid suspension contains 10 mg in each milliliter. This allows a more economical method of taking tailoring doxepin for sleep.

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