III. Adverse Effects

  1. See Tricyclic Antidepressant
  2. Significant Anticholinergic effects, including sedation

IV. Safety

  1. Unknown safety in pregnancy
  2. Avoid in Lactation

V. Mechanism

  1. See Tricyclic Antidepressant
  2. Primarily affects Norepinephrine reuptake

VI. Dosing (Adults and Age over 12 years)

  1. Mood Disorders (Major Depression, Anxiety Disorder)
    1. Start: 75 mg orally at bedtime
    2. Titrate to 50 to 150 mg/day as tolerated and to effect
    3. Max: 300 mg/day (divide higher doses, above 150 mg/day, twice daily)
  2. Insomnia
    1. Adult: 6 mg orally 30 min before bed
    2. Elderly (over age 65 years): 3 mg orally 30 min before bed
      1. May advance to 6 mg orally as needed
  3. Pruritus
    1. Start 10 to 25 mg orally at bedtime
    2. Titrate to 10 to 100 mg/day as tolerated and to effect

VIII. References

  1. (2023) Med Lett Drugs Ther 62(1592): 25-32
  2. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 38-9
  3. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Related Studies

Cost: Medications

doxepin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
DOXEPIN 10 MG CAPSULE Generic $0.12 each
DOXEPIN 10 MG/ML ORAL CONC Generic $0.31 per ml
DOXEPIN 100 MG CAPSULE Generic $0.48 each
DOXEPIN 150 MG CAPSULE Generic $0.61 each
DOXEPIN 25 MG CAPSULE Generic $0.21 each
DOXEPIN 50 MG CAPSULE Generic $0.29 each
DOXEPIN 75 MG CAPSULE Generic $0.39 each
DOXEPIN HCL 3 MG TABLET Generic $6.96 each
DOXEPIN HCL 6 MG TABLET Generic $8.43 each

Ontology: Doxepin (C0013085)

Definition (NCI) A dibenzoxepin derivative and tricyclic antidepressant (TCA) with antipruritic, antidepressive and anxiolytic activities. Doxepin blocks the reuptake of norepinephrine and serotonin (5-HT) into presynaptic terminals thereby prolonging the availability of the monoaminergic neurotransmitters within the synaptic cleft and enhancing their neurotransmission. Doxepin also has antagonistic effects on histamine H1, 5-HT2, alpha-1 adrenergic, and muscarinic receptors. The antipruritic effect of this agent is mediated through inhibition of histamine receptors.
Definition (MSH) A dibenzoxepin tricyclic compound. It displays a range of pharmacological actions including maintaining adrenergic innervation. Its mechanism of action is not fully understood, but it appears to block reuptake of monoaminergic neurotransmitters into presynaptic terminals. It also possesses anticholinergic activity and modulates antagonism of histamine H(1)- and H(2)-receptors.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D004316
SnomedCT 11841005, 372587005
LNC LP14717-0, MTHU004933
English Doxepin, 1-Propanamine, 3-dibenz(b,e)oxepin-11(6H)-ylidene-N,N-dimethyl-, Doxepin [Chemical/Ingredient], DOXEPIN, doxepin, Doxepin (product), Doxepin (substance)
Swedish Doxepin
Czech doxepin
Finnish Doksepiini
Russian DOKSEPINGIDROKHLORID, DOKSEPIN, ДОКСЕПИН, ДОКСЕПИНГИДРОХЛОРИД
Japanese ドキセピン
Croatian DOKSEPIN
Polish Doksepina, Curantin
Spanish doxepina (producto), doxepina (sustancia), doxepina, Doxepina
French Doxépine
German Doxepin
Italian Doxepina
Portuguese Doxepina