Formulary
Dosulepin hydrochloride: Indications, Dosing, Side Effects and Interactions
Dosulepin hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
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Dosulepin hydrochloride: Indications, Dosing, Side Effects and Interactions
Dosulepin hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Depressive illness, particularly where sedation is required (not recommended-increased risk of fatality in overdose) (initiated by a specialist)**
- **Adult** (By Mouth): Initially 75 mg daily in divided doses, alternatively initially 75 mg once daily, dose to be taken at bedtime, increased if necessary to 150 mg daily, doses to be increased gradually; up to 225 mg daily in some circumstances (e.g. hospital use).
- **Elderly** (By Mouth): Initially 50-75 mg daily in divided doses, alternatively initially 50-75 mg once daily, dose to be taken at bedtime, increased if necessary to 75-150 mg daily, doses to be increased gradually; up to 225 mg daily in some circumstances (e.g. hospital use).
Cautions
Cardiovascular disease; chronic constipation; diabetes; epilepsy; history of bipolar disorder; history of psychosis; hyperthyroidism (risk of arrhythmias); increased intra-ocular pressure; patients with a significant risk of suicide; phaeochromocytoma (risk of arrhythmias); prostatic hypertrophy; susceptibility to angle-closure glaucoma; urinary retention Cautions, further information Treatment should be stopped if the patient enters a manic phase. M Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects. M
Contraindications
Acute porphyrias ; arrhythmias; during the manic phase of bipolar disorder; heart block; immediate recovery period after myocardial infarction
Side effects
Frequency not known Accommodation disorder; agranulocytosis; alveolitis; anticholinergic syndrome; appetite abnormal; arrhythmias; asthenia; bone marrow depression; cardiac conduction disorder; confusion; constipation; dizziness; drowsiness; dry mouth; endocrine disorder; eosinophilia; epigastric discomfort; galactorrhoea; gynaecomastia; hepatic disorders; hyperhidrosis; hypertension; hyponatraemia; increased risk of fracture; leucopenia; mood altered; movement disorders; nausea; nervousness; paranoid delusions; photosensitivity reaction; postural hypotension; psychosis; seizures; sexual dysfunction; SIADH; skin reactions; speech disorder; suicidal behaviours; testicular hypertrophy; thrombocytopenia; tremor; urinary hesitation; vomiting; weight changes; withdrawal syndrome Side-effects, further information The risk of side-effects are reduced by titrating slowly to the minimum effective dose (every 2-3 days). Consider using a lower starting dose in elderly patients. Overdose Overdosage with dosulepin is associated with a relatively high rate of fatality. Tricyclic and related antidepressants cause dry mouth, coma of varying degree, hypotension, hypothermia, hyperreflexia, extensor plantar responses, convulsions, respiratory failure, cardiac conduction defects, and arrhythmias. Dilated pupils and urinary retention also occur. For details on the management of poisoning see Tricyclic and related antidepressants under Emergency treatment of poisoning.
Interactions
**Other interactions (4):**
- Dosulepin may alter the pharmacological effect of some concurrently administered drugs including CNS depressants such as alcohol and narcotic analgesics; the effect of these will be potentiated as...
- It is advisable to review all antihypertensive therapy during treatment with tricyclic antidepressants.
- There is an increased risk of postural hypotension when tricyclic antidepressants are given with diuretics.
- Tricyclic antidepressants may also antagonise the anticonvulsant effect of antiepileptics (convulsive threshold decreased).
Pregnancy
Use only if potential benefit outweighs risk.
Breast feeding
The amount secreted into breast milk is too small to be harmful.
Hepatic impairment
Manufacturer advises caution in mild to moderate impairment; avoid in severe impairment.
Medicinal forms
Solution,Tablet,Capsule
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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