Formulary
Doxepin: Indications, Dosing, Side Effects and Interactions
Doxepin clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Doxepin: Indications, Dosing, Side Effects and Interactions
Doxepin clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Depressive illness (particularly where sedation is required)**
- **Adult** (By Mouth): Initially 75 mg daily in divided doses, alternatively 75 mg once daily, adjusted according to response, dose to taken at bedtime; maintenance 25-300 mg daily, doses above 100 mg given in 3 divided doses.
- **Elderly** (By Mouth): Start with lower doses and adjust according to response.
**Pruritus in eczema**
- **Child** (To The Skin): 12-17 years Apply up to 3 g 3-4 times a day, apply thinly; coverage should be less than 10% of body surface area; maximum 12 g per day.
- **Adult** (To The Skin): Apply up to 3 g 3-4 times a day, apply thinly; coverage should be less than 10% of body surface area; maximum 12 g per day.
**Depressive illness (particularly where sedation is required) for doxepin**
- **Child 12-17 years** (By mouth): Initially 75 mg daily in divided doses, alternatively 75 mg once daily, adjusted according to response, dose to taken at bedtime; maintenance 25-300 mg daily, doses above 100 mg given in 3 divided doses.
**Pruritus in eczema for doxepin**
- **Child 12-17 years** (To the skin): Apply up to 3 g 3-4 times a day, apply thinly; coverage should be less than 10% of body surface area; maximum 12 g per day.
Cautions
General cautions: Arrhythmias; susceptibility to angle-closure glaucoma; urinary retention Specific cautions: With oral use Cardiovascular disease; chronic constipation; diabetes; epilepsy; heart block; history of bipolar disorder; history of psychosis; hyperthyroidism (risk of arrhythmias); immediate recovery period after myocardial infarction; increased intra-ocular pressure (in adults); patients with significant risk of suicide; phaeochromocytoma (risk of arrhythmias); prostatic hypertrophy (in adults) With topical use Avoid application to large areas; mania; severe heart disease Cautions, further information With oral use: Treatment should be stopped if the patient enters a manic phase. Elderly With oral use in adults: 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.
Contraindications
With oral use Acute porphyrias ; during manic phase of bipolar disorder
Side effects
General side-effects: Frequency not known Constipation; diarrhoea; dizziness; drowsiness; dry mouth; dyspepsia; headache; nausea; skin reactions; suicidal behaviours; taste altered; urinary retention; vision blurred; vomiting Specific side-effects: Frequency not known With oral use Agitation; agranulocytosis; alopecia; anticholinergic syndrome; appetite decreased; asthenia; asthma exacerbated; bone marrow depression; breast enlargement; cardiovascular effects; chills; confusion; eosinophilia; face oedema; flushing; galactorrhoea; gynaecomastia; haemolytic anaemia; hallucination; hyperhidrosis; hyperpyrexia; increased risk of fracture; jaundice; leucopenia; mania; movement disorders; oral ulceration; paranoid delusions; photosensitivity reaction; postural hypotension; psychosis; seizure; sensation abnormal; sexual dysfunction; SIADH; sleep disorders; tachycardia; testicular swelling; thrombocytopenia; tinnitus; tremor; weight increased With topical use Dry eye; fever; paraesthesia Side-effects, further information The risk of side-effects is reduced by titrating slowly to the minimum effective dose (every 2-3 days). Consider using a lower starting dose in elderly patients. Overdose With oral use 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 (3):**
- Combinations where caution is advised: Concomitant use of naltrexone with barbiturates, benzodiazepines, anxiolytics other than benzodiazepines (e.g.
- Combined therapy with the following drugs which prolong the QT interval is contra-indicated (see section 4.3) due to the increased risk of torsades de pointes; for example: Class Ia...
- Examples of such drugs include certain antihistamines (e.g.
Pregnancy
With oral use: Use with caution-limited information available. With topical use: Manufacturer advises use only if potential benefit outweighs risk.
Breast feeding
With oral use: The amount secreted into breast milk is too small to be harmful. Accumulation of metabolite may cause sedation and respiratory depression in neonate. With topical use: Manufacturer advises use only if potential benefit outweighs risk.
Hepatic impairment
With topical use: Manufacturer advises caution in severe impairment. With oral use: Manufacturer advises caution in mild to moderate impairment; avoid in severe impairment. Dose adjustments With oral use: Manufacturer advises consider dose reduction in mild to moderate impairment.
Renal impairment
With oral use: Use with caution. M Dose adjustments With oral use: Consider dose reduction. M
Medicinal forms
Solution,Capsule,Cream
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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