Side effects of Doxepin hat you need to monitor carefully

This article will help you know about the side effects of Doxepin that you need to monitor carefully and call medical help in case of emergency.

Anticholinergic Effects
·         Constipation
·         Urinary retention
·         Blurred vision
·         Dry mouth
If the above side effects do not subside with regular therapy or become serious, your doctor may reduce the dosage of Doxepin.
CNS effects
Drowsiness is the most common side effect observed in patients. This effect disappears as the patient starts receiving the therapy. Other CNS side effects that do not occur quite often are
·         Hallucinations
·         Hypertension
·         Cardiovascular effects
·         Hypotension
·         Tachycardia
Allergic effects
·         Edema
·         Skin rash
·         Pruritus
·         Photosensitization
Hematologic
Eosinophillia is seen in a few patients. Occasional reports of depression of bone marrow are exhibited as purpura, leukpenia, thrombocytopenia, and agranulocytosis.
·         Endocrine
·         Raised libido
·         Gynecomastia (in males)
·         Testicular swelling
·         Enlargement of breasts
·         Galactorrhea (in females)
·         Increase or decrease in blood sugar levels
Gastrointestinal
·         Vomiting
·         Nausea
·         Taste disturbances
·         Indigestion
·         Diarrhea
·         Anorexia
Other side effects are
·         Dizziness
·         Weight gain
·         Chills
·         Weakness
·         Fatigue
·         Dizziness
·         Flushing
·         Alopecia
·         Jaundice
·         Angle closure glaucoma
·         Hyperpyrexia
·         Asthma
·         Sweating
·         Tinnitus
·         Headache
·          Mydriasis
Major side effects are
·         Stomach or abdominal pain
·         Bleeding gums
·         Canker sores
·         Chills
·         Chest pain
·         Blood in stools or urine
·         Convulsions
·         Dark urine
·         Decreased urine volume
·         Hoarseness or cough
·         Pale or cool skin
·         Cold sweats
·         Depression
·         Drooling
·         Breathing difficulty
·         Urinating difficulty
·         Dry, flushed skin
·         Fever
·         Irritability
·         Nightmares
·         Noisy breathing
·         Restlessness
·         Shuffling walk
·         Slurred speech
·         Vomiting blood
·         Yellow skin or eyes
·         Trembling, unsteadiness or problems with muscle coordination or control
·         Unusual bruising or bleeding
·         Stupor
·         Swollen glands
Common side effects are
·         Feeling tired, drowsy or dizzy
·         Vomiting, constipation, nausea
·         Blurred vision, dry mouth
·         Decreased interest in sex
·         Breast swelling in females and males
Frequency not known
·         Agitation
·         Insomnia
·         Sweating
·         Anxiety
·         Headache
·         Confusion, parenthesis
·         Sexual dysfunction
·         Skin rash
·         Lethargy, weakness, fatigue or sedation
Symptoms of overdose
·         Disturbed concentration
·         Clumsiness
·         Enlarged pupils
·         Muscle aches
·         Shivering
·         Sleepiness
·         Weight gain
·         Feeble or weak pulse
·         Low body temperature
·         Muscle weakness
·         Excessive unconsciousness
Occurrence not known
·         Heartburn
·         Diarrhea
·         Severe sunburn
·         Inability to have erection or keep erection
·         Loss in sexual drive, desire, ability or performance
·         Increased sexual drive, desire, ability or performance
·         Increased skin sensitivity to sunlight
·         Swollen testicles
·         Unexpected flow of milk from breasts
·         Weight loss
·         Discoloration or redness of skin
·         Gas in stomach
·         Change in taste
·         Hair thinning or hair loss

Proper use of Doxepin can help you get maximum benefits

Proper use of any drug can give you maximum benefits whereas not taking the right dosages can lead to complications. Take Doxepin as directed by your physician and avoid taking it very often or for a prolonged period than recommended by your doctor.

You should read the instructions given on the label and in the medical guide that you get, along with the medicine. In case you have any questions you should ask your doctor.

If you are taking the oral liquid form of Doxepin

  1. Use the calibrated dropper provided with the medicine to measure the dose
  2. Take 4 ounces of water (one-half glass), skimmed or whole milk, grapefruit juice, prune juice, pineapple juice, tomato juice or orange juice to mix each dose. Avoid mixing this medicine with carbonated beverages or grape juice. Prepare the medicine mix just before you use it. Do not prepare it in advance.

To use Doxepin tablet

  1. Avoid taking this medicine at least for 3 hours after your meal. It may not show its effect or make you drowsy and sleepy until next day if you take the medicine with meal or just after the meal.
  2. Take the doxepin tablet half an hour before bedtime, when you are going to sleep.
  3. Avoid taking medicine if you can’t get 7-8 hours of sleep as if you wake up early you may feel drowsy.

Dosing Information

The doxepin dose differs from person to person.  Follow the instruction of your doctor or directions mentioned on the label. The information provided below gives you details of the average doses of doxepin. If you are using a different dose do not change your dose until and unless your doctor asks you to do so.

The amount of doxepin you use depends on the medicine’s strength and also on other factors like number of doses used each day, the time gap between two doses and duration after which you use the medicine solely depends on the specific medical problems for which you are taking doxepin.

Oral dosage- solution or capsules

For anxiety of depression

Adults and children aged 12 years and above

Initial dose: 75mg/day or in split doses throughout the day. You doctor will adjust the dose as required.

However the maximum dose should not exceed 150mg/per day

Oral dosage- tablets

For insomnia

Adults 6 mg/day

Older adults

Initial dose – 3mg once in a day

Your doctor will adjust the dose as required.

Missed Dose

In case you miss a Doxepin dose, take it as soon as it strikes your mind. If it is time for your next dose, skip the dose you missed and follow the normal dosing schedule. Do not take extra dose to make up for the missed dose.

Use a closed container to store the medicine and keep it at room temperature away from direct light, moisture and heat. Keep the medicine away from children. Look for expiry date and do not use the medicine that crosses the expiry date.

Is Doxepin unsafe to use during pregnancy and breastfeeding

Doxepin and Pregnancy

Doxepin can be unsafe to use during pregnancy or breastfeeding. In animal studies the medicine has exhibited harmful effects to the foetus when used in high doses. However, doctors still recommend Doxepin during pregnancy if they feel that the benefits of the medicine are higher than the risks to the foetus in pregnant women.

If you are using Doxepin and you get pregnant, let your doctor know. Using Doxepin hydrochloride during pregnancy is not safe. A few studies reported birth defects in humans.

Animal studies have shown that when Doxepin was given during pregnancy in animals, it enhanced the risk of structural abnormalities, low weight in foetus, and low rates of survival in new born. In a few studies its has been reported that use of Doxepin during pregnancy is linked to some birth defects like cleft palate, heart defects and too many toes and fingers. This is not been confirmed in any other study.

Make sure you consult your doctor before using Doxepin during pregnancy so that your doctor can determine the benefits and risks associated with use of Doxepin in pregnancy based on your current medical condition.

Use of Doxepin during first/second trimester of pregnancy increased the rate of infant mortality.

Doxepin and Breastfeeding

Women who are using Doxepin during breastfeeding should know that the medicine can pass to their babies via breast milk. Some health problems seen in babies whose mothers used Doxepin during breastfeeding are jaundice, breathing problems, drowsiness and vomiting. If you are a nursing mother, let your doctor know so that he can guide you whether you can take this medicine or not.

Looking at the harmful effects of medicine and as the medicine secretes in breast milk, the use of Doxepin is generally not advised. As there are many other alternative medicines available to treat depression or anxiety, your doctor can suggest you trying a different medication. In other case if the symptoms of depression are quite severe; your doctor might suggest you to discontinue breastfeeding.

Talk to your doctor before taking Doxepin as each case is different and depending on your current health condition, you doctor can suggest you a better option. If your doctor prescribes you Doxepin to combat severe symptoms of depression, make sure you monitor your baby closely to check for any unusual symptoms and call the doctor immediately if you notice any unusual symptoms.

You can also choose to stop breastfeeding for a short period while you are on this medication to ensure your child’s better health. In case you can use alternative non narcotic medications to treat depression, go for it as they will not harm your baby’s health and also treat depression safely.

Even doctors recommend all natural medicines, meditation, yoga and other therapies that can help you overcome depression without taking narcotic medicines that can harm your baby.

Speak to your doctor for proper guidance and wise decision. He can examine you and suggest you a better option.

Doxepin treats depression and anxiety safely

Doxepin is an antidepressant used to treat different types of depression like

  1. Refractory depression
  2. depression anxiety(mixed)
  3. major depression
  4. neurotic depression
  5. spontaneous endogenous(depression)

Doxepin is also used to treat other health ailments like itching, chronic skin problems, peptic ulcers, panic disorders, anxiety, postprandial hypoglycaemia, PTSD, sleep disorders, or to stop the craving for swelling, smoking, decreased urination happening at night. Doxepin is also used to manage chronic pain in arthritis, herpes lesions, diabetic disease, and pain in patients suffering from cancer, migraines, tic douloureux or tension headaches.

Generic Name is Doxepin Hydrochloride

It is supplied in the form of

Capsules : available in 10mg, 25mg, 50mg, 75mg,100 mg, 150mg

Topical Cream

50mg/gram

Oral Concentrate

10mg/ml

It takes around 1-2 weeks to see the full benefits of this medication.

Some important information

Doxepin is not a habit forming medication. If halted suddenly withdrawal syndromes are seen with the use of this medication. Avoid using this medicine if you are pregnant; try some other alternative non drug medications. Also avoid taking Doxepin if you are planning to conceive or breastfeeding. Avoid smoking while you are on this drug and also avoid drinking alcohol.

Avoid giving this medication to children below age of 12.             If the patient is above 60 years of age, use small doses of this drug and monitor the patient closely for side effects and they should be extra careful while rising from sitting position as there are chances that elderly people fall while they are on this medication.

Do not use Doxepin if

  1. You are allergic to the drug.
  2. Used or using MAO inhibitors in past 14 days
  3. If you had an heart attack recently
  4. if you have narrow-angle glaucoma

Let your doctor know if

  1. You experience any negative reactions to Doxepin or other drug that belongs to same class in the past.
  2. You have a history of glaucoma, heart disease, epilepsy, diabetes, liver disease, enlarged prostate, overactive thyroid
  3. if you are using any prescription/non prescription drugs
  4. If you are undergoing any surgery or plan to get anaesthesia in couple of months ahead and also if you will have to undergo certain medical tests.

Is Doxepin addictive?

Doxepin is not an addictive antidepressant. Halting the use of Doxepin can lead to withdrawal symptoms like nausea and headache. Dosage should be reduced gradually to reduce withdrawal.

Doxepin treatment should not be stopped suddenly as the associated withdrawal symptoms can be serious. Therefore the dose adjustment should be done slowly. That is why some experts combine the dosage adjustment with all natural medications, which doesn’t react with Doxepin and provide desired relief while Doxepin dosage adjustment is carried out. To avoid the effects of withdrawal symptoms, programs are conducted especially for managing withdrawal symptoms wherein all natural medicines are given to reduce Doxepin dependency and through this program the patient finds it more comfortable to manage withdrawal symptoms. It helps the patients follow the right steps to avoid complications that occur as a result of severe withdrawal symptoms.

Check with your doctor for Doxepin drug interactions

Using Doxepin with certain drugs that make you drowsy or slow your breathing can lead to problems. Check with your doctor if you are taking Doxepin with a pain medicine (narcotic), sleeping pill, and muscle relaxer, medicine for depression, anxiety or seizures.

Also let your doctor know if you have taken an antidepressant (an SSRI) in last 5 weeks like escitalopram, citalopram, paroxetine, fluvoxamine, fluoxetine or sertraine. You should not take Doxepin for minimum 5 weeks after you stop using fluoxetine (Prozac).
Inform your doctor about all medicines you are taking, stopped taking or started taking while you are on Doxepin treatment especially
• terbinafine
• bupropion
• tolazamide
• cimetidine
• St. John’s wort;
• Any other antidepressant to medication to manage mental illness.
• medications for heart rhythm like flecainide, quinidine, propafenone
MAO inhibitors and Doxepin
A serious side effect including death has been observed in cases where MAO inhibitors are used with Doxepin. Therefore, use of MAO inhibitors should be stopped for minimum 2 weeks before starting with Doxepin therapy. The accurate period can vary depending on which MAO inhibitor is being used, the duration it is being administered for and the dosage recommended.
Doxepin and escitalopram
Using Doxepin and escitalopram together can lead to rare yet serious condition known serotonin syndrome which includes the following symptoms

• Hallucinations
• Confusion
• Excessive sweating
• Shivering
• Fever
• Shaking
• Blurred vision
• Tremor
• Muscle stiffness
• In coordination
• Muscle stiffness
• Vomiting
• Nausea
• Stomach cramp
• Coma
• Increased heart beat

Serious cases even result in death. You should call your doctor immediately if you notice these symptoms during treatment. Also using these medications together can result in irregular heart rhythm that can be life threatening, which otherwise is a side effect that is quite rare. The chances are higher if you are suffering from a heart condition known as long QT syndrome or certain cardiac diseases, electrolyte disturbances, conduction abnormalities. Speak to your doctor if you have any doubts or questions.

You doctor may be aware of these risks and can help you treat these symptoms effectively to avoid complications. You should immediately call your doctor if you notice symptoms like breathlessness, fainting, sudden dizziness, lightheadedness, and heart palpitations while you are on these medications, whether while taking either of these medications or taking combination of both the medications. Do not stop using the medication without your doctor’s advice.

Doxepin and hydrocodone

Using Doxepin and hydrocodone together can cause
1. Drowsiness
2. Dizziness
3. Difficulty in concentrating
4. Confusion

In some cases where elderly people are using these medications may experience symptoms like impairment in judgment, thinking and motor co-ordination. Do not use alcohol while you are on these medications. Avoid getting involved in activities that need extra alertness or need you to be awake like driving. Let your doctor know about additional medications that you are using apart from these two medications including herbs and vitamins. Avoid halting medications without your doctor’s consent.

Treating different depression types with Doxepin

Doxepin is basically an antidepressant that is used to help with problems related to mood/mental like anxiety and depression. It helps an individual improve his/her feelings, moods, relieve tension and anxiety, increase energy and sleep better.

How to use

It is always better to read the medication guide properly before you start using Doxepin and in case you have any questions you can ask your doctor or pharmacist. You can take this drug orally 1-3 times on a daily basis as suggested by the doctor. If you are advised to take once in a day, you can take during bedtime to avoid sleepiness that occurs during the daytime. The dosage depends on your response and medical condition.

In order to lessen the side effects of Doxepin, your doctor might start the mediation with a low dose and gradually increase the dose, so you need to follow the instructions of your doctor very carefully.

Taking medicine on a regular basis can help you get maximum benefit from the medication. Avoid using high doses of the medication and also do not continue taking the medication for a long term to avoid serious side effects.

Make sure you do not stop taking the medication without your doctor’s advice even if you think you don’t need the medication now. Some of the side effects of Doxepin are as below

Dry mouth, drowsiness, dizziness, constipation, blurred vision, urinating problems etc., contact your doctor immediately if you experience any such effects.

Doxepin can lead to a condition that affects the rhythm of your heart. This is known as QT prolongation which can rarely lead to fatal symptoms like irregular heartbeat, fainting, dizziness and you need medical attention immediately.

Before you start taking Doxepin, discuss with your doctor about your medical conditions or if you are using any drugs that can lead to QT prolongation, and also if you have family history of heart problems.

If you have low levels of magnesium or potassium in your blood, it can increase the chances of QT prolongation and also there can be a risk if you are suffering from problems like vomiting, severe sweating and diarrhea. The medication also makes   you quite sensitive to sunlight. You can wear sunscreen or protective clothing to avoid sun exposure. In case you are suffering from diabetes, this medication can create problems in controlling blood sugar levels in your body. It is better to keep a check on your blood sugar levels when you are using Doxepin.

If you are a nursing mother, or pregnant and also if planning pregnancy, talk to the doctor to know if you should take this medication or not. For nursing mothers the medication can pass into the breast milk and can lead to unpleasant effects on the infant.

This medication also interacts with other medications, so be careful and take advice from your doctor if you are already taking any other medicines apart from Doxepin as this drug can have interactions with other medications.