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Doxepin

The meaning of «doxepin»

Doxepin is a medication used to treat major depressive disorder, anxiety disorders, chronic hives, and trouble sleeping.[8][9] For hives it is a less preferred alternative to antihistamines.[8] It has a mild to moderate benefit for sleeping problems.[10] It is used as a cream for itchiness due to atopic dermatitis or lichen simplex chronicus.[11]

Common side effects include sleepiness, dry mouth, constipation, nausea, and blurry vision.[8] Serious side effects may include suicide in those under the age of 25, mania, and urinary retention.[8] A withdrawal syndrome may occur if the dose is rapidly decreased.[8] Use during pregnancy and breastfeeding is not generally recommended.[12][13] Doxepin is a tricyclic antidepressant (TCA).[8] While how it works for treating depression is unclear, it may involve increasing the levels of norepinephrine, along with blocking histamine, acetylcholine, and serotonin.[8]

Doxepin was approved for medical use in the United States in 1969.[8] It is available as a generic medication.[12] A month supply in the United Kingdom costs the NHS at least £100 as of 2019.[12] In the United States the wholesale cost of this amount is about US$23.[14] In 2017, it was the 240th most commonly prescribed medication in the United States, with more than two million prescriptions.[15][16]

Doxepin is used as a pill to treat major depressive disorder, anxiety disorders, and chronic hives, and for short-term help with trouble remaining asleep after going to bed (a form of insomnia).[8][6][9] As a cream it is used for short-term treatment of itchiness to due atopic dermatitis or lichen simplex chronicus.[11]

In 2016 the American College of Physicians advised that insomnia be treated first by treating comorbid conditions, then with cognitive behavioral therapy and behavioral changes, and then with drugs; doxepin was among those recommended for short-term help maintaining sleep, on the basis of weak evidence.[17][18] The 2017 American Academy of Sleep Medicine recommendations focused on treatment with drugs were similar.[17] A 2015 AHRQ review of treatments for insomnia had similar findings.[19]

A 2010 review found that topical doxepin is useful to treat itchiness.[20]

A 2010 review of treatments for chronic hives found that doxepin had been superseded by better drugs but was still sometimes useful as a second-line treatment.[21]

Known contraindications include:[22]

Its use in pregnant and lactating women is advised against, although the available evidence suggests it is unlikely to cause negative effects on fetal development.[6] The lack of evidence from human studies, however, means it is currently impossible to rule out any risk to the fetus and it is known to cross the placenta.[6] Doxepin is secreted in breast milk[3] and neonatal cases of respiratory depression in association with maternal doxepin use have been reported.[24]

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