Sinequan

Doxepin (Insomnia)



(dox' e pin)

Silenor®

Doxepin is used to treat depression and anxiety. Doxepin is in a class of medications called tricyclic antidepressants. It works by increasing the amounts of certain natural substances in the brain that are needed for mental balance.
Doxepin is also available as a tablet to treat insomnia. This monograph only gives information about doxepin for depression or anxiety. If you are using this medication for insomnia, read the monograph entitled doxepin (insomnia).

Doxepin comes as a cream to apply to the skin. It is usually applied four times a day, at least 3 to 4 hours apart, for up to 8 days. Use doxepin at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use doxepin topical exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
To use the cream, follow these steps:



Wash the affected skin with water and a mild soap or soapless cleansing lotion and pat dry with a soft towel.

Apply a thin layer of cream to the affected skin. Gently and thoroughly massage it into the skin. Be careful not to get the medication in your eyes or mouth. If you do get doxepin in your eyes, wash with plenty of water and call your doctor if your eyes are irritated.

Do not cover the affected area with any bandages, dressings, or wrappings.

Wash your hands with soap and water after you finish handling the medication.

Before taking doxepin,

tell your doctor and pharmacist if you are allergic to doxepin, amoxapine, loxapine, any other medications, or any of the ingredients in doxapine capsules, or concentrate.

tell your doctor if you are taking a monoamine oxidase (MAO) inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate), or if you have stopped taking an MAO inhibitor within the past 14 days. Also tell your doctor if you are taking or receiving methylene blue (Provayblue) or linezolid (Zyvox). Your doctor will probably tell you not to take doxepin. If you stop taking doxepin, you should wait at least 14 days before you start to take an MAO inhibitor.

tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: certain antipsychotics such as chlorpromazine, fluphenazine, perphenazine, prochlorperazine (Compro, Procomp), thioridazine, trifluoperazine ; bupropion (Wellbutrin, Zyban, others,in Contrave); cimetidine (Tagamet); duloxetine (Cymbalta); flecainide (Tambocor); propafenone (Rythmol); quinidine (in Nuedexta);  selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Selfemra, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Paxil, Pexeva), and sertraline (Zoloft);  and tolazamide (Tolinase). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Your doctor may tell you not to take doxepin if you have taken fluoxetine in the past 5 weeks.

tell your doctor if you have glaucoma or difficulty urinating. Your doctor will probably tell you not to take doxepin.

tell your doctor if you have or have ever drunk large amounts of alcohol, , or have or have ever had asthma, or liver or kidneydisease.

tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking this medication, call your doctor.

talk to your doctor about the risks and benefits of taking doxepin if you are 65 years of age or older. Older adults should not usually take doxepin because it is not as safe or effective as other medications that can be used to treat the same condition.


you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.

ask your doctor about the safe use of alcoholic beverages while you are taking doxepin. Alcohol can make the side effects from doxepin worse.

you should know that doxepin may cause angle-closure glaucoma (a condition where the fluid is suddenly blocked and unable to flow out of the eye causing a quick, severe increase in eye pressure which may lead to a loss of vision). Talk to your doctor about having an eye examination before you start taking this medication. If you have nausea, eye pain, changes in vision, such as seeing colored rings around lights, and swelling or redness in or around the eye, call your doctor or get emergency medical treatment right away.

Unless your doctor tells you otherwise, continue your normal diet

Take the missed dose as soon as you remember it. However, if it is almost time for your next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Doxepin may cause side effects. Call your doctor if any of these symptoms are severe or do not go away:



nausea

vomiting

weakness or tiredness

dizziness

increase in pupil size

dry mouth

mouth sores

skin more sensitive to sunlight than usual

flushing

changes in appetite or weight

changes in the way things taste

indigestion

constipation

diarrhea

difficulty urinating

excessive thirst and urination

ringing in your ears

changes in sex drive

swollen testicles

increased breast size

milky discharge from nipples in females

excessive sweating

chills

headache

hair loss

If you experience any of the following symptoms or those listed in the IMPORTANT WARNING or SPECIAL PRECAUTIONS sections, call your doctor immediately:



yellowing of the skin or eyes

fast heartbeat

unusual bleeding or bruising

skin rash, itching, or swelling
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).
Doxepin may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication.

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from light, and excess heat and moisture (not in the bathroom).
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them.  However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community.  See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.
It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Keep all appointments with your doctor.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.