Slipaid 6

Indications

Doxepin is a tricyclic medicine available in several forms. Low-dose tablets are used to treat insomnia, especially difficulty staying asleep. Higher-dose capsules or tablets are used for depression and anxiety. A cream containing Doxepin (usually 5%) is used for short-term relief of itching in eczema and similar skin conditions.

How It Works

At low doses, Doxepin mainly blocks histamine H1 receptors in the brain, which reduces wakefulness and helps people stay asleep. At higher doses it also increases the levels of the brain chemicals serotonin and noradrenaline, which improves mood and reduces anxiety. On the skin, its strong antihistamine effect reduces itching.

Dosage and Administration

Take exactly as prescribed. For insomnia, low-dose tablets are taken once a day within 30 minutes of bedtime, not within 3 hours of a meal, and only when you can sleep 7 to 8 hours. For depression and anxiety, the doctor starts with a low dose and increases it gradually; benefits may take 2 to 4 weeks. Do not stop suddenly after long use; the doctor will reduce the dose slowly. Cream: apply a thin layer to the itchy area up to 4 times a day for no more than 8 days, or as directed, and do not cover with a tight dressing.

Interactions

• Do not use with MAO inhibitors (such as Selegiline or Linezolid) or within 2 weeks of stopping them.
• Alcohol, sleeping tablets, opioids, antihistamines and other sedatives increase drowsiness and breathing problems.
• Cimetidine, Fluoxetine, Paroxetine and some other medicines can raise Doxepin levels.
• Other medicines that affect heart rhythm or serotonin (such as Tramadol, Triptans or other antidepressants) increase risks.

Contraindications

• Allergy to Doxepin or other tricyclic medicines
• Untreated narrow-angle glaucoma
• Severe urinary retention
• Recent heart attack or certain heart rhythm problems
• Use of MAO inhibitors in the last 2 weeks
• Children, unless a specialist advises it

Side Effects

• Drowsiness, dizziness, tiredness the next day
• Dry mouth, constipation, blurred vision
• Weight gain, increased appetite
• Difficulty passing urine
• Fast heartbeat, low blood pressure on standing
• Cream: burning or stinging, and drowsiness if used on large areas

Get urgent medical help if you have thoughts of harming yourself, unusual agitation or mood changes, fainting, a fast or irregular heartbeat, eye pain with vision changes, inability to pass urine, fits, or signs of a severe allergic reaction such as swelling of the face or difficulty breathing.

Pregnancy and Lactation

Use in pregnancy only if your doctor decides the benefit outweighs the risk. Doxepin passes into breast milk and has caused breathing problems and severe drowsiness in nursing babies, so it is usually avoided during breastfeeding.

Precautions and Warnings

• Antidepressants can increase suicidal thoughts in young people, especially early in treatment; families should watch for changes.
• Do not drive or operate machinery if you feel drowsy.
• Avoid alcohol.
• Use with care in older people, heart disease, epilepsy, enlarged prostate, glaucoma, liver disease and bipolar disorder.
• Complex sleep behaviours (such as sleep-walking or driving while not fully awake) can occur; stop and tell your doctor.

Overdose

Overdose of tricyclic medicines is dangerous and can cause severe drowsiness, confusion, fits, very low blood pressure, irregular heartbeat, coma and death. Call emergency services or go to hospital immediately, even if there are no symptoms yet.

Therapeutic Class

Tricyclic antidepressant; sedative (H1 antihistamine at low dose); topical antipruritic

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.