May 28, 2017
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Doxepin

Medical and Pharmacy Editor:

Brand Name: Silenor

Generic Name: doxepin

Drug Class: Antidepressants, TCAs

What Is Doxepin and How Does It Work?

Doxepin is recommended for the treatment of:

  • Psychoneurotic patients with depression and/or anxiety
  • Depression and/or anxiety associated with alcoholism (not to be taken concomitantly with alcohol)
  • Depression and/or anxiety associated with organic disease (the possibility of drug interaction should be considered if the patient is receiving other drugs concomitantly)
  • Psychotic depressive disorders with associated anxiety including involutional depression and manic-depressive disorders
  • The target symptoms of psychoneurosis that respond particularly well to doxepin hydrochloride capsules include anxiety, tension, depression, somatic symptoms and concerns, sleep disturbances, guilt, lack of energy, fear, apprehension and worry

Clinical experience has shown that doxepin is safe and well tolerated even in the elderly patient. Owing to lack of clinical experience in the pediatric population, doxepin hydrochloride capsules are not recommended for use in children under 12 years of age.

The Silenor brand of doxepin is indicated for the treatment of insomnia characterized by difficulty with sleep maintenance. The clinical trials performed in support of efficacy were up to 3 months in duration

Doxepin is available under the following different brand names: Silenor.

Dosages of Doxepin:

Dosage Forms and Strengths

Capsule (generic)

  • 10 mg
  • 25 mg
  • 50 mg
  • 75 mg
  • 100 mg
  • 150 mg

Tablet (Silenor)

  • 3 mg
  • 6 mg

Oral concentrate (generic)

  • 10mg/mL

Dosage Considerations – Should be Given as Follows:

Children under 12 years old: Not recommended

Depression/Anxiety

  • Initiate at low dose (25 mg/day); gradually titrate upward every 5-7 days
  • Dosage range: 25-300 mg/day orally, up to 150 mg/day as single dose
  • If dose exceeds 150 mg/day, divide every 12 hours
  • Dosing considerations
    • May give at bedtime to decrease daytime sedation
    • Geriatric: Lower initial dose (i.e., 10 mg/day) and adjust gradually; 10-25 mg orally at bedtime; may increase by 10-25 mg increments every 3 days for inpatients and weekly for outpatients if tolerated

Insomnia (Silenor)

  • Sleep maintenance
  • Adult: 3-6 mg orally within 30 minutes before bedtime; not to exceed 6 mg/day
  • Hepatic impairment/debilitated patients: 3 mg orally within 30 minutes before bedtime
  • Geriatric starting dose: 3 mg orally within 30 minutes before bedtime; may increase to 6 mg orally at bedtime if clinically indicated

Dosing considerations

  • To minimize potential for next day drowsiness, do not take within 3 hours of a meal (AUC increased by 41% and Cmax by 15% when taken with high fat meal)

Geriatric:

Dosing Modifications

  • Hepatic impairment: Use lower dose and adjust gradually for depression; initiate Silenor at 3 mg daily for insomnia
Medically Reviewed by a Doctor on 4/14/2017



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