Doxepin: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Uses

What is doxepin used for?

Doxepin is commonly used to treat certain types of anxiety or depression.

Doxepin can also be used to treat insomnia or trouble sleeping.

Doxepin may also be used for other conditions as determined by your healthcare provider.

Doxepin is also available as a topical cream. See Doxepin topical for more information.

How does doxepin work (mechanism of action)?

Doxepin belongs to a group of medicines called tricyclic antidepressants (TCAs). It may work by increasing the amount of natural chemicals called norepinephrine and serotonin in the brain. Doxepin tablets may work for sleep by affecting a substance in your body called histamine.

How is doxepin supplied (dosage forms)?

Doxepin is available as Silenor and generic doxepin in the following dosage forms that are taken by mouth.

10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg oral capsules
10 mg/mL oral solution (concentrate)
3 mg, 6 mg oral tablets

How should I store doxepin?

Doxepin should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a tightly closed container. Protect from light.

Side Effects

What are the most common side effects of doxepin?

The most common side effects of doxepin are listed below. Tell your healthcare provider if you have any of these side effects that bother you.

Constipation
Inability to empty your bladder
Dry mouth
Drowsiness
Dizziness
Confusion
Blurred vision
Nausea and vomiting
Infection in the nose or throat, sore throat, or common cold symptoms (tablets)

There may be other side effects of doxepin that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of doxepin?

While less common, the most serious side effects of doxepin are described below, along with what to do if they happen.

Severe Allergic Reactions. Doxepin may cause allergic reactions, which can be serious. Stop using doxepin and get help right away if you have any of the following symptoms of a serious allergic reaction.

Breathing problems or wheezing
Racing heart
Fever or general ill feeling
Swollen lymph nodes
Swelling of the face, lips, mouth, tongue, or throat
Trouble swallowing or throat tightness
Itching, skin rash, or pale red bumps on the skin called hives
Nausea or vomiting
Dizziness, feeling lightheaded, or fainting
Stomach cramps
Joint pain

Suicidal Thoughts or Actions. Doxepin or other antidepressants may increase the risk of suicidal thoughts or actions in a small number of children, teenagers, or young adults in the first few months of taking the medicine or when the dose is changed. Depression or other serious mental health conditions are the most important causes of suicidal thoughts or actions. If you or your child is about to harm themselves, call 911 or call or text 988, the Suicide & Crisis Lifeline. Call your healthcare provider right away if you have any of the following symptoms.

New or increased thoughts of suicide or death
Suicide attempt
New or increased feelings of anxiety, depression, or other unusual changes in your mood or behavior

Glaucoma. Doxepin may increase pressure inside the eye and cause or worsen narrow-angle glaucoma in some people. This can lead to blindness. Ask your healthcare provider if you should have your eyes examined to see if you are at risk. Tell your healthcare provider right away if you have any of the following symptoms.

Loss of vision
Eye pain or redness
Severe headache or vomiting
Seeing bright, colorful circles around lights (vision halos)

Extremely Elevated Mood (Mania). People with bipolar disorder can have severe high and low moods. The first symptom of bipolar disorder may be depression. People with bipolar disorder who take an antidepressant, such as doxepin, may have a higher risk of having mania or a manic episode. Call your doctor right away if you have any of the following symptoms of a manic episode.

Very increased energy
Significant trouble sleeping
Racing, fast-paced thoughts
Reckless behavior
Unusually grand ideas
Excessive happiness or irritability
Talking faster or more than usual

Serotonin Syndrome. Serotonin syndrome is when there is too much of a substance called serotonin in your body. Doxepin may cause serotonin syndrome when it is taken alone or with other medicines that affect serotonin. This condition can be life-threatening. Get emergency help if you have any of the following symptoms of serotonin syndrome.

Sweating, fever, or flushing
Confusion
Feeling agitated or restless
Seeing or hearing unusual things
Dizziness
Fast or racing heartbeat
Nausea, vomiting, or diarrhea
Muscle twitching, stiffness, or tremor
Seizures

Heart Rhythm Changes. Doxepin may cause a rare, dangerous heart rhythm problem called QT prolongation and torsade de pointes. Some people have a higher risk of this, including people who are older, have other people in their family who have had these conditions, have low potassium or magnesium levels, or who take some medicines for other heart rhythm problems. Tell your healthcare provider right away if you faint or have changes in your heart rate or rhythm, such as a fast or skipping heartbeat.

Activities While Not Fully Awake. Doxepin may cause you to do an activity that you do not know you are doing. The next morning, you may not remember doing anything. Stop taking doxepin, and call your healthcare provider right away if you do any of the following activities while not fully awake.

Driving a car, also called “sleep driving”
Making and eating food
Talking on the phone
Having sex
Sleepwalking

Blood Disorders. Doxepin may cause blood disorders, such as agranulocytosis, low platelet levels (thrombocytopenia), and low white blood cell levels (leukopenia). Stop using doxepin and get help right away if you have any of the following symptoms of blood disorders.

Fever
Easy bruising or bleeding
Frequent infection or sore throat
Unusual weakness or tiredness

Warnings & Precautions

Who should not use doxepin?

Allergies to Ingredients. People who are allergic to any of the following should not use doxepin.

Doxepin
Silenor
Any other medicine known as a tricyclic antidepressant
Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific doxepin products they stock.

Drug Interactions. Doxepin should not be taken while you are using certain other medicines. Before taking doxepin, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Glaucoma. Doxepin may increase pressure inside the eye and cause or worsen narrow-angle glaucoma, which can lead to blindness.

Inability to Empty Bladder (Urinary Retention). Doxepin might make it harder to empty your bladder, especially if you already have a blockage or take other medicines for overactive bladder.

What should I know about doxepin before using it?

Do not take doxepin unless it has been prescribed to you by a healthcare provider. Take it as prescribed.

Do not share doxepin with other people, even if they have the same condition as you. It may harm them.

Keep doxepin out of the reach of children.

If you take doxepin oral liquid, use an accurate measuring device to measure your dose. A household spoon is not an accurate measuring device and may cause you to take the wrong dose. Ask your pharmacist to recommend an appropriate measuring device.

If you take doxepin tablets, take the medicine 30 minutes before bedtime. After you take it, limit your activities to getting ready to go to sleep. If your insomnia worsens or is not better within 7 to 10 days, call your healthcare provider. There may be another condition causing your sleep problem.

Doxepin can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how doxepin affects you.

Doxepin can make your skin more sensitive to light from the sun, sunlamps, and tanning beds. This is called photosensitivity. Exposure to this light can cause severe sunburns, blisters, and swelling. If you need to be in sunlight, wear sunscreen, a hat, and clothing that covers your skin.

Talk with your healthcare provider if you get electroconvulsive therapy (ECT). Doxepin may increase the risk of problems from such therapy.

Do not stop taking doxepin without talking to your healthcare provider. Stopping too quickly may cause serious side effects. Call your healthcare provider right away if you have any of the following symptoms.

Headache
Nausea
Feeling unwell

Older adults and adolescents can be at greater risk for some side effects from doxepin. Talk to your healthcare provider about your risks if you are in either of these age groups.

What should I tell my healthcare provider before using doxepin?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if doxepin is right for you.

In particular, make sure that you discuss any of the following.

Brugada Syndrome. Doxepin should not be taken by people who have or are suspected to have this genetic heart rhythm disorder. For example, you should not take doxepin if you have a history of unexplained fainting or a family history of sudden unexplained death before age 45.

Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.

Diabetes
Heart problems
Kidney or liver problems
Bipolar disorder, mania, or schizophrenia
Family history of suicide, bipolar disorder, or depression
Glaucoma
Inability to empty your bladder
Planned surgery
Sleep apnea (tablets)
History or alcohol or drug abuse or addiction (tablets)
History of depression, mental problems, or suicidal thoughts (tablets)

Pregnancy. Do not take doxepin during the third trimester of pregnancy without talking to your healthcare provider. Taking doxepin during this time may cause harm to an unborn baby. Tell your healthcare provider if you are or plan to become pregnant. If you become pregnant while taking doxepin for depression, you can register in the National Pregnancy Registry for Antidepressants by calling 844-405-6185 or at womensmentalhealth.org/research/pregnancyregistry/. This registry collects safety information about the use of antidepressant medicines during pregnancy.

Breastfeeding. Doxepin passes into breast milk. Breastfeeding is not recommended while you are taking doxepin. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should take doxepin while breastfeeding.

Interactions

Does doxepin interact with foods or drinks?

Take doxepin tablets on an empty stomach. If you eat within 3 hours of taking your dose, the medicine may take longer to work, and you may be sleepy the next day. There are no known interactions between doxepin capsules or liquid and foods or drinks.

Avoid drinking alcohol while taking doxepin. The combination can increase sleepiness, affect your alertness or concentration, or increase the risk of doing activities while you are not fully awake.

Does doxepin interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using doxepin.

A monoamine oxidase inhibitor (MAOI) within the past 2 weeks, which is a medicine usually used for depression or Parkinson’s disease
A selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI), which are medicines commonly used for anxiety and depression
An antipsychotic, which is a medicine for certain mental health conditions
Certain medicines used to manage irregular heart rhythms, such as flecainide, propafenone, or quinidine
An antihistamine, such as chlorpheniramine or diphenhydramine (Benadryl), which is a medicine commonly used to treat allergy symptoms
Any other medicine that causes dizziness and sleepiness (such as prescription pain medicines, sleep medicines, and medicines for anxiety)
Cimetidine, which is a medicine that is commonly used for indigestion or stomach ulcers

Many other medicines may alter the blood levels of doxepin, and vice versa. Tell your healthcare provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with doxepin. Always check with your healthcare provider.

Does Doxepin interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much doxepin?

If you or someone else has used too much doxepin, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of doxepin?

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only take the next dose. Do not take double or extra doses.