Doxepin

Doxepin hydrochloride or doxepin is tricyclic antidepressant which is also used for many other conditions in non-depressed people including: Doxepin is a similar drug to amitriptyline and nortriptyline, but also has antihistamine effects.
 * anxiety
 * pain, particularly neuropathic pain
 * insomnia, which Doxepin has FDA approval for
 * migraine prevention
 * sleep problems including as a sleep sustainer
 * the topical form is used for pruritus (chronic hives causing severe itching)

Doxepin is also sold under the brand names Silenor, Sinequan, Prudoxin. and Zonalon.

Theory
Doxepin has not been suggested as a primary treatment for ME/CFS. It is effective for a number of common symptoms found in ME/CFS, and has antagonist effects on alpha-adrenergic, muscarinic, and histaminic receptors.

ME/CFS
Doxepin is not recommended as a first-line antidepressant for ME/CFS patients.

The International Consensus Criteria for myalgic encephalomyelitis states that doxepin may be helpful as a sleep sustainer in the short-term, when used at a low dose, but warns that side effects can be severe.

Dosage for ME/CFS
The Canadian Consensus Criteria for ME/CFS suggests:
 * 2-20mg each night at bedtime for sleep
 * 5-100 mg each night at bedtime as tolerated for pain
 * 5-10 mg at bedtime/during hours of sleep to 75-100 mg daily for depression

As is typical for ME/CFS patients, clinicians are advised to start with a low and gradually increase the dosage as tolerated. It is slower acting, but helps to keep patient asleep longer.

Risks and safety
Doxepin has similar side effects to amitriptyline. This includes the US antidepressant black box warning of an increased risk of suicidal thoughts or actions and self-harm in children, teenagers, and young people under age 24.

Costs and availability
Doxepin is a perscription only drug which is inexpensive in capsule form, and generic forms are widely available. It is available as a tablet/capsule, oral solution and for pruritus as a topical treatment to be applied to the skin.

Doxepin prices in the US are typically around $17 per 30 capsules (10mg), $25 for 118ml of oral solution (10mg/mL). Doxepin 3mg and 6mg tablets are considerably more expensive, at $165-450 per 30.

Doxepin topical cream is approximately $625 for 45g (5% strength). Topical brand names include Zonalon and Prudoxin.

Learn more

 * Doxepin - MedlinePlus