Doxepin hydrochloride or doxepin is tricyclic antidepressant which is also used for many other conditions in non-depressed people including:
- 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)
Theory[edit | edit source]
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.
Evidence[edit | edit source]
ME/CFS[edit | edit source]
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[edit | edit source]
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.
Clinicians[edit | edit source]
Risks and safety[edit | edit source]
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[edit | edit source]
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.
See also[edit | edit source]
Learn more[edit | edit source]
- Doxepin - MedlinePlus
References[edit | edit source]
- Almasi, Anasheh; Meza, Carlos E. (2022). Doxepin. Treasure Island (FL): StatPearls Publishing. PMID 31194446.
- "Doxepin (Depression, Anxiety)". MedlinePlus Drug Information. Retrieved February 20, 2022.
- Carruthers, Bruce M.; Jain, Anil Kumar; De Meirleir, Kenny L.; Peterson, Daniel L.; Klimas, Nancy G.; Lerner, A. Martin; Bested, Alison C.; Flor-Henry, Pierre; Joshi, Pradip; Powles, A C Peter; Sherkey, Jeffrey A.; van de Sande, Marjorie I. (2003), "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols" (PDF), Journal of Chronic Fatigue Syndrome, 11 (2): 7-115, doi:10.1300/J092v11n01_02
- Carruthers, BM; van de Sande, MI; De Meirleir, KL; Klimas, NG; Broderick, G; Mitchell, T; Staines, D; Powles, ACP; Speight, N; Vallings, R; Bateman, L; Bell, DS; Carlo-Stella, N; Chia, J; Darragh, A; Gerken, A; Jo, D; Lewis, DP; Light, AR; Light, KC; Marshall-Gradisnik, S; McLaren-Howard, J; Mena, I; Miwa, K; Murovska, M; Stevens, SR (2012), Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners (PDF), ISBN 978-0-9739335-3-6
- "Doxepin Prices, Coupons & Patient Assistance Programs". Drugs.com. Retrieved February 20, 2022.
- "Doxepin topical Prices, Coupons & Patient Assistance Programs". Drugs.com. Retrieved February 20, 2022.
antagonist A chemical that reduces or helps block the activity of another chemical in the body. For example, most antihistamines are H1 antagonists because they block the H1 histamine receptor, which helps relieve allergy symptoms. The opposite of an agonist.
adverse reaction Any unintended or unwanted response to a treatment, whether in a clinical trial or licensed treatment. May be minor or serious.