Doxepin
Doxepin hydrochloride or doxepin is tricyclic antidepressant which is also used for many other conditions in non-depressed people including:
- 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)[1][2]
Doxepin is a similar drug to amitriptyline and nortriptyline, but also has antihistamine effects.
Doxepin is also sold under the brand names Silenor, Sinequan, Prudoxin. and Zonalon.[2][1]
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.[3][4]
Evidence[edit | edit source]
ME/CFS[edit | edit source]
Doxepin is not recommended as a first-line antidepressant for ME/CFS patients.[3][4]
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.[4]
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.[3]
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.[1]
Costs and availability[edit | edit source]
Doxepin is a perscription only drug which is inexpensive in capsule form, and generic forms are widely available.[5] It is available as a tablet/capsule, oral solution and for pruritus as a topical treatment to be applied to the skin.[1][2]
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.[5]
Doxepin topical cream is approximately $625 for 45g (5% strength). Topical brand names include Zonalon and Prudoxin.[6]
See also[edit | edit source]
Learn more[edit | edit source]
- Doxepin - MedlinePlus
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 Almasi, Anasheh; Meza, Carlos E. (2022). Doxepin. Treasure Island (FL): StatPearls Publishing. PMID 31194446.
- ↑ 2.0 2.1 2.2 "Doxepin (Depression, Anxiety)". MedlinePlus Drug Information. Retrieved February 20, 2022.
- ↑ 3.0 3.1 3.2 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, AC 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
- ↑ 4.0 4.1 4.2 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
- ↑ 5.0 5.1 "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.
