Doxepin for insomnia
Low-dose doxepin may relieve sleep maintenance insomnia and is not designated as a controlled substance
Symptoms of withdrawal and rebound insomnia—an increase in WASO compared with baseline after discontinuing the medication—were assessed in a 35-day double-blind study of adults with chronic insomnia.1 There was no evidence of withdrawal syndrome as measured by Tyler’s Symptom Checklist after doxepin 3 mg and 6 mg was discontinued. Discontinuation period-emergent nausea and vomiting was noted in 5% of patients taking 6 mg of doxepin, but not in those taking placebo or 3 mg of doxepin. There was no evidence of rebound insomnia after doxepin 3 mg and 6 mg was discontinued.1
Contraindications
Doxepin is contraindicated in patients with hypersensitivity to doxepin hydrochloride, with severe urinary retention, with narrow angle glaucoma, and who have used monoamine oxidase inhibitors (MAOIs) within the previous 2 weeks. Serious adverse effects, including hypertensive crisis and death, have been reported with coadministration of MAOIs and certain drugs, such as serotonergic antidepressants and some opioids derivatives. There are no reports of concomitant use of doxepin with MAOIs.1
Dosing
In adults, the recommended hypnotic dose for doxepin is 6 mg taken 30 minutes before bedtime. For patients age ≥65, the recommended starting hypnotic dose is 3 mg 30 minutes before bedtime, which can be increased to 6 mg if indicated.1
Related Resources
- Doghramji K, Grewal R, Markov D. Evaluation and management of insomnia in the psychiatric setting. Focus. 2009;8(4):441-454.
- Psychiatric Clinics of North America. December 2006. All articles in this issue address sleep disorders encountered in psychiatric practice.
- National Sleep Foundation. www.sleepfoundation.org.
Drug Brand Names
- Amitriptyline • Elavil
- Cimetidine • Tagamet
- Desipramine • Norpramin
- Doxepin (3 mg and 6 mg) • Silenor
- Doxepin (10 to 150 mg, oral) • Sinequan
- Doxepin cream • Prudoxin
- Fluoxetine • Prozac
- Paroxetine • Paxil
- Ramelteon • Rozerem
Disclosure
The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
