Drug reference
Depressive illness (particularly where sedation is required) ▶BY MOUTH ▶Adult: Initially 75 mg daily in divided doses, Nervous system alternatively 75 mg once daily, adjusted according to response, dose to taken at bedtime; maintenance 25–300 mg daily, doses above 100 mg given in 3 divided doses ▶Elderly: Start with lower doses and adjust according to response
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Acute porphyrias p. 1120. during manic phase of bipolar disorder
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Arrhythmias. cardiovascular disease. chronic constipation. diabetes. epilepsy. heart block. history of bipolar disorder. history of psychosis. hyperthyroidism (risk of arrhythmias). immediate recovery period after myocardial infarction. increased intra-ocular pressure. patients with significant risk of suicide. phaeochromocytoma (risk of arrhythmias). prostatic hypertrophy. susceptibility to angle-closure glaucoma. urinary retention CAUTIONS, FURTHER INFORMATION Treatment should be stopped if the patient enters a manic phase. ▶Elderly Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects.
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Limited quantities of tricyclic antidepressants should be prescribed at any one time because their cardiovascular and epileptogenic effects are dangerous in overdosage.
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→Appendix 1: tricyclic antidepressants
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Agitation. agranulocytosis. alopecia. anticholinergic syndrome. appetite decreased. asthenia. asthma exacerbated. bone marrow depression. breast enlargement. cardiovascular effects. chills. confusion. constipation. diarrhoea. dizziness. drowsiness. dry mouth. dyspepsia. eosinophilia. face oedema. flushing. galactorrhoea. gynaecomastia. haemolytic anaemia. hallucination. headache. hyperhidrosis. hyperpyrexia. increased risk of fracture. jaundice. leucopenia. mania. movement disorders. nausea. oral ulceration. paranoid delusions. photosensitivity reaction. postural hypotension. psychosis. seizure. sensation abnormal. sexual dysfunction. SIADH. skin reactions. sleep disorders. suicidal tendencies. tachycardia. taste altered. testicular swelling. thrombocytopenia. tinnitus. tremor. urinary retention. vision blurred. vomiting. weight increased SIDE-EFFECTS, FURTHER INFORMATION The risk of side- effects is reduced by titrating slowly to the minimum effective dose (every 2–3 days). Consider using a lower starting dose in elderly patients. Overdose Tricyclic and related antidepressants cause dry mouth, coma of varying degree, hypotension, hypothermia, hyperreflexia, extensor plantar responses, convulsions, respiratory failure, cardiac conduction defects, and arrhythmias. Dilated pupils and urinary retention also occur. For details on the management of poisoning see Tricyclic and related antidepressants under Emergency treatment of poisoning p. 1430.
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Use with caution—limited information available.
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The amount secreted into breast milk is too small to be harmful. Accumulation of metabolite may cause sedation and respiratory depression in neonate.
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Manufacturer advises caution in mild to moderate impairment; avoid in severe impairment. Dose adjustments Manufacturer advises consider dose reduction in mild to moderate impairment.
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Use with caution.
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: capsule, oral suspension, oral solution Capsule CAUTIONARY AND ADVISORY LABELS 2 ▶Doxepin (Non-proprietary) Doxepin (as Doxepin hydrochloride) 25 mg Doxepin 25mg capsules | 28 capsule P £97.00 DT = £97.00 Doxepin (as Doxepin hydrochloride) 50 mg Doxepin 50mg capsules | 28 capsule P £154.00 DT = £154.00
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Withdrawal effects may occur within 5 days of stopping treatment with antidepressant drugs; they are usually mild and self-limiting, but in some cases may be severe. The risk of withdrawal symptoms is increased if the antidepressant is stopped suddenly after regular administration for 8 weeks or more. The dose Nervous system should preferably be reduced gradually over about 4 weeks, or longer if withdrawal symptoms emerge (6 months in patients who have been on long-term maintenance treatment). If possible tricyclic and related antidepressants should be withdrawn slowly.
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Driving and skilled tasks Drowsiness may affect performance of skilled tasks (e.g. driving). Effects of alcohol enhanced.
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Initially 75 mg daily in divided doses,
First-line fragment. Read the complete Indications and Dose section above.
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Start with lower doses and adjust according to
First-line fragment. Read the complete Indications and Dose section above.
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