Doxepin, Oral

What are other names for this medicine?

Type of medicine: tricyclic antidepressant

Generic and brand names: doxepin, oral; Sinequan

What is this medicine used for?

This medicine is taken by mouth to relieve anxiety and depression.

It may be used for other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• an allergic reaction to any medicine
• diabetes
• glaucoma
• heart problems or a heart attack
• high or low blood pressure
• liver or kidney disease
• a mental disorder such as schizophrenia, paranoia, or bipolar disorder
• thyroid disorder
• seizures
• problems with alcohol or substance abuse
• urinary retention (cannot urinate)

Also tell your provider if you have taken MAO inhibitors such as phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl), or isocarboxazid (Marplan) within the past 2 weeks.

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I take it?

Check the label on the medicine for directions about your specific dose. Take this medicine exactly as your healthcare provider prescribes.

This medicine may take several weeks to work. Take this medicine exactly as your healthcare provider prescribes. Do not take more or less or take it longer than prescribed. Do not stop taking this medicine without your healthcare provider's approval. You may have to reduce your dosage gradually.

What if I miss a dose?

If you miss a dose, take it as soon as you remember unless it is almost time for the next scheduled dose. If you take only one dose at bedtime and you miss the dose, do not take the medicine in the morning. Wait until the next night. Skip the missed dose and take the next one as directed. Do not take double doses. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: irregular heartbeat, extreme drowsiness, restlessness, vomiting, blurred vision, confusion, hallucinations, muscle stiffness, lightheadedness, fever, chills, fainting, seizures, coma.

What should I watch out for?

Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment. Talk with your provider about this.

Behavior changes may be caused by the medicine or by depression or another mental illness. Contact your provider right away if you or your family notice any disturbing changes in your thoughts or behavior, such as:

• more outgoing or aggressive behavior than normal
• confusion
• hallucinations
• worsening of depression
• suicidal thoughts

If you need to take this medicine for more than a few days, do not stop taking it suddenly. You may have to reduce your dosage gradually to avoid withdrawal symptoms. Follow your healthcare provider's instructions.

This medicine may decrease sex drive or cause impotence in men (trouble having and keeping an erection).

This medicine may cause weight gain. Ask your healthcare provider about this.

You may need regular blood tests to find out how this medicine affects your blood and your liver. Keep all appointments for these tests.

This medicine may increase the effects of alcohol and other drugs that slow down your nervous system. Do not drink alcohol or take other medicines unless your healthcare provider approves.

This medicine may cause drowsiness or blurred vision. Do not drive or operate machinery unless you are fully alert and can see clearly.

This medicine may make you may feel dizzy if you get up quickly after sitting or lying down. Getting up slowly may help.

Before you have any kind of surgery or emergency treatment, tell the healthcare provider you are taking this medicine.

This medicine may make your skin more sensitive to the sun and may cause you to sunburn more easily. While you are taking this medicine, avoid long exposure to the sun. While you are in the sun, wear protective clothing and sunscreen lotion until you know how you will react to the sun. Do not use a sunlamp. If you get a severe sunburn, contact your healthcare provider right away.

This medicine may cause dry mouth. Sucking hard candy, taking sips of water, or chewing sugarless gum may help.

Adults over the age of 65 may be at greater risk for side effects. Talk with your healthcare provider about this.

Diabetics: This medicine may affect your blood sugar level and change the amount of insulin or other diabetes medicines you may need. Talk to your healthcare provider about this.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Serious (report these to your healthcare provider right away): Loss of bladder control; seizures; unusual weakness or tiredness; trouble breathing; high fever with rash; inability to urinate; rapid heartbeat; fever with increased sweating; severe muscle stiffness; twitching or involuntary movement of your body or face; fainting spells, yellowing of the skin or eyes; tingling, pain, or numbness in the feet or hands; confusion; hallucinations; unexplained sore throat.

Other: Headache, dizziness, drowsiness, dry mouth, nausea, vomiting, bad taste, itching, weight gain or loss, constipation, diarrhea, stomach pain, blurred vision, abnormal production of milk in women, testicle swelling in men, breast enlargement, nightmares, change in sexual ability or desire.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• alcohol
• antibiotics such as ciprofloxacin (Cipro), levofloxacin (Levaquin), clarithromycin (Biaxin), erythromycin (Ery-tab, E.E.S.), norfloxacin (Noroxin), ofloxacin (Floxin), and moxifloxacin (Avelox)
• antiarrhythmics (medicine to treat irregular heartbeat) such as amiodarone (Cordarone, Pacerone), flecainide (Tambocor), procainamide (Pronestyl), propafenone (Rythmol), and quinidine
• anticholinergic medicines such as amantadine (Symmetrel), procyclidine (Kemadrin), trihexyphenidyl, dicyclomine (Bentyl), atropine sulfate, belladonna, propantheline (Pro-Banthine), methscopolamine (Pamine), benztropine (Cogentin), hyoscyamine (Levsin, Levsinex), ipratropium (Atrovent), scopolamine (Isopto Hyoscine, Transderm Scop), and tolterodine (Detrol)
• antidepressants such as duloxetine (Cymbalta), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Lexapro), and bupropion (Wellbutrin, Zyban)
• antifungal medicines such as fluconazole (Diflucan) and terbinafine (Lamisil)
• antihistamines such as diphenhydramine (Benadryl), hydroxyzine (Atarax, Vistaril), meclizine (Antivert, Dramamine), and chlorpheniramine (Chlor-Trimeton)
• anti-HIV medicines such as indinavir (Crixivan), nelfinavir (Viracept), nevirapine (Viramune), delavirdine (Rescriptor), ritonavir (Norvir), and saquinavir (Fortovase, Invirase)
• antinausea medicines such as prochlorperazine (Compazine) and promethazine (Phenergan)
• antipsychotic medicines such as chlorpromazine (Thorazine), fluphenazine (Prolixin, Permitil), haloperidol (Haldol), perphenazine, trifluoperazine (Stelazine), promazine (Sparine), olanzapine (Zyprexa), risperidone (Risperdal), ziprasidone (Geodon), and thioridazine
• antiseizure medicines such as carbamazepine (Tegretol), primidone (Mysoline), gabapentin (Neurontin), felbamate (Felbatol), lamotrigine (Lamictal), levetiracetam (Keppra), topiramate (Topamax), valproic acid (Depacon, Depakene, Depakote), oxcarbazepine (Trileptal), tiagabine (Gabitril), and phenytoin (Dilantin)
• birth control pills and estrogen products such as estradiol (Estrace, Estratab), conjugated estrogens (Premarin), norethindrone (Aygestin, Micronor), norgestrel (Ovrette), megestrol (Megace), and medroxyprogesterone (Provera, Curretab, Cycrin)
• beta blockers such as atenolol (Tenormin), acebutolol (Sectral), betaxolol (Kerlone), carteolol, bisoprolol (Zebeta), pindolol, metoprolol (Lopressor, Toprol XL), timolol, sotalol (Betapace), nadolol (Corgard), propranolol (Inderal), labetalol (Normodyne, Trandate), and carvedilol (Coreg)
• calcium channel blockers such as diltiazem (Cardizem, Dilacor, Tiamate, Tiazac), nicardipine (Cardene), nifedipine (Procardia, Adalat), isradipine (DynaCirc), felodipine (Plendil), amlodipine (Norvasc), and verapamil (Calan, Isoptin, Verelan)
• medicine that reduces the chance of blood clots forming such as warfarin (Coumadin)
• clonidine (Catapres)
• cold and flu medicines, especially antihistamines and decongestants
• diabetes medicines such as insulin, chlorpropamide (Diabinese), tolazamide (Tolinase), glyburide (DiaBeta, Micronase), glipizide (Glucotrol), repaglinide (Prandin), metformin (Glucophage), rosiglitazone (Avandia), and pioglitazone (Actos)
• disulfiram (Antabuse)
• epinephrine
• heartburn medicines such as cimetidine (Tagamet), famotidine (Pepcid, Pepcid AC, Pepcid Complete), nizatidine (Axid), and ranitidine (Zantac, Zantac 75)
• herbal remedies such as St. John's wort, kava, gotu kola, valerian and SAMe
• lithium (Eskalith, Eskalith CR, Lithobid)
• MAO inhibitor antidepressants such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl), and tranylcypromine (Parnate) (Do not take an MAO inhibitor and this medicine within 14 days of each other.)
• medicines to treat Parkinson's disease such as bromocriptine (Parlodel), levodopa/carbidopa (Sinemet), pergolide (Permax), pramipexole (Mirapex), ropinirole (Requip), cabergoline (Dostinex), and entacapone (Comtan)
• methylphenidate (Concerta, Metadate CD, Methylin, Ritalin, Ritalin LA, Ritalin SR)
• metoclopramide (Reglan)
• muscle relaxants such as cyclobenzaprine (Flexeril), carisoprodol (Soma), tizanidine (Zanaflex), methocarbamol (Robaxin), and baclofen (Lioresal)
• nicotine (smoking) and nicotine replacement products such as Habitrol, NicoDerm, Nicorette, Commit, NicoDerm CQ, Nicotrol Inhaler, Nicotrol NS, Nicotrol Patch
• pain medicine such as codeine, hydrocodone (Vicodin, Lortab), oxycodone (Percocet, Tylox, OxyContin), morphine (MS Contin), propoxyphene (Darvocet N-100), pentazocine (Talwin), meperidine (Demerol), fentanyl (Duragesic patches), methadone (Dolophine), tramadol (Ultram), and hydromorphone (Dilaudid)
• procarbazine (Matulane)
• sedatives such as alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), phenobarbital (Solfoton), butabarbital (Butisol), pentobarbital (Nembutal), flurazepam (Dalmane), temazepam (Restoril), triazolam (Halcion), oxazepam (Serax), zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta), and chloral hydrate
• thyroid medicine such as levothyroxine (Synthroid), thyroid (Armour Thyroid, Nature-Throid, Westhroid), liotrix (Thyrolar), and liothyronine (Cytomel, Triostat)

The effects of this medicine may be increased if you take it with grapefruit juice. Talk with your healthcare provider about this.

Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.

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