Description and Brand Names

Drug information provided by: Merative, Micromedex®

US Brand Name

1. Silenor
2. SINEquan

Descriptions

Doxepin is used to treat anxiety or depression. It is also used to treat insomnia (trouble with sleeping).

Doxepin is a tricyclic antidepressant (TCA). It works on the central nervous system (CNS) to increase levels of certain chemicals in the brain.

This medicine is available only with your doctor's prescription.

This product is available in the following dosage forms:

• Tablet
• Capsule
• Solution

Before Using

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of doxepin capsules and solution for the treatment of depression and anxiety in children younger than 12 years of age. Safety and efficacy have not been established.

Appropriate studies have not been performed on the relationship of age to the effects of doxepin tablets for the treatment of insomnia in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of doxepin in the elderly. However, elderly patients are more likely to have unwanted effects (eg, confusion or unusual drowsiness) or age-related heart, liver, or kidney problems, which may require caution and an adjustment in the dose for patients receiving doxepin.

Breastfeeding

Studies in women breastfeeding have demonstrated harmful infant effects. An alternative to this medication should be prescribed or you should stop breastfeeding while using this medicine.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Bepridil
• Bromopride
• Cisapride
• Dronedarone
• Eliglustat
• Grepafloxacin
• Isocarboxazid
• Levoketoconazole
• Levomethadyl
• Linezolid
• Mesoridazine
• Methylene Blue
• Metoclopramide
• Moclobemide
• Pimozide
• Piperaquine
• Potassium Citrate
• Ranolazine
• Safinamide
• Saquinavir
• Sparfloxacin
• Terfenadine
• Thioridazine
• Tranylcypromine
• Ziprasidone

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Abiraterone Acetate
• Acecainide
• Aceclofenac
• Acemetacin
• Adagrasib
• Albuterol
• Alfentanil
• Almotriptan
• Amantadine
• Amiodarone
• Amisulpride
• Amitriptyline
• Amoxapine
• Amphetamine
• Amtolmetin Guacil
• Anagrelide
• Apomorphine
• Aripiprazole
• Aripiprazole Lauroxil
• Arsenic Trioxide
• Aspirin
• Astemizole
• Atazanavir
• Azimilide
• Benzhydrocodone
• Benzphetamine
• Bretylium
• Bromfenac
• Bufexamac
• Buprenorphine
• Bupropion
• Buserelin
• Butorphanol
• Carbamazepine
• Carisoprodol
• Celecoxib
• Ceritinib
• Chloroquine
• Choline Salicylate
• Citalopram
• Clarithromycin
• Clofazimine
• Clonidine
• Clonixin
• Clorgyline
• Clothiapine
• Clozapine
• Cobicistat
• Codeine
• Crizotinib
• Cyclobenzaprine
• Dabrafenib
• Darunavir
• Dasatinib
• Degarelix
• Delamanid
• Deslorelin
• Desmopressin
• Desvenlafaxine
• Deutetrabenazine
• Dexibuprofen
• Dexketoprofen
• Dexmedetomidine
• Dextroamphetamine
• Dextromethorphan
• Diclofenac
• Diflunisal
• Dihydrocodeine
• Dipyrone
• Disopyramide
• Dofetilide
• Dolasetron
• Domperidone
• Donepezil
• Droperidol
• Droxicam
• Duloxetine
• Efavirenz
• Encorafenib
• Enflurane
• Entrectinib
• Epinephrine
• Erythromycin
• Escitalopram
• Eslicarbazepine Acetate
• Etodolac
• Etofenamate
• Etoricoxib
• Etrasimod
• Felbinac
• Fenfluramine
• Fenoprofen
• Fentanyl
• Fepradinol
• Feprazone
• Fexinidazole
• Fingolimod
• Floctafenine
• Fluconazole
• Flufenamic Acid
• Fluoxetine
• Flurbiprofen
• Fluvoxamine
• Formoterol
• Foscarnet
• Fostemsavir
• Frovatriptan
• Gatifloxacin
• Gemifloxacin
• Gepirone
• Glasdegib
• Glucagon
• Glycopyrrolate
• Glycopyrronium Tosylate
• Gonadorelin
• Goserelin
• Granisetron
• Halofantrine
• Haloperidol
• Halothane
• Histrelin
• Hydrocodone
• Hydromorphone
• Hydroxychloroquine
• Hydroxytryptophan
• Hydroxyzine
• Ibuprofen
• Ibutilide
• Indomethacin
• Inotuzumab Ozogamicin
• Iobenguane I 123
• Iobenguane I 131
• Iproniazid
• Isoflurane
• Isradipine
• Ivabradine
• Ivosidenib
• Ketoconazole
• Ketoprofen
• Ketorolac
• Lasmiditan
• Lefamulin
• Lenvatinib
• LetibotulinumtoxinA-wlbg
• Leuprolide
• Levalbuterol
• Levofloxacin
• Levomilnacipran
• Levorphanol
• Lisdexamfetamine
• Lithium
• Lofexidine
• Lorcaserin
• Lornoxicam
• Loxapine
• Loxoprofen
• Lumiracoxib
• Macimorelin
• Meclofenamate
• Mefenamic Acid
• Meloxicam
• Meperidine
• Metaxalone
• Methacholine
• Methadone
• Methamphetamine
• Metronidazole
• Milnacipran
• Mirtazapine
• Mobocertinib
• Moricizine
• Morniflumate
• Morphine
• Morphine Sulfate Liposome
• Moxifloxacin
• Nabumetone
• Nafarelin
• Nalbuphine
• Naproxen
• Naratriptan
• Nebivolol
• Nefopam
• Nepafenac
• Niflumic Acid
• Nilotinib
• Nimesulide
• Nimesulide Beta Cyclodextrin
• Norepinephrine
• Octreotide
• Olanzapine
• Oliceridine
• Ondansetron
• Osilodrostat
• Osimertinib
• Oxaliplatin
• Oxaprozin
• Oxycodone
• Oxymetazoline
• Oxymorphone
• Oxyphenbutazone
• Ozanimod
• Pacritinib
• Palonosetron
• Panobinostat
• Parecoxib
• Pargyline
• Paroxetine
• Pasireotide
• Pazopanib
• Peginterferon Alfa-2b
• Pentamidine
• Pentazocine
• Phenelzine
• Phenylbutazone
• Piketoprofen
• Pimavanserin
• Piroxicam
• Pitolisant
• Ponesimod
• Posaconazole
• Pranoprofen
• Procainamide
• Procarbazine
• Prochlorperazine
• Proglumetacin
• Propyphenazone
• Proquazone
• Quetiapine
• Quinidine
• Quizartinib
• Rasagiline
• Relugolix
• Remifentanil
• Revefenacin
• Ribociclib
• Risperidone
• Rofecoxib
• Salicylic Acid
• Salsalate
• Scopolamine
• Secretin Human
• Selegiline
• Selpercatinib
• Sematilide
• Sertindole
• Sertraline
• Sevoflurane
• Siponimod
• Sodium Salicylate
• Solifenacin
• Sotalol
• Spiramycin
• Sufentanil
• Sulfamethoxazole
• Sulindac
• Sulpiride
• Sultopride
• Sumatriptan
• Sunitinib
• Tacrolimus
• Tamoxifen
• Tapentadol
• Tedisamil
• Telithromycin
• Tenoxicam
• Tiaprofenic Acid
• Tiotropium
• Tolfenamic Acid
• Tolmetin
• Tramadol
• Triclabendazole
• Trifluoperazine
• Trimethoprim
• Triptorelin
• Valdecoxib
• Vandetanib
• Vardenafil
• Vemurafenib
• Venlafaxine
• Vilanterol
• Vilazodone
• Vinflunine
• Voclosporin
• Vortioxetine
• Zolmitriptan
• Zotepine
• Zuclopenthixol

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Acenocoumarol
• Arbutamine
• Bethanidine
• Cimetidine
• Desogestrel
• Dicumarol
• Dienogest
• Drospirenone
• Ethinyl Estradiol
• Ethynodiol
• Fosphenytoin
• Gestodene
• Guanethidine
• Levonorgestrel
• Mestranol
• Nomegestrol
• Norethindrone
• Norgestimate
• Norgestrel
• Phenprocoumon
• Phenytoin
• Propoxyphene
• Ramelteon
• S-Adenosylmethionine
• Warfarin

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Bipolar disorder (mood disorder with mania and depression), or risk of or
• Breathing problems or
• Psychosis (mental illness) or
• Sleep apnea (breathing stops during sleeping), severe—Use with caution. May make these conditions worse.

• Glaucoma or
• Urinary retention (trouble urinating), severe—Should not be used in patients with these conditions.

• Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use

Take this medicine only as directed by your doctor to benefit your condition as much as possible. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

This medicine comes with a Medication Guide. Read and follow the instructions carefully. Ask your doctor if you have any questions.

If you are using the Sinequan® oral liquid or capsule once a day, you may take it at bedtime.

To use the Sinequan® oral liquid:

• Measure the dose with the calibrated dropper that comes with the medicine.
• Mix each dose with about one-half glass (4 ounces) of water, whole or skimmed milk, orange juice, grapefruit juice, tomato juice, prune juice, or pineapple juice. Do not mix this medicine with grape juice or carbonated beverages (soda pop). Mix the medicine just before taking the dose. Do not prepare it ahead of time.

To use the Silenor® tablet:

• Do not take this medicine within 3 hours of a meal. It may not work as well, or it might make you sleepy the next day if you take it with or right after a meal.
• Take the tablet 30 minutes before going to bed, when you are ready to go to sleep.
• Do not take the medicine unless you can get a full night's sleep (7 to 8 hours). If you wake up too soon, you may feel drowsy from the medicine.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage forms (capsules or solution):
  • For depression or anxiety:
    • Adults and children 12 years of age and older—At first, 75 milligrams (mg) once a day or in divided doses during the day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 150 mg per day.
    • Children younger than 12 years of age—Use is not recommended.
• For oral dosage form (tablets):
  • For insomnia:
    • Adults—6 milligrams (mg) once a day.
    • Older adults—At first, 3 mg once a day. Your doctor may adjust your dose as needed.
    • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions

It is very important that your doctor check the progress of you or your child at regular visits to allow for changes in the dose and to check for any unwanted effects.

For some children, teenagers, and young adults, this medicine can increase thoughts of suicide. Tell your doctor or your child's doctor right away if you or your child start to feel more depressed and have thoughts about hurting yourself. Report any unusual thoughts or behaviors that trouble you or your child, especially if they are new or are getting worse quickly. Make sure the doctor knows if you or your child have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Also tell the doctor if you or your child have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive illness) or has tried to commit suicide.

Do not take doxepin if you have taken a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid [Marplan®], phenelzine [Nardil®], selegiline [Eldepryl®], or tranylcypromine [Parnate®]) in the past 2 weeks. If you do, you may have confusion, agitation, restlessness, stomach or intestinal symptoms, a sudden high body temperature, an extremely high blood pressure, or severe convulsions.

If you or your child are using this medicine for depression or anxiety, do not stop taking it without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This may help prevent a possible worsening of your condition and reduce the possibility of withdrawal symptoms, such as headache, nausea, or a general feeling of discomfort or illness.

Silenor® tablets may cause sleep-related behaviors such as driving a car (sleep-driving), walking (sleep-walking), having sex, making phone calls, or preparing and eating food while asleep or not fully awake. If any of these reactions occur, tell your doctor right away.

If you think you need to take Silenor® tablets for 7 to 10 days, talk to your doctor.

This medicine may cause some people to become drowsy. Make sure you know how you react to this medicine before you drive, use medicines, or do anything else that could be dangerous if you are drowsy or not alert.

This medicine will add to the effects of alcohol and other CNS depressants (medicines that slow down the nervous system, possibly causing drowsiness). Some examples of CNS depressants are antihistamines or medicine for hay fever, allergies, or colds, sedatives, tranquilizers, or sleeping medicine, prescription pain medicine or narcotics, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. This effect may last for a few days after you stop taking this medicine. Check with your doctor before taking any of the above while you or your child are using this medicine.

Tell your doctor if you are pregnant or planning to become pregnant during treatment with this medicine. This medicine may cause symptoms of sedation (eg, breathing problems, sluggishness, low muscle tone, feeding problems, or withdrawal symptoms) in the baby during the third trimester.

Talk with your doctor before using this medicine if you plan to have children. Some men and women who use this medicine have become infertile (unable to have children).

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines) and herbal or vitamin supplements.

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Incidence not known

1. Agitation
2. black, tarry stools
3. bleeding gums
4. blood in the urine or stools
5. blurred vision
6. burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
7. canker sores
8. chest pain or tightness
9. chills
10. clay-colored stools
11. cold sweats
12. confusion about identity, place, and time
13. cool, pale skin
14. cough or hoarseness
15. dark urine
16. decrease in the frequency of urination
17. decrease in urine volume
18. decreased urine output
19. depression
20. difficulty in passing urine (dribbling)
21. difficulty with breathing
22. difficulty with speaking
23. dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
24. drooling
25. dry mouth
26. fast, pounding, or irregular heartbeat or pulse
27. feeling of warmth
28. fever
29. flushed, dry skin
30. fruit-like breath odor
31. general feeling of tiredness or weakness
32. headache
33. hearing loss
34. hostility
35. increased hunger
36. increased thirst
37. increased urination
38. irritability
39. itching or rash
40. lethargy
41. lip smacking or puckering
42. loss of appetite
43. loss of balance control
44. loss of bladder control
45. lower back or side pain
46. mood or mental changes
47. muscle spasm or jerking of all extremities
48. muscle trembling, jerking, or stiffness
49. muscle twitching
50. nausea
51. nervousness
52. nightmares
53. noisy breathing
54. painful or difficult urination
55. pinpoint red spots on the skin
56. pounding in the ears
57. puffing of the cheeks
58. rapid or worm-like movements of the tongue
59. rapid weight gain
60. redness of the face, neck, arms, and occasionally, upper chest
61. restlessness
62. ringing or buzzing or other unexplained noise in the ears that continues
63. seeing, hearing, or feeling things that are not there
64. seizures
65. shakiness and unsteady walk
66. shakiness in the legs, arms, hands, or feet
67. shuffling walk
68. sore throat
69. sores, ulcers, or white spots on the lips, tongue, or in the mouth
70. slurred speech
71. stiffness of the limbs
72. stomach pain
73. stupor
74. sudden loss of consciousness
75. sweating
76. swelling of the face, ankles, or hands
77. swollen glands
78. trouble breathing
79. twisting movements of the body
80. uncontrolled chewing movements
81. uncontrolled movements, especially of the arms, face, legs, neck, and back
82. unexplained weight loss
83. unpleasant breath odor
84. unsteadiness, trembling, or other problems with muscle control or coordination
85. unusual bleeding or bruising
86. unusual tiredness or weakness
87. vomiting of blood
88. yellow eyes or skin

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

1. Clumsiness
2. disturbed concentration
3. drowsiness
4. enlarged pupils
5. increased or excessive unconscious or jerking movements
6. low body temperature
7. muscle aches
8. muscle weakness
9. shivering
10. sleepiness
11. weak or feeble pulse
12. weight gain

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Incidence not known

1. Change in taste or bad, unusual or unpleasant (after) taste
2. decreased interest in sexual intercourse
3. diarrhea
4. difficulty having a bowel movement (stool)
5. enlargement of the breasts
6. gas in the stomach
7. hair loss or thinning of the hair
8. heartburn
9. inability to have or keep an erection
10. increased in sexual ability, desire, drive, or performance
11. increased interest in sexual intercourse
12. increased sensitivity of the skin to sunlight
13. loss in sexual ability, desire, drive, or performance
14. redness or other discoloration of the skin
15. severe sunburn
16. swelling of the breasts or breast soreness in both females and males
17. swelling of the testicles
18. unexpected or excess milk flow from breasts
19. weight loss

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Portions of this document last updated: April 01, 2024

Original article: https://www.mayoclinic.org/drugs-supplements/doxepin-oral-route/before-using/drg-20072083