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New Use For Antidepressants: Doxepin Can Ease Radiation-Related Pain

New research shows that the antidepressant doxepin, used as an oral rinse, helps patients with radiation-related mouth pain in head, neck cancer.

- by Alexia Severson

The Gist

Doxepin is delivered as a mouth rinse.Doxepin, an antidepressant used to treat a combination of symptoms of anxiety and depression, can also significantly ease pain associated with oral mucositis in patients receiving radiation therapy for cancers of the head and neck, according to a Mayo Clinic study presented today at the American Society for Radiation Oncology annual meeting in Boston.

Oral mucositis is the painful inflammation and ulceration of the mucous membranes lining the mouth, gums, tongue, and throat. It is a common and often debilitating side effect of radiation therapy and chemotherapy cancer treatments. But ongoing research into the effects of doxepin on oral mucositis shows that the pain associated with this kind of inflammation can be significantly reduced.

Doxepin is sold under the brand names Adapin, Silenor, and Sinequan, among others.

The Expert Take

In this study, researchers found that doxepin was well-tolerated and eased pain among patients with oral mucositis. However, a few subjects reported side effects, such as stinging, burning, unpleasant taste, and drowsiness. Given the option, 64 percent of the 155 participants decided to continue using doxepin after the study was complete.

"Oral mucositis or mouth sores is a painful and debilitating side effect of radiation therapy," said principal investigator Robert Miller, M.D., a radiation oncologist at Mayo Clinic. "Our findings represent a new standard of care for treating this condition."

While participants reported a few side effects, Miller said doxepin rinse does not cause the side effects associated with narcotic pain medicines, making it a better treatment for oral mucositis.

Source and Method

The Phase III study assessed the effectiveness of doxepin oral rinse versus a placebo in 155 patients receiving radiation therapy for head and neck cancer. Patients received a single blinded dose of doxepin on day one and crossed over to the opposite study arm on a subsequent day.

Patients reported pain associated with oral mucositis on a pain questionnaire with a scale of 0 to 10 administered at baseline and then at five, 15, 30, 60, 120 and 240 minutes after rinsing with doxepin.

The Takeaway

The results of this study could lead to more advanced treatments of patients with oral mucositis in future.  

According to the National Cancer Institute, “Erythematous mucositis typically appears seven to 10 days after initiation of high-dose cancer therapy” and that high-dose chemotherapy, such as that used in the treatment of leukemia and hematopoietic stem cell transplant regimens, is often the cause of severe mucositis.

The National Cancer Institute recommends these specific recommendations for minimizing the risk of severe oral mucositis in patients:

  • good oral hygiene
  • avoidance of spicy, acidic, hard, and hot foods and beverages
  • use of mild-flavored toothpastes
  • use of saline-peroxide mouthwashes three or four times per day

Other Research

Previous research has been conducted on the use of Doxepin to treat mucositis pain in patients with cancer. One study published in Special Care in Dentistry in 2008, assessed the effectiveness of oral doxepin rinse for mucositis-related pain management in patients following one week of repeated dosing. Statistically significant reductions in pain scores were reported for 2 hours following doxepin rinse during the initial visit and their pain significantly dropped within 5 minutes of rinsing over the week of repeated dosing. At the follow-up visit, subjects reported statistically significant pain reduction 5 minutes after doxepin rinsing, indicating that doxepin rinsing produces reduced intensity of pain levels over a 1-week span of repeated dosing.

And as part of an expansion on a prior study, research published in Anesthesia and Analgesia in 2006 continued to enroll patients with painful oral mucositis attributable solely to cancer therapy and performed further analysis on the duration of pain reduction. In the total sample, the average patient reported a 70 percent maximum decrease in pain and 37 percent of patients reported a reduction from baseline pain.

Similarly, a study published in Oral Oncology in 2001, also assessed the impact of doxepin oral rinse in the management of oral mucosal pain in cancer patients. Researchers found that Doxepin rinse resulted in a reduction of pain intensity of more than 50 percent, with pain relief extending for more than 3 hours with pain not returning to baseline 4 hours after rinsing.                                                             

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Tags: Drugs , Latest Studies & Research , Treatments

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