Doxepin, Oral Capsule

FDA warning: Suicide risk

This drug has boxed warnings. These are the most serious warnings from the Food and Drug Administration (FDA). Boxed warnings alert doctors and patients about drug effects that may be dangerous.

• Suicide risk: Antidepressant drugs, such as doxepin, may cause you to have suicidal thoughts or behaviors. This risk may be especially high during the first few months of treatment or when changing doses. Children, teenagers, and young adults have an increased risk. You and your family members, caregivers, and doctor should pay attention to changes in your mood, behaviors, thoughts, or feelings while you take this drug.

Other warnings

• Drowsiness warning: You shouldn’t drive, use machinery, or do other activities that require alertness until you know how this drug affects you.
• Dementia warning: Research has indicated that this type of medication can cause effects similar to those caused by drugs called anticholinergics. This can raise your risk of dementia.

Doxepin is a prescription drug. It comes as an oral tablet, oral capsule, oral solution, and topical cream.

Doxepin oral capsule doesn’t have a brand-name version. It’s only available as a generic drug. Generic drugs usually cost less than brand-name drugs.

Why it’s used

Doxepin oral capsule is used to treat mood disorders, such as depression and anxiety.

How it works

Doxepin belongs to a class of drugs called tricyclic antidepressants. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

It isn’t known exactly how doxepin works to treat depression or anxiety. It may block your brain from reabsorbing norepinephrine, a chemical messenger that affects your mood. This action increases the levels of norepinephrine in your body, which helps improve your mood.

Doxepin oral capsule may cause drowsiness. You shouldn’t drive, use machinery, or do other activities that require alertness after taking this drug until you know how it affects you.

This drug can also cause other side effects.

More common side effects

Some of the more common side effects that can occur with use of doxepin include:

• drowsiness
• dizziness
• dry mouth
• blurred vision
• constipation
• trouble urinating
• nausea or vomiting
• upset stomach
• changes in how foods taste
• weight gain

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk with your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Suicidal thoughts and behaviors and worsening depression. Symptoms can include:
  • thoughts about suicide or dying
  • attempts to commit suicide
  • new or worsened symptoms of anxiety
  • feeling very agitated or restless
  • panic attacks
  • trouble sleeping (insomnia)
  • new or worsened irritability
  • acting aggressive, angry, or violent
  • acting on dangerous impulses
  • an extreme increase in activity and talking (mania)
  • other unusual changes in your behavior or mood
• Urinary retention (problems urinating). Symptoms include:
  • not being able to empty your bladder
  • painful or urgent need to urinate
  • pain or bloating in your lower belly
  • feeling like you cannot completely empty your bladder when you urinate

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare professional who knows your medical history.

Doxepin oral capsule can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk with your doctor or pharmacist.

Examples of drugs that can cause interactions with doxepin are listed below.

Drugs for stomach problems

Taking doxepin with certain drugs used to treat stomach problems can increase the amount of doxepin in your body. This can raise your risk of side effects. If you take these drugs together, your doctor may lower your dosage of doxepin or monitor you for side effects.

Examples of these drugs used to treat stomach problems include:

• cimetidine

Antidepressant drugs

Taking doxepin with drugs called monoamine oxidase inhibitors (MAOIs) may lead to serious side effects and even death. You shouldn’t take doxepin if you’re taking MAOIs or if you have used MAOIs within the past 14 days.

Examples of MAOIs include:

• isocarboxazid
• selegiline
• phenelzine
• tranylcypromine

Also, taking doxepin with other drugs used to treat depression and anxiety can increase the amount of doxepin in your body. This can raise your risk of side effects. Examples of these drugs include:

• bupropion
• duloxetine
• fluoxetine
• fluvoxamine
• paroxetine
• sertraline

Antifungal drugs

Taking doxepin with certain drugs used to treat fungal infections can increase the amount of doxepin in your body. This can raise your risk of side effects. Examples of these drugs include:

• fluconazole
• terbinafine
• voriconazole

Heart rhythm drugs

Taking doxepin with certain drugs used to treat heart rhythm problems can increase your risk of dangerous heart rhythm problems. Examples of these drugs include:

• dronedarone
• quinidine

Kidney disease drug

Taking cinacalcet with doxepin can increase the amount of doxepin in your body. This can raise your risk of side effects.

Diabetes drug

Taking tolazamide with doxepin can lead to dangerously low blood sugar levels.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare professional about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you’re taking.

This drug comes with several warnings.

Allergy warning

Doxepin can cause a severe allergic reaction. Symptoms can include:

• trouble breathing
• swelling of your throat or tongue
• itching
• hives

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Alcohol interaction warning

The use of drinks that contain alcohol can increase the drowsiness you feel from doxepin. If you drink alcohol, talk with your doctor.

Warnings for people with certain health conditions

For people with glaucoma: You shouldn’t take this drug if you have glaucoma. It can worsen your condition.

For people with problems urinating: You shouldn’t take this drug if you have urinary problems, such as trouble urinating. It can worsen your condition.

Warnings for other groups

For pregnant women: It is not known if doxepin is safe for use in pregnant women.

Tell your doctor if you’re pregnant or plan to become pregnant. Doxepin should be used during pregnancy only if the potential benefit justifies the potential risk.

For women who are breastfeeding: Doxepin may pass into breast milk and may cause side effects in a child who is breastfed. These effects include drowsiness and breathing problems.

Talk with your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

For seniors: Seniors may be more sensitive to doxepin. This may make them more likely to feel confused or drowsy while taking the drug.

For children: Doxepin has not been established as safe or effective for use in children younger than 12 years. It should not be used in people in this age range.

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

• your age
• the condition being treated
• the severity of your condition
• other medical conditions you have
• how you react to the first dose

Drug form and strengths

Generic: Doxepin

• Form: oral capsule
• Strengths: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg

Dosage for depression

Adult dosage (ages 18 to 64 years)

• Typical starting dosage: 75 mg per day. Your doctor may tell you to take the entire dose at once, or divide it into smaller doses throughout the day.
• Dosage adjustments: Your doctor will adjust your dosage depending on how your body responds to the drug. The usual dosage range is 75 to 150 mg per day. For severe depression, your doctor may increase your dosage to 300 mg per day. For very mild depression, dosage as low as 25 to 50 mg per day may be used.
• Maximum dosage: 300 mg per day. If given once daily, the maximum dosage is 150 mg per day, which may be given at bedtime.

Child dosage (ages 12 to 17 years)

• Typical starting dosage: 75 mg per day. Your doctor may tell you to take the entire dose at once, or divide it into smaller doses throughout the day.
• Dosage adjustments: Your doctor will adjust your dosage depending on how your body responds to the drug. The usual dosage range is 75 to 150 mg per day. For severe depression, your doctor may increase your dosage to 300 mg per day. For very mild depression, dosage as low as 25 to 50 mg per day may be used.
• Maximum dosage: 300 mg per day. If given once daily, the maximum dosage is 150 mg per day, which may be given at bedtime.

Child dosage (ages 0 to 11 years)

It isn’t known if doxepin is safe and effective for children younger than 12 years.

Senior dosage (ages 65 years and older)

The liver and kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, a higher amount of a drug stays in your body for a longer time. This increases your risk of side effects.

Your doctor may start you on a lower dosage or a different medication schedule. This can help keep levels of this drug from building up too much in your body.

Dosage for anxiety

Adult dosage (ages 18 to 64 years)

• Typical starting dosage: 75 mg per day. Your doctor may tell you to take the entire dose at once, or divide it into smaller doses throughout the day.
• Dosage adjustments: Your doctor will adjust your dosage depending on how your body responds to the drug. The usual dosage range is 75 to 150 mg per day. For severe anxiety, your doctor may increase your dosage to 300 mg per day. For very mild anxiety, dosage as low as 25 to 50 mg per day may be used.
• Maximum dosage: 300 mg per day. If given once daily, the maximum dosage is 150 mg per day, which may be given at bedtime.

Child dosage (ages 12 to 17 years)

• Typical starting dosage: 75 mg per day. Your doctor may tell you to take the entire dose at once, or divide it into smaller doses throughout the day.
• Dosage adjustments: Your doctor will adjust your dosage depending on how your body responds to the drug. The usual dosage range is 75 to 150 mg per day. For severe depression, your doctor may increase your dosage to 300 mg per day. For very mild depression, dosage as low as 25 to 50 mg per day may be used.
• Maximum dosage: 300 mg per day. If given once daily, the maximum dosage is 150 mg per day, which may be given at bedtime.

Child dosage (ages 0 to 11 years)

It isn’t known if doxepin is safe and effective for children younger than 12 years.

Senior dosage (ages 65 years and older)

The liver and kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, a higher amount of a drug stays in your body for a longer time. This increases your risk of side effects.

Your doctor may start you on a lower dosage or a different medication schedule. This can help keep levels of this drug from building up too much in your body.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Your symptoms of depression should start to improve after you’ve been taking doxepin oral capsule for two to three weeks. Your symptoms of anxiety should start to improve sooner than that.

Doxepin oral capsule is used for short- or long-term treatment. It comes with risks if you don’t take it as prescribed.

If you stop taking the drug or don’t take it at all: You may still have symptoms of depression or anxiety. If you’ve been taking this drug for a long time, you shouldn’t stop taking it suddenly. Stopping it suddenly may cause side effects. These include nausea, headache, and tiredness.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You could have dangerous levels of the drug in your body. You may have the following symptoms:

• abnormal heart rhythms
• low blood pressure
• sudden involuntary body movements
• overactive reflexes
• muscle stiffness
• confusion
• trouble concentrating
• coma
• drowsiness
• hallucinations (seeing things that aren’t real)
• dilated pupils
• agitation
• vomiting
• very low body temperature or very high fever
• seizures
• coma

If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 1-800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working: You should have fewer symptoms of depression or anxiety. You may be in a better mood. It may take two to three weeks of treatment with this drug for your symptoms of depression to improve. Your symptoms of anxiety should improve sooner than that.

Keep these considerations in mind if your doctor prescribes doxepin for you.

General

• You can take doxepin with or without food. Taking it with food may help to reduce your risk of upset stomach.
• Doxepin oral capsule can be opened, and the powder can be mixed with water.

Storage

• Store doxepin at room temperature between 68°F and 77°F (20°C and 25°C).
• Protect this drug from light.
• Keep this drug in the container it came in, with the lid tightly closed.
• Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don’t worry about airport X-ray machines. They can’t harm your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

You and your doctor should monitor certain health issues. This can help make sure you stay safe while you take this drug. These issues include:

• Mood: Pay close attention to sudden changes in your mood, behaviors, thoughts, or feelings. If you have any unusual changes, call your doctor right away.
• Vision: This drug may cause vision problems. Your doctor may examine your eyes.

Availability

Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk with your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.