Doxepin: Price, Dosage & Where to Buy

Doxepin is a tricyclic antidepressant used to treat depression, particularly when anxiety is also present. Its listed treatment targets include low mood, tension, worry and sleep disturbances associated with these conditions, and improvement in anxiety may appear before the antidepressant effect. Doxepin requires a prescription in the United Kingdom and is available in several oral forms as well as a topical cream.

The oral doxepin label describes treatment for depression and anxiety, including when these occur together. It also lists depression or anxiety associated with alcohol dependence or physical illness, although alcohol must not be used alongside doxepin. Other listed indications include depressive disorders with psychotic features and associated anxiety.

Symptoms described as responding to treatment include tension, worry, fear, low mood, guilt, lack of energy, disturbed sleep, and physical symptoms or concerns associated with emotional distress. The label also discusses manic-depressive disorders, but separately states that doxepin is not approved for bipolar depression and calls for screening for bipolar disorder before antidepressant treatment. These indications relate to the oral treatment label, rather than establishing uses for every available formulation.

Doxepin belongs to the tricyclic antidepressant family. Medicines in this family affect chemical messengers involved in communication between nerve cells, particularly serotonin and noradrenaline. By reducing the reabsorption of these messengers, they can help support signalling involved in mood and anxiety.

Tricyclic antidepressants also affect other receptors, which helps explain effects such as drowsiness, dry mouth and constipation. Changes in nerve signalling do not necessarily produce an immediate improvement in mood. The doxepin label describes relief of anxiety appearing before the full antidepressant effect.

The label lists oral capsules containing 10 mg, 25 mg, 50 mg, 75 mg, 100 mg and 150 mg, oral solution containing 10 mg/mL, oral tablets and film-coated tablets containing 3 mg and 6 mg, and topical cream containing 50 mg/g. The usual starting dose is 75 mg daily for most patients with mild to moderate illness. The label lists a usual optimum range of 75 mg/day to 150 mg/day, with gradual increases to 300 mg/day for more severe illness if necessary.

The label lists divided or once-daily administration of the total daily dosage, with a maximum of 150 mg/day for the once-daily schedule, which may be given at bedtime. The label lists the 150 mg capsule as intended for maintenance therapy only, not for starting treatment.

These oral treatment schedules are not dosing schedules for every formulation. Dose adjustments are described as depending on individual response, and the antidepressant effect may develop later than the anti-anxiety effect.

If a dose is missed, follow the medicine leaflet or ask a pharmacist for advice about the prescribed schedule. General pharmacy advice is to avoid doubling a dose to make up for a missed one.

If the next scheduled dose is close, the missed dose is usually skipped. Repeated missed doses should be discussed with the prescriber.

The label does not specify pregnancy or breastfeeding data. Anyone who is pregnant, planning a pregnancy or breastfeeding should discuss doxepin with a doctor or pharmacist so that treatment can be reviewed. The absence of information does not establish that use is safe during pregnancy or breastfeeding.

The capsule label specifies storage at 20° to 25°C and protection from light in a tightly closed, light-resistant container. For other formulations, follow the storage directions on the product label to maintain quality. Keep medicines out of the sight and reach of children.