Doxepin (Sinequan)
TCA • Last reviewed 2025-09-27
General information
Doxepin is a tertiary amine TCA indicated for depression and anxiety disorders; low-dose formulations (Silenor) treat insomnia via strong antihistamine action.
It has among the most potent H1 antagonism of TCAs, leading to pronounced sedation and weight gain.
Therapeutic drug monitoring (target combined doxepin + nordoxepin 150–250 ng/mL) optimizes efficacy and safety.
Potent anticholinergic effects can precipitate urinary retention, blurred vision, and worsening narrow-angle glaucoma; monitor high-risk patients closely.
Dosing & administration
Depression/anxiety: start 25–50 mg nightly; increase by 25–50 mg every few days to 75–300 mg/day (divided or bedtime).
Insomnia: 3–6 mg taken 30 minutes before bedtime (do not exceed 6 mg).
Use lower doses in elderly or hepatic impairment.
Mechanism of action
Inhibits serotonin and norepinephrine reuptake while potently antagonizing histamine H1, muscarinic, and alpha-1 receptors.
Metabolism & pharmacokinetics
Peak concentrations 2–3 h post-dose. Metabolized hepatically via CYP2D6/CYP2C19 to nordoxepin. Half-life ~28–31 h (longer in elderly).
Drug interactions
Avoid MAOIs; allow 14-day washouts.
CYP2D6 inhibitors (fluoxetine, paroxetine, quinidine) elevate levels; enzyme inducers reduce efficacy.
Additive sedation with alcohol, benzodiazepines, antihistamines.
Monitoring & safety checks
Plasma level (goal 150–250 ng/mL combined)
Assess for anticholinergic burden
Discontinuation guidance
Taper gradually over ≥4 weeks to minimize insomnia, nausea, and cholinergic rebound.
References
- Doxepin Prescribing Information — DailyMed
- CANMAT guidance on tertiary amine TCAs (2024)
- Silenor (doxepin) insomnia label — DailyMed (2023)
Educational use only — verify details in current prescribing information and authoritative clinical guidelines before making prescribing decisions.