From the Guidelines
Doxepin is contraindicated in patients with known hypersensitivity to doxepin or other tricyclic antidepressants, and its use should be avoided in patients with a history of suicidal thoughts or behavior, particularly children and young adults with depression, due to the risk of increased suicidal tendencies 1. When considering the use of doxepin, it is essential to weigh the potential benefits against the risks, particularly in vulnerable populations such as the elderly, who may be more susceptible to anticholinergic effects, including cognitive decline and increased risk of falls and confusion 1. Some key points to consider when evaluating the contraindications for doxepin include:
- History of allergic reactions to tricyclic antidepressants or doxepin
- Presence of severe urinary retention or closed-angle glaucoma
- Recent use of monoamine oxidase inhibitors (MAOIs) within the past 14 days
- Cardiovascular disease, seizure disorders, thyroid disorders, or hepatic or renal impairment, which may require cautious use
- Pregnancy or breastfeeding, as doxepin can be excreted in breast milk and may pose risks to the fetus or newborn
- History of suicidal thoughts or behavior, which necessitates close monitoring, especially during initial treatment or dose changes It is crucial to carefully assess these factors and consider alternative treatment options when doxepin is contraindicated or its use is not recommended, prioritizing the patient's safety and well-being above all else.
From the FDA Drug Label
Doxepin Hydrochloride Capsules are contraindicated in individuals who have shown hypersensitivity to the drug. Possibility of cross sensitivity with other dibenzoxepines should be kept in mind Doxepin Hydrochloride Capsules are contraindicated in patients with glaucoma or a tendency to urinary retention.
The contraindications for doxepin are:
- Hypersensitivity to the drug
- Cross sensitivity with other dibenzoxepines
- Glaucoma
- Tendency to urinary retention 2
From the Research
Contraindications for Doxepin
- Doxepin is a tricyclic antidepressant that may exacerbate certain medical conditions, including:
- Glaucoma: Patients with narrow iridocorneal angles are at risk of angle closure, which can be triggered by doxepin's anticholinergic mechanisms 3
- Renal damage: Doxepin may worsen renal injury, particularly in obese individuals 4
- Nonalcoholic fatty liver disease: Doxepin has been shown to increase fatty liver scores and worsen liver damage in obese mice 4
- Diabetes: Doxepin may exacerbate insulin resistance and glucose intolerance 4
- Patients with certain medical conditions, such as hypermetropia (near-sightedness), older adults, and individuals with an Asian background, may be at higher risk of developing angle closure glaucoma when taking doxepin 3, 5
- Doxepin may not be suitable for patients with a history of urinary chromium loss, as it may increase urinary excretion of chromium 4