From the Guidelines
Doxepin is contraindicated in patients with a history of suicidal tendencies, particularly children and young adults with depression, as it may increase suicidal tendencies 1. When considering the use of doxepin, it is essential to weigh the potential benefits against the risks, especially in vulnerable populations.
Key Contraindications
- Patients with a history of suicidal tendencies, especially children and young adults with depression, should avoid doxepin due to the potential increase in suicidal tendencies 1.
- Elderly patients should use doxepin with caution, as they are more susceptible to anticholinergic effects, such as cognitive decline, and orthostatic hypotension 1.
- Doxepin may be contraindicated in patients with certain medical conditions, such as glaucoma, urinary retention, or severe prostatic hypertrophy, due to its anticholinergic effects.
Special Considerations
- Patients taking monoamine oxidase inhibitors (MAOIs) should not use doxepin, and a washout period of at least 14 days is required when switching between these medications to prevent serotonin syndrome.
- Pregnant and breastfeeding women should avoid doxepin unless the benefits clearly outweigh the risks, as it can pass through the placenta and into breast milk.
Potential Risks
- Doxepin can cause drowsiness and cognitive decline, particularly in the elderly, which may impact daily activities and increase the risk of falls 1.
- The use of doxepin in patients with a history of seizure disorders should be approached with caution, as it can lower the seizure threshold.
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
Doxepin Contraindications
- Doxepin is a tricyclic antidepressant with potential cardiovascular effects, making it essential to consider contraindications in patients with preexisting heart conditions 3.
- A study published in The Journal of Clinical Psychiatry found that doxepin did not have a robust effect on heart rate, but it did cause a significant increase in orthostatic hypotension and slowed cardiac conduction in depressed patients with heart disease 3.
- The same study reported that 16% of patients dropped out due to cardiovascular side effects, and the overall dropout rate was 41%, indicating that doxepin may not be well-tolerated in patients with heart disease 3.
- There is no direct evidence in the provided studies to suggest that doxepin is contraindicated in patients with a specific condition, but its cardiovascular effects should be considered when prescribing the medication 3.
- Other studies, such as the one published in Circulation, discuss the effects of selective serotonin reuptake inhibitors (SSRIs) on myocardial infarction, but do not provide information on doxepin contraindications 4.
- A study on taxanes and hypersensitivity reactions does not provide relevant information on doxepin contraindications 5.