Can I stop taking doxepin (Sinequan) 10mg?

Discontinuing Doxepin 10 mg

Do not stop doxepin 10 mg abruptly—gradual tapering is essential to avoid withdrawal symptoms including anxiety, insomnia, dizziness, and sensory disturbances. 1

Withdrawal Risk and Symptoms

• Abrupt discontinuation of doxepin can cause withdrawal symptoms that are not indicative of addiction but reflect physiological adaptation to the medication 1
• Withdrawal symptoms may include: dizziness, fatigue, lethargy, general malaise, myalgias, chills, headaches, nausea, vomiting, diarrhea, insomnia, imbalance, vertigo, sensory disturbances, paresthesias, anxiety, irritability, and agitation 1
• The FDA drug label explicitly states: "The possibility of development of withdrawal symptoms upon abrupt cessation of treatment after prolonged Doxepin administration should be borne in mind" 1

Recommended Tapering Approach

Gradual dose reduction over several weeks is the safest approach:

• Start by reducing the dose by 10% of the original dose per week as a reasonable baseline tapering strategy 2
• For patients on 10 mg, this could mean reducing by 1 mg per week, though even slower tapers (10% per month) may be better tolerated, particularly if the medication has been used long-term 2
• The taper should be slow enough to minimize withdrawal symptoms—if symptoms emerge, pause the taper and restart when the patient is ready 2
• Consider that tapers may need to be slowed further once reaching very low doses 2

Clinical Context Considerations

The decision to discontinue should account for why doxepin was prescribed:

• If prescribed for insomnia (common at 10 mg dose), assess whether the underlying sleep disorder has resolved or if alternative treatments are in place 2, 3, 4
• Low-dose doxepin (3-6 mg) has demonstrated efficacy for sleep maintenance with small to medium effect sizes 4
• If prescribed for depression or anxiety, ensure adequate alternative treatment is established before discontinuation 2, 5
• The anti-anxiety effect of doxepin appears before the antidepressant effect, and optimal antidepressant effect may take 2-3 weeks 1

Monitoring During Discontinuation

Close monitoring is essential throughout the tapering process:

• Watch for emergence of original symptoms (insomnia, anxiety, depression) that may indicate need for continued treatment or alternative therapy 1
• Monitor for withdrawal symptoms at each dose reduction 2
• Be particularly vigilant in elderly patients who may be more susceptible to adverse effects during discontinuation 1
• Consider that some patients may experience rebound insomnia even with gradual tapering 3

Special Populations

Elderly and medically complex patients require extra caution:

• Elderly patients should be monitored more closely due to increased sensitivity to side effects and withdrawal symptoms 1
• Patients with hepatic or renal impairment may require slower tapers due to altered drug metabolism 1
• Sedating drugs like doxepin can cause confusion and oversedation in the elderly, making careful dose reduction particularly important 1

Common Pitfall to Avoid

The most critical error is abrupt discontinuation without tapering. Even at the relatively low dose of 10 mg, withdrawal symptoms can occur and cause significant distress 1. Always implement a gradual taper unless there is an urgent medical reason for immediate cessation (such as severe adverse reaction or overdose) 1.