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Generic Sinequan Doxepin is ineffective for treating insomnia
(Doxepin)
Trade names
Doxepin.
Generic Sinequan
Subgroup
Antidepressant tricyclic structures derived dibenzoksepina.
Action
Pharmacological Effects:
* Antidepressant,
* Anxiolytic,
* Sedative,
* Antiulcer,
* Anticholinergic,
* Antiserotoninovoe,
* Antihistaminic,
* Spasmolytic,
* Vasodilator (moderate peripheral),
* Miorelaksiruyuschee,
* Anticonvulsant.
The distinct antidepressant effect develops after 2-3 weeks of treatment. Not stimulate the central doxepin side effects nervous system, does not inhibit MAO.
Mechanism of
The mechanism of action associated with the influence of adrenergic transmission in the CNS, in doxepin anti-itch particular, with the blockade of neuronal capture of norepinephrine.
Pharmacokinetics
Quickly and completely absorbed in the gastrointestinal tract, metabolized in the liver, with the participation of cytochrome P450 2D6 to the pharmacologically active dimethyl-doxepin, further glyukuronidiruetsya and excreted in the urine, T1 / 2 – 28-52 hours, distributed doxepin cream in the body, found in particular in the lungs, heart, brain, liver.
Indications
Depression and / or anxiety in the neuroses, alcoholism, organic diseases of the CNS, psychosis (including in involutional depression and manic-depressive psychosis).
In practice obscheterapevticheskoy – duodenal ulcer, dumping syndrome, premenstrual syndrome, chronic pain in cancer patients, itchy skin, chronic idiopathic urticaria.
Contraindications
* Hypersensitivity to doxepin,
* Angle-closure glaucoma,
* AV blockade
* Prostate adenoma and a tendency to urinary retention,
* Pregnancy
* Breastfeeding (should abandon breastfeeding)
* Children’s age (12 years).
Side effects
Cuhost mouth, nausea, vomiting, anorexia, breach of taste, diarrhea, constipation, aphthous stomatitis, urinary retention, jaundice. Weight loss, increased sweating, chills, general weakness, feeling a rush of blood to the face.
Dizziness, tinnitus, headache, blurred vision, drowsiness, disorientation, hallucinations, paresthesia, ataxia, extrapyramidal disorders, convulsions, dyskinesia tardive, tremor, hypotension, hypertension, tachycardia.
Allergic reactions – skin rash, itching, photosensitivity, angioedema, eosinophilia.
Contribution to the flow of bronchial asthma.
Seldom – leukopenia, agranulocytosis, thrombocytopenia.
Increase or decrease in libido, testicular swelling, gynecomastia (male), breast enlargement, galactorrhea (females). Hypo-or hyperglycemia, syndrome of inappropriate secretion of antidiuretic hormone, alopecia.
Dependence and withdrawal syndrome
With sudden cessation of treatment may develop withdrawal symptoms (nausea, headache, general weakness).
Interaction
Cimetidine increases the concentration of doxepin in plasma, enhances its main and side effects. In patients with diabetes mellitus in a joint application with tolazamidom may develop severe hypoglycemia. With simultaneous application of doxepin with chlorpromazine develops hyperpyrexia.
Dosage and administration of adult
At moderate degree of depression and / or anxiety starting dose of doxepin when administered at 75 mg / day. In the future, gradually picked individually effective dose (usually 75-150 mg / day).
With a large degree of depression and / or the anxiety effective dose of doxepin can reach 300 mg / day. Patients with minimally expressed disturbances effective dose – 25-50 mg / day.
Is inside 1-2 times / day (with the single dose a day dose of doxepin should not exceed 150 mg).
When sleep disorders most of the daily dose taken in the evening.
Dosage and administration in pediatric practice
Suitable for children over 12 years.
Pregnancy and lactation
Pregnancy and lactation are contraindications.
Overdose
Drowsiness, stupor, hallucinations, blurred vision, dilated pupils, dry mouth, nausea, respiratory depression, severe hypotension, coma, seizures, muscular rigidity, tachycardia, arrhythmias, typical of the tricyclic antidepressant intoxication ECG changes (especially the QRS).
Cautions
In the treatment doxepin should not engage in activities where required a high concentration of attention and psychomotor rapid reaction, increased the speed of mental and motor responses.