Editing Doxepin

'''Doxepin hydrochloride''' or '''doxepin''' is tricyclic antidepressant which is also used for many other conditions in non-depressed people including:
* [[anxiety]]
* [[pain]], particularly [[neuropathic pain]]
* [[insomnia]], which Doxepin has FDA approval for
* [[migraine]] prevention
* [[sleep dysfunction|sleep problems]] including as a sleep sustainer
* the topical form is used for [[pruritus]] (chronic hives causing severe itching)<ref name="Almasi2022" /><ref name="medlineplus" /><br>
Doxepin is a similar drug to [[amitriptyline]] and [[nortriptyline]], but also has [[antihistamine]] effects.

Doxepin is also sold under the brand names ''Silenor'', ''Sinequan'', ''Prudoxin''. and ''Zonalon''.<ref name="medlineplus">{{Cite web| url = https://medlineplus.gov/druginfo/meds/a682390.html | title = Doxepin (Depression, Anxiety) | last = | first = | authorlink = | date = | website = MedlinePlus Drug Information|language=en| archive-url = | archive-date = |url-status = | access-date=2022-02-20}}</ref><ref name="Almasi2022">{{Cite book | title = Doxepin | date = 2022 | url=http://www.ncbi.nlm.nih.gov/books/NBK542306/ | last = Almasi | first = Anasheh | last2 = Meza | first2 = Carlos E.|location=Treasure Island (FL)| publisher = StatPearls Publishing|pmid=31194446}}</ref>

==Theory==
Doxepin has not been suggested as a primary treatment for ME/CFS. It is effective for a number of common symptoms found in ME/CFS, and has antagonist effects on alpha-adrenergic, muscarinic, and histaminic receptors.<ref name="canadianconsensus-CCC" /><ref name="ICC2011primer" />

==Evidence==
===ME/CFS ===
Doxepin is not recommended as a first-line antidepressant for ME/CFS patients.<ref name="canadianconsensus-CCC">{{Citation | last1 = Carruthers | first1 = Bruce M. | author-link1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | authorlink2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 = Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | author-link6 = Martin Lerner | last7 = Bested | first7 = Alison C. | author-link8 = Alison Bested | last8 = Flor-Henry | first8 = Pierre | author-link8 = Pierre Flor-Henry | last9 =Joshi | first9 = Pradip | author-link9 = Pradip Joshi | last10 = Powles | first10 = AC Peter | author-link10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | author-link11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I. | author-link12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols| journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 |  pmid = | doi = 10.1300/J092v11n01_02| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf}}</ref><ref name="ICC2011primer" />

The [[International Consensus Criteria]] for [[myalgic encephalomyelitis]] states that doxepin may be helpful as a sleep sustainer in the short-term, when used at a low dose, but warns that side  effects can be severe.<ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | author-link1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | author-link6 = Terry Mitchell | last7 = Staines | first7 = D | author-link8 = Donald Staines | last8 = Powles | first8 = ACP | author-link8 = A C Peter Powles | last9 = Speight | first9 = N | author-link9 = Nigel Speight | last10 = Vallings | first10 = R | author-link10 = Rosamund Vallings | last11 = Bateman | first11 =  L | author-link11 = Lucinda Bateman | last12 = Bell | first12 = DS | author-link12 = David Bell | last13 = Carlo-Stella | first13 =  N | author-link13 = Nicoletta Carlo-Stella | last14 = Chia | first14 =  J | author-link14 = John Chia | last15 = Darragh | first15 =  A | author-link15 = Austin Darragh | last16 = Gerken | first16 =  A | author-link16 = Anne Gerken | last17 = Jo | first17 =  D | author-link17 = Daehyun Jo | last18 = Lewis | first18 =  DP | author-link18 = Donald Lewis | last19 = Light | first19 = AR | author-link19 = Alan Light | last20 = Light | first20 =  KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 =  S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 =  J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 =  I | authorlink23 =  Ismael Mena | last24 = Miwa | first24 =  K | authorlink24 =  Kunihisa Miwa | last25 = Murovska | first25 =  M | authorlink25= Modra Murovska | last26 = Stevens | first26 =  SR | authorlink26 =  Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012| isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf}}</ref>

==Dosage for ME/CFS ==
The [[Canadian Consensus Criteria]] for ME/CFS suggests:
* 2-20mg each night at bedtime for sleep 
* 5-100 mg each night at bedtime as tolerated for pain 
* 5-10 mg at bedtime/during hours of sleep to 75-100 mg daily for depression 

As is typical for ME/CFS patients, clinicians are advised to start with a low and gradually increase the dosage as tolerated. It is slower acting, but helps to keep patient asleep longer.<ref name="canadianconsensus-CCC" />

==Clinicians==

==Risks and safety==
Doxepin has similar side effects to [[amitriptyline]]. This includes the US antidepressant black box warning of an increased risk of suicidal thoughts or actions and self-harm in children, teenagers, and young people under age 24.<ref name="Almasi2022" />

==Costs and availability==
Doxepin is a perscription only drug which is inexpensive in capsule form, and generic forms are widely available.<ref name="goodrx" /> It is available as a tablet/capsule, oral solution and for pruritus as a topical treatment to be applied to the skin.<ref name="Almasi2022" /><ref name="medlineplus" />

Doxepin prices in the US are typically around $17 per 30 capsules (10mg), $25 for 118ml of oral solution (10mg/mL). Doxepin 3mg and 6mg tablets are considerably more expensive, at $165-450 per 30.<ref name="goodrx">{{Cite web| url = https://www.drugs.com/price-guide/doxepin | title = Doxepin Prices, Coupons & Patient Assistance Programs|website=Drugs.com|language=en|access-date=2022-02-20}}</ref>

Doxepin topical cream is approximately $625 for 45g (5% strength). Topical brand names include Zonalon and Prudoxin.<ref name="topical">{{Cite web| url = https://www.drugs.com/price-guide/doxepin-topical | title = Doxepin topical Prices, Coupons & Patient Assistance Programs|website=Drugs.com|language=en|access-date=2022-02-20}}</ref>

==See also==
*[[Anxiety]]
*[[Depression]]
*[[Pain]]
*[[Sleep dysfunction]]

==Learn more==
*[https://medlineplus.gov/druginfo/meds/a682390.html Doxepin] - MedlinePlus 

==References==
{{reflist}}

[[Category:Potential treatments]]
[[Category:Analgesics‎]]
[[Category:Antihistamines‎]]
[[Category:H1 antihistamines‎]]
[[Category:Sedating antihistamines‎]]
[[Category:Sleep aids and hypnotics‎]]
[[Category:Non-benzodiazepine hypnotics]]