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Doxepin hydrochloride or doxepin is tricyclic antidepressant which is also used for many other conditions in non-depressed people including:

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.[2][1]

Theory[edit | edit source]

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.[3][4]

Evidence[edit | edit source]

ME/CFS[edit | edit source]

Doxepin is not recommended as a first-line antidepressant for ME/CFS patients.[3][4]

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.[4]

Dosage for ME/CFS[edit | edit source]

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.[3]

Clinicians[edit | edit source]

Risks and safety[edit | edit source]

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.[1]

Costs and availability[edit | edit source]

Doxepin is a perscription only drug which is inexpensive in capsule form, and generic forms are widely available.[5] It is available as a tablet/capsule, oral solution and for pruritus as a topical treatment to be applied to the skin.[1][2]

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.[5]

Doxepin topical cream is approximately $625 for 45g (5% strength). Topical brand names include Zonalon and Prudoxin.[6]

See also[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]