Jeffrey Panko NP Psychiatry · Patient education
Doxepin
Silenor / Generic low-dose tablets, antidepressant capsules and solution
A guide for adults taking doxepin.
Follow the directions on your prescription and your provider's recommendations.
Formulations: Low-dose insomnia tablets are not equivalent to antidepressant capsules or oral concentrate. Confirm the strength and reason for treatment whenever a prescription changes.
What it is used for
Low-dose doxepin treats insomnia involving difficulty staying asleep. Much higher oral doses treat depression or anxiety. These regimens have different instructions and side-effect burdens. Topical doxepin for itching is a separate formulation.
How it works
At low sleep doses, doxepin mainly blocks histamine H1 receptors. At antidepressant doses, it also affects serotonin and norepinephrine reuptake and has more anticholinergic effects.
What to expect over time
Sleep-maintenance benefit can appear early. Antidepressant benefit usually develops over several weeks. Review persistent insomnia, mood symptoms, and next-day functioning.
Taking your medication
- For low-dose insomnia tablets, take within 30 minutes of bedtime and not within three hours of a meal. Allow a full night for sleep.
- For antidepressant formulations, follow their separate schedule and liquid-dilution instructions.
- Do not double a missed dose. Skip an insomnia dose if a full sleep period is no longer available.
- Do not change the dose to move between sleep and antidepressant treatment.
When to get help
Emergency symptoms. Get emergency care for a seizure, fainting with an irregular heartbeat, inability to urinate, severe abdominal pain, or a severe allergic reaction. Any suspected overdose needs immediate advice.
Prompt medical advice. Stop the sleep formulation and contact your provider after sleep-driving or other activity while not fully awake. Report worsening depression or marked agitation.
If you feel unsafe or have thoughts of self-harm, call 911 or go to an emergency department.
Possible side effects
- Sleepiness or next-day impairment
- At higher doses: dry mouth, constipation, blurred vision, or dizziness
- At antidepressant doses: weight or sexual-function changes
Keeping track of treatment
Some side effects resolve with time; others may require a change of medication. Discuss persistent or bothersome side effects with your provider.
Watch for falls, confusion, urinary difficulty, and constipation, especially with higher doses or in older adults. Antidepressant treatment requires monitoring for worsening mood and suicidal thoughts, particularly under age 25.
If you take too much
For a suspected overdose, call Poison Control at 1-800-222-1222 immediately, even if you feel well. Call 911 for a seizure, collapse, trouble breathing, or inability to wake.
Before you start
Discuss glaucoma, severe urinary retention, heart disease, sleep apnea, liver disease, seizures, and bipolar symptoms.
Discuss pregnancy, pregnancy plans, and breastfeeding with your provider. Treatment decisions should consider both the medication and the condition being treated.
Medicines and interactions
Review all your medications with your provider, including over-the-counter medicines and supplements. Have new medications checked before taking them.
Do not combine with an MAOI; a 14-day interval is required. Alcohol, sedatives, and other anticholinergic medicines can increase impairment or bowel and urinary problems.
Some antidepressants and cimetidine raise doxepin exposure. Have the exact dose and formulation reviewed.
Everyday tips
Keep the sleep and antidepressant instructions separate.
Use CBT-I and a consistent sleep routine for persistent insomnia.
Your questions answered
Why are the doses so different?
Low-dose sleep treatment mainly targets histamine receptors. Antidepressant doses engage additional effects and carry a different risk profile.
Do I need a taper?
Consult with your provider. Antidepressant doses usually require gradual reduction; low-dose insomnia treatment has different stopping considerations.
Storage and safety
Keep medication in its labeled container, away from excess heat and moisture and out of reach of children and pets. Do not share it. Ask a pharmacy about disposal of unused medication.
Sources
About this information
Educational handout; does not replace your prescription or provider's recommendations.
Educational inclusion does not mean this medication or its indications are treated at this practice. Review the guide for your exact product with your prescriber or pharmacist.