For Insomnia: I've waited a long time to post this review because I really wanted to like this drug and given a fair trial, but I've been on various doses ranging from 3 mg to 50 mg over the last three years, and I have to say that I don't like the drug at all. Lower initial dose (ie, 10 mg/day) and adjust gradually; 10-25 mg PO qHS. Liquid doxepin costs 10 to 20 cents per dose. Visit 6 mg once daily; for some patients, 3 mg once daily may be appropriate if, clinically indicatedThe daily dose can be increased to 6 mg, if clinically indicatedFor faster onset and to minimize the potential for next-day effects, SILENOR These other dosage forms of doxepin, however, are not FDA-approved for insomnia. provider for the most current information.The recipient will receive more details and instructions to access this offer.By clicking send, you acknowledge that you have permission to email the recipient with this information.The recipient will receive more details and instructions to access this offer.By clicking send, you acknowledge that you have permission to email the recipient with this information.

informational and educational purposes only. Initiate at low dose (25 mg/day); gradually titrate upward every 5-7 daysDosage range: 25-300 mg/day PO, up to 150 mg/day as single dose3-6 mg PO within 30 minutes before bedtime; not to exceed 6 mg/dayHepatic impairment/debilitated patients: 3 mg PO within 30 minutes before bedtimeHepatic impairment: Use lower dose and adjust gradually for depression; initiate Silenor at 3 mg daily for insomniaStarting dose: 3 mg PO within 30 minutes before bedtimeLower initial dose (ie, 10 mg/day) and adjust gradually; 10-25 mg PO qHSMay increase by 10-25 mg increments q3Day for inpatients and weekly for outpatients if toleratedAvoid; strong anticholinergic and sedative effects; may cause orthostatic hypotension (Beers criteria)Consider alternatives; if must use, initiate with lower initial doseConfusion, extrapyramidal symptoms (EPS), dizziness, paresthesiaIn short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 years) taking antidepressants for major depressive disorders and other psychiatric illnessesThis increase was not seen in patients >24 years; a slight decrease in suicidal thinking was seen in adults >65 yearsIn children and young adults, risks must be weighed against the benefits of taking antidepressantsPatients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during initial 1-2 months of therapy and dosage adjustmentsThe patient’s family should communicate any abrupt changes in behavior to the healthcare providerWorsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapyThis drug is not approved for use in pediatric patientsUse caution in BPH, urinary retention, decreased GI motility, hyperthyroidism, brain tumor, diabetes, hepatic impairment, cardiovascular disease, mania/hypomania, respiratory disease, and seizure disordersClinical worsening and suicidal ideation may occur despite medication in adolescents and young adults (aged 18-24 years)Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomyCNS depressant; can impair alertness and motor coordination; avoid use with other CNS depressants (eg, alcohol)Overdose may cause EKG QRS widening and risk of dysrhythmiasProtect capsules and oral concentrate from direct sunlightPrescriptions should be written for smallest quantity consistent with good patient care; patient's family or caregiver should alert healthcare professional about emergence of suicidality and related behaviors including agitation, panic attacks, irritability, impulsivity, mania, and insomnia or if worsening depression or psychosis occursAnticholinergic effects including blurred vision, urinary retention, xerostomia, and constipation may occurNeuropsychiatric symptoms may occur unpredictably including anxiety and psychosisBone fracture reported with use of antidepressant therapy; consider possibility of fracture if patient presents with unexplained bone pain, joint tenderness, bruising or swellingMay cause orthostatic hypotension; use caution in patients at risk of this effect or that may not tolerate hypotensive episodes (eg, hypovolemia, cardiovascular or cerebrovascular disease and others)Sleep related activities including sleep driving, eating food, cooking, making phone calls reported; discontinue therapy if patient reports sleep-related episodesPossibility of EPS and neuroleptic malignant syndrome (NMS)May cause confusion in the elderly; avoid doses >6 mg/dayLactation: Enters breast milk; not recommended (AAP states "may be of concern")A: Generally acceptable.


This monograph only gives information about doxepin (Silenor) for insomnia. It is also used to treat insomnia (trouble with sleeping).

Doxepin, the active ingredient in SILENORFor faster onset and to minimize the potential for next day effects, SILENORIn clinical trials, the most common treatment-emergent adverse reaction was somnolence/sedation.You are encouraged to report negative side effects of prescription drugs to the FDA. Visit © 2019 Currax Pharmaceuticals LLC.

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