Doxepin (HCl)

It should be used with extreme caution in patients with a pre-existing seizure disorder because the seizure threshold may be lowered, diabetes mellitus, hepatic disease, pre-existing hematological disease, with respiratory depression, in patients with Parkinsons disease, in patients who have hyperthyroidism or are receiving thyroid drugs, with cardiac disease (because of the alterations inECG patterns). Patients with cardiovascular disease should be closely monitored and regular ECG tracings made. It should not be given to patients who are in the acute recovery phase following myocardial infarction; sudden death is possible. Therapy should be discontinued for several days prior to elective surgery because of the risk of hypertensive episodes. Patients may be more prone to sunburn during therapy with doxepin and suitable precautions should be taken (wearing long-sleeved clothing and applying sunblock). It is classified as a pregnancy category C drug. It should not be used during pregnancy, unless the possible benefits outweigh the risks to fetus. Following prolonged therapy in high doses, abrupt discontinuation of doxepin should be avoided because this can precipitate symptoms of cholinergic rebound. It should be used with caution in patients who have a history of alcoholism or who may use alcohol or other sedative medications because the depressant effects on the central nervous system can be potentiated. Bipolar disorder patients who are not concomitantly treated with an anticyclic medication are likely to switch from depression to mania, and some schizophrenic patients can experience exacerbation of psychosis.