Adapin, Sinequan, Triadapin , Zonalon
Classifications: psychotherapeutic; tricyclic antidepressant; anxiolytic; Therapeutic: tricyclic antidepressant; antianxiety agent
Pregnancy Category: C
10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg capsules; 10 mg/mL oral concentrate
Dibenzoxepin is one of the most sedating tricyclic antidepressants (TCAs). Inhibits serotonin reuptake from the synaptic
gap; also inhibits norepinephrine reuptake to a moderate degree. Recent evidence suggests that the upset of monoamine oxidase
output seen in depressed patients may be regulated by long-term treatment with antidepressants due to their action on beta-adrenergic
receptors. This action on beta-receptors may be a better explanation than the reuptake theory for TCAs' antidepressant effects.
Effective for treatment of both depression and anxiety.
Psychoneurotic anxiety or depressive reactions; mixed symptoms of anxiety and depression; anxiety or depression associated
with alcoholism; organic disease; psychotic depressive disorders; topical for treatment of pruritus.
Peptic ulcer disease, neuralgia.
Prior sensitivity to any TCA; during acute recovery phase following MI; bundle-branch block, cardiac arrhythmias, QT prolongation;
ileus; glaucoma; increased intraocular pressure; prostatic hypertrophy; tendency for urinary retention; concurrent use of
MAO inhibitors; pregnancy (category C), lactation. Safe use in children <12 y is not established.
Patients receiving electroconvulsive therapy, patients with suicidal tendency, bipolar disorder, schizophrenia, psychosis;
diabetes mellitus; GI disease; GERD; Parkinson's disease; seizure disorders; renal, cardiovascular, or hepatic dysfunction.
Route & Dosage
Adult: PO 30150 mg/d h.s. or in divided doses, may gradually increase to 300 mg/d (use lower doses in older adult patients)
Geriatric: PO 1025 mg h.s., may gradually increase to 75 mg/d
Child: PO 13 mg/kg/d in single or divided doses
Adult: Topical Apply a thin film q.i.d. with at least 34 h between applications, may use up to 8 d
- Give oral concentrate diluted with approximately 120 mL water, milk, or fruit juice.
- Empty capsule and swallow contents with fluid or mix with food as necessary if it cannot be swallowed whole.
- Inform physician if daytime sedation is pronounced. Entire daily dose (up to 150 mg) may be prescribed for bedtime administration.
- Apply a thin film to affected areas; allow 34 h between applications.
- Store all forms at 15°30° C (59°86° F) in tightly closed, light-resistant container.
Adverse Effects (≥1%) All:
Anticholinergic. CNS: Drowsiness,
dizziness, weakness, fatigue
, headache, hypomania, confusion, tremors, paresthesias. CV: Orthostatic hypotension,
palpitation, hypertension, tachycardia, ECG changes. Special Senses:
Mydriasis, blurred vision, photophobia. GI: Dry-mouth,
sour or metallic taste, epigastric distress, constipation
Urinary retention, delayed micturition, urinary frequency. Other:
Increased perspiration, tinnitus, weight gain, photosensitivity reaction, skin rash, agranulocytosis, burning or stinging at application site,
May decrease some antihypertensive response to antihypertensives
; cns depressants
, alcohol, hypnotics
potentiate CNS depression; may increase hypoprothrombinemic effect of oral anticoagulants
may cause transient delirium; levodopa, sympathomimetics
(e.g., epinephrine, norepinephrine
) introduce possibility of sympathetic hyperactivity with hypertension and hyperpyrexia; mao inhibitors
introduce possibility of severe reactions, toxic psychosis, cardiovascular instability; methylphenidate
increases plasma TCA levels; thyroid agents
may increase possibility of arrhythmias; cimetidine
may increase plasma TCA levels. Herbal: Ginkgo
may decrease seizure threshold; St. John's wort
may cause serotonin
Rapidly absorbed from GI sites through intact skin. Peak:
2 h. Distribution:
Crosses placenta; distributed into breast milk. Metabolism:
In liver. Elimination:
Primarily in urine. Half-Life:
Assessment & Drug Effects
- Monitor use of other CNS depressants, including alcohol. Danger of overdosage or suicide attempt is increased when patient
uses excessive amounts of alcohol.
- Be alert to changes in voiding and evaluate patient for constipation and abdominal distention; drug has moderate to strong
Patient & Family Education
- Maintain established dosage regimen and avoid change of intervals, doubling, reducing, or skipping doses.
- Consult physician about safe amount of alcohol, if any, that can be taken. The actions of both alcohol and doxepin are potentiated
when used together and for up to 2 wk after doxepin is discontinued.
- Do not drive or engage in other potentially hazardous activities until response to drug is known.