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Psychotropic Use during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Doxepin is another tricyclic antidepressant with efficacy equivalent to imipramine, nortriptyline, and amitriptyline in treating depression, but has a stronger sedative effect than the other tricyclics. No reports have been published on studies of congenital anomalies among the infants born to women treated with doxepin during the first trimester. The frequency of congenital anomalies was not increased among rats and rabbits exposed to doxepin during embryogenesis (Owaki et al., 1971a, 1971b). However, at doses 40 to 100 times those used in humans, an increase in fetal loss and neonatal death was found.
Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Doxepin is a dibenzoxepin derivative and tricyclic antidepressant-like drug with antipruritic, anti-depressive, sedative and anxiolytic activities with structural similarities to phenotheazines. Oral doxepin is approved for treatment of depression and/or anxiety associated with different conditions, including alcoholism, organic disease and manic-depressive disorders and for treatment of insomnia characterized by difficulties with sleep maintenance. Topical doxepin is also approved for short-term (up to 8 days) management of moderate pruritus in adult patients with atopic dermatitis, pruritus or lichen simplex chronicus. In pharmaceutical products, doxepin is employed as doxepin hydrochloride (CAS number 1229-29-4, EC number 214-966-8, molecular formula C19H22ClNO) (1).
Atopic Dermatitis
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Luz Fonacier, Amanda Schneider
Relieving the pruritus of AD is crucial in preventing the itch-scratching cycle of this disorder. Therapy with systemic antihistamines and anxiolytics are effective through their soporific effects used in the evening. The tricyclic antidepressant doxepin possesses both H1 and H2 receptor binding affinity. Doxepin can be given at low doses (10 mg to 50 mg) in the evening in adults. Second-generation antihistamines are often ineffective in relieving the pruritus of AD; however some studies have shown mild clinical benefit in a subgroup of patients with AD (Diepgen 2002). Topical antihistamines should generally be avoided because of irritation and possible sensitization (Shelley et al. 1996).
Current and emerging pharmacotherapy for chronic spontaneous Urticaria: a focus on non-biological therapeutics
Published in Expert Opinion on Pharmacotherapy, 2021
Kam Lun Hon, Joyce T. S. Li, Alexander K.C. Leung, Vivian W. Y. Lee
Doxepin is a tricyclic antidepressant which has potent H1 and H2 receptor antagonist activity. Maximum response could usually be achieved within a few days. Doxepin has been proven to be equal or superior to antihistamines mequitazine and diphenhydramine in the treatment of CU [82,83]. A randomized double-blinded cross-over study on 50 CSU patients compared doxepin (10 mg, 3 times a day) to diphenhydramine (25 mg, 3 times a day) [82]. Total clearance of itching and urticarial lesions was seen in 43% of patients receiving doxepin versus 5% of patients who received diphenhydramine (p < 0.001). Partial or total control of itching and hives was reported in 74% of patients receiving doxepin versus 10% of patients who received diphenhydramine (p < 0.001). In addition, doxepin induced less sedation than diphenhydramine [82]. Mirtazapine, a piperazinoazepine tetracyclic antidepressant, may also be efficacious in CSU. A case report described a patient who entered remission from severe CU after seven days of mirtazapine use [84]. The patient experienced relapse within one week of discontinuation, but reintroducing mirtazapine yielded good response [84]. Two patients with concurrent CU and panic disorder who previously required systemic corticosteroids showed symptom improvement after starting sertraline and fluoxetine [85]. Responses lasted throughout the treatment periods.
Optimizing doxepin therapy in dermatology: introducing blood level monitoring and genotype testing
Published in Journal of Dermatological Treatment, 2022
Bridget Myers, Vidhatha Reddy, Stephanie Chan, Quinn Thibodeaux, Nicholas Brownstone, John Koo
Doxepin is an especially efficacious antipruritic agent in dermatology, but due to interindividual variability in clinical response the typical dermatologic dosing range may prove subtherapeutic in many patients. For this reason, both a 300 mg per day maximum dose and a 10 mg per cc liquid doxepin concentrate have been approved by the FDA. It is important for the practicing dermatologist to understand that a variety of factors are capable of affecting doxepin pharmacokinetics, so that patients initially unresponsive or intolerant to treatment are first considered cases of needed dosage adjustment and not treatment failures. BLM is an efficacious, widely available tool that can help dermatologists make safe dose adjustments to reach therapeutic concentrations.
Safety considerations when using drugs to treat pruritus
Published in Expert Opinion on Drug Safety, 2020
Kayla Fourzali, Gil Yosipovitch
Topical antihistamines are commonly used by patients and there is a large OTC market for these medications. However, chronic itch is not typically histaminergic in nature and therefore these agents are not of therapeutic utility. Doxepin, a tricyclic medication with potent antihistaminergic properties has shown modest efficacy as a topical antipruritic in some randomized trials, but topical diphenhydramine has failed to demonstrate antipruritic efficacy [25]. Reported adverse effects with use include localized stinging and burning as well as contact dermatitis. Mild drowsiness due to the systemic absorption is also reported with topical doxepin use in up to 25% of patients [26].