sedation. Use Caution/Monitor.Minor (1)marijuana will increase the level or effect of doxepin by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.meclizineMonitor Closely (1)meclizine and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.mefloquineSerious - Use Alternative (1)mefloquine increases toxicity of doxepin by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.melatoninMonitor Closely (1)doxepin and melatonin both increase sedation. Use Caution/Monitor.meperidineMonitor Closely (1)meperidine and doxepin both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)doxepin and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.meprobamateMonitor Closely (1)doxepin and meprobamate both increase sedation. Use Caution/Monitor.mestranolMinor (1)mestranol, doxepin. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.metaproterenolMonitor Closely (1)doxepin increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)doxepin, metaproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.metaxaloneMonitor Closely (1)metaxalone and doxepin both increase sedation. Use Caution/Monitor.metforminMinor (1)doxepin increases effects of metformin by pharmacodynamic synergism. Minor/Significance Unknown.methadoneMonitor Closely (2)doxepin and methadone both increase QTc interval. Modify Therapy/Monitor Closely. methadone and doxepin both increase sedation. Use Caution/Monitor.methamphetamineMonitor Closely (1)doxepin increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)doxepin, methamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.methocarbamolMonitor Closely (1)methocarbamol and doxepin both increase sedation. Use Caution/Monitor.methscopolamineMonitor Closely (1)methscopolamine and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.methylene blueSerious - Use Alternative (1)methylene blue and doxepin both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.methylenedioxymethamphetamineMonitor Closely (1)doxepin increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)doxepin, methylenedioxymethamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.methylphenidateMonitor Closely (1)doxepin, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.methylphenidate transdermalMonitor Closely (1)methylphenidate transdermal will increase the level or effect of doxepin by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. metoclopramide intranasalSerious - Use Alternative (1)doxepin, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.midazolamMonitor Closely (1)midazolam and doxepin both increase sedation. Use Caution/Monitor.midazolam intranasalMonitor Closely (1)midazolam intranasal, doxepin. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.midodrineMonitor Closely (1)doxepin increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)doxepin, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.midostaurinSerious - Use Alternative (1)doxepin and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.mifepristoneMonitor Closely (1)doxepin and mifepristone both increase QTc interval. Use Caution/Monitor.miglitolMinor (1)doxepin increases effects of miglitol by pharmacodynamic synergism. Minor/Significance Unknown.milnacipranSerious - Use Alternative (1)milnacipran and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.mirabegronMonitor Closely (1)mirabegron will increase the level or effect of doxepin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.mirtazapineMonitor Closely (2)doxepin and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely. doxepin and mirtazapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)doxepin and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.mitotaneMonitor Closely (1)mitotane decreases levels of doxepin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.mobocertinibMonitor Closely (1)doxepin and mobocertinib both increase QTc interval. Use Caution/Monitor.modafinilMonitor Closely (1)doxepin increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.morphineMonitor Closely (2)doxepin and morphine both increase serotonin levels. Modify Therapy/Monitor Closely. morphine and doxepin both increase sedation. Use Caution/Monitor.motherwortMonitor Closely (1)doxepin and motherwort both increase sedation. Use Caution/Monitor.moxifloxacinSerious - Use Alternative (1)doxepin and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.moxonidineMonitor Closely (1)doxepin and moxonidine both increase sedation. Use Caution/Monitor.nabiloneMonitor Closely (1)doxepin and nabilone both increase sedation. Use Caution/Monitor.nalbuphineMonitor Closely (1)nalbuphine and doxepin both increase sedation. Use Caution/Monitor.naratriptanMonitor Closely (1)naratriptan and doxepin both increase serotonin levels. Modify Therapy/Monitor Closely.nateglinideMinor (1)doxepin increases effects of nateglinide by pharmacodynamic synergism. Minor/Significance Unknown.nefazodoneSerious - Use Alternative (1)nefazodone and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.nefopamMonitor Closely (1)nefopam, doxepin. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Use combination with caution.neostigmineMonitor Closely (1)neostigmine increases and doxepin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.netupitant/palonosetronSerious - Use Alternative (1)netupitant/palonosetron, doxepin. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.nilotinibMonitor Closely (1)nilotinib will increase the level or effect of doxepin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)doxepin and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.norepinephrineMonitor Closely (2)doxepin increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor. doxepin increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)doxepin, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.nortriptylineMonitor Closely (2)doxepin and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. doxepin and nortriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)doxepin and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug. doxepin and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.octreotideSerious - Use Alternative (1)doxepin and octreotide both increase QTc interval. Avoid or Use Alternate Drug.octreotide (Antidote)Serious - Use Alternative (1)doxepin and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.ofloxacinMonitor Closely (1)doxepin and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.olanzapineMonitor Closely (2)doxepin and olanzapine both increase QTc interval. Use Caution/Monitor. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instances olanzapine and doxepin both increase sedation. Use Caution/Monitor.oliceridineMonitor Closely (2)doxepin, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. doxepin increases toxicity of oliceridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor for signs of urinary retention or reduced gastric motility if oliceridine is coadministered with anticholinergics.olodaterol inhaledMonitor Closely (1)doxepin and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmiasolopatadine intranasalSerious - Use Alternative (1)doxepin and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. onabotulinumtoxinAMonitor Closely (1)onabotulinumtoxinA and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.ondansetronMonitor Closely (1)doxepin and ondansetron both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)ondansetron, doxepin. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.opium tinctureMonitor Closely (1)opium tincture and doxepin both increase sedation. Use Caution/Monitor.orphenadrineMonitor Closely (2)doxepin and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor. orphenadrine and doxepin both increase sedation. Use Caution/Monitor.osilodrostatMonitor Closely (1)osilodrostat and doxepin both increase QTc interval. Use Caution/Monitor.osimertinibSerious - Use Alternative (1)doxepin and osimertinib both increase QTc interval. Avoid or Use Alternate Drug.oxaliplatinMonitor Closely (1)doxepin and oxaliplatin both increase QTc interval. Use Caution/Monitor.oxazepamMonitor Closely (1)oxazepam and doxepin both increase sedation. Use Caution/Monitor.oxybutyninMonitor Closely (1)oxybutynin and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.oxybutynin topicalMonitor Closely (1)oxybutynin topical and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.oxybutynin transdermalMonitor Closely (1)oxybutynin transdermal and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.oxycodoneMonitor Closely (1)oxycodone and doxepin both increase sedation. Use Caution/Monitor.oxymetazoline intranasalMonitor Closely (1)doxepin increases effects of oxymetazoline intranasal by pharmacodynamic synergism. Use Caution/Monitor. TCAs inhibit norepinephrine uptake in adrenergic neurons, thereby increasing synaptic norepinephrine levels. Coadministration with alpha1 agonists may cause increased adrenergic receptor stimulation. When oxymetazoline is combined with intranasal tetracaine for dental anesthesia, avoid or use alternant anesthetic in patients taking TCAs.oxymorphoneMonitor Closely (1)oxymorphone and doxepin both increase sedation. Use Caution/Monitor.ozanimodSerious - Use Alternative (2)doxepin and ozanimod both increase QTc interval. Contraindicated. ozanimod increases toxicity of doxepin by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.paliperidoneMonitor Closely (2)doxepin and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. paliperidone and doxepin both increase sedation. Use Caution/Monitor.palonosetronSerious - Use Alternative (1)palonosetron, doxepin. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.panax ginsengMinor (1)panax ginseng increases effects of doxepin by pharmacodynamic synergism. Minor/Significance Unknown.pancuroniumMonitor Closely (1)pancuronium and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.panobinostatSerious - Use Alternative (1)doxepin and panobinostat both increase QTc interval. Avoid or Use Alternate Drug.papaveretumMonitor Closely (1)papaveretum and doxepin both increase sedation. Use Caution/Monitor.papaverineMonitor Closely (1)doxepin and papaverine both increase sedation. Use Caution/Monitor.parecoxibMinor (1)parecoxib will increase the level or effect of doxepin by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.paroxetineMonitor Closely (1)doxepin and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)paroxetine and doxepin both increase serotonin levels. Avoid or Use Alternate Drug. paroxetine will increase the level or effect of doxepin by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.pasireotideMonitor Closely (1)doxepin and pasireotide both increase QTc interval. Use Caution/Monitor.pazopanibMonitor Closely (1)doxepin and pazopanib both increase QTc interval. Use Caution/Monitor.peginterferon alfa 2bMonitor Closely (1)peginterferon alfa 2b, doxepin. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.pentamidineContraindicated (1)doxepin and pentamidine both increase QTc interval. Contraindicated.pentazocineMonitor Closely (2)doxepin and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely. pentazocine and doxepin both increase sedation. Use Caution/Monitor.pentobarbitalMonitor Closely (1)pentobarbital and doxepin both increase sedation. Use Caution/Monitor.Minor (1)pentobarbital, doxepin. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.perphenazineMonitor Closely (1)perphenazine and doxepin both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)perphenazine and doxepin both increase QTc interval. Avoid or Use Alternate Drug.Minor (3)perphenazine will increase the level or effect of doxepin by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown. doxepin, perphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. doxepin, perphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.phendimetrazineMonitor Closely (1)doxepin increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)doxepin, phendimetrazine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.phenelzineContraindicated (1)phenelzine and doxepin both increase serotonin levels. Contraindicated.phenobarbitalMonitor Closely (1)phenobarbital and doxepin both increase sedation. Use Caution/Monitor.Minor (1)phenobarbital, doxepin. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs.