AdultPediatricGeriatricDosage Forms & Strengths capsule (generic) 10mg 25mg 50mg 75mg 100mg 150mg tablet (Silenor) 3mg 6mg oral concentrate (generic) 10mg/mL Depression/Anxiety Initiate at low dose (25 mg/day); gradually titrate upward every 5-7 days Dosage range: 25-300 mg/day PO, up to 150 mg/day as single dose If dose exceeds 150 mg/day, divide q12hr Dosing considerations May give qHS to decrease daytime sedation Insomnia (Silenor) Sleep maintenance 3-6 mg PO within 30 minutes before bedtime; not to exceed 6 mg/day Hepatic impairment/debilitated patients: 3 mg PO within 30 minutes before bedtime Dosing considerations To minimize potential for next day drowsiness, do not take within 3 hr of a meal (AUC increased by 41% and Cmax by 15% when taken with high fat meal) Dosing Modifications Hepatic impairment: Use lower dose and adjust gradually for depression; initiate Silenor at 3 mg daily for insomnia<12 years old: Not recommendedInsomnia (Silenor) Sleep maintenance Starting dose: 3 mg PO within 30 minutes before bedtime May increase to 6 mg PO HS if clinically indicated Depression/Anxiety Lower initial dose (ie, 10 mg/day) and adjust gradually; 10-25 mg PO qHS May increase by 10-25 mg increments q3Day for inpatients and weekly for outpatients if tolerated Dosing considerations Avoid; strong anticholinergic and sedative effects; may cause orthostatic hypotension (Beers criteria) Consider alternatives; if must use, initiate with lower initial dose May cause confusion and oversedation in elderlyInteraction CheckerEnter a drug name and doxepinNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (17)disopyramidedoxepin and disopyramide both increase QTc interval. Contraindicated.ibutilidedoxepin and ibutilide both increase QTc interval. Contraindicated.indapamidedoxepin and indapamide both increase QTc interval. Contraindicated.iobenguane I 123doxepin decreases effects of iobenguane I 123 by pharmacodynamic antagonism. Contraindicated. If clinically appropriate, discontinue drugs that decrease uptake of NE for at least 5 half-lives; may cause false-negative imaging results.isocarboxazidisocarboxazid and doxepin both increase serotonin levels. Contraindicated.lefamulinlefamulin will increase the level or effect of doxepin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.pentamidinedoxepin and pentamidine both increase QTc interval. Contraindicated.phenelzinephenelzine and doxepin both increase serotonin levels. Contraindicated.pimozidedoxepin and pimozide both increase QTc interval. Contraindicated.procainamidedoxepin and procainamide both increase QTc interval. Contraindicated.procarbazineprocarbazine and doxepin both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.quinidinequinidine and doxepin both increase QTc interval. Contraindicated.safinamidedoxepin, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.selegilineselegiline and doxepin both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicatedsotaloldoxepin and sotalol both increase QTc interval. Contraindicated.thioridazinethioridazine will increase the level or effect of doxepin by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated.tranylcyprominetranylcypromine and doxepin both increase serotonin levels. Contraindicated.Serious - Use Alternative (150)abametapirabametapir will increase the level or effect of doxepin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.albuteroldoxepin, albuterol. 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.amiodaronedoxepin and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.amitriptylineamitriptyline and doxepin both increase QTc interval. Avoid or Use Alternate Drug.amitriptyline and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.amoxapineamoxapine and doxepin both increase QTc interval. Avoid or Use Alternate Drug.amoxapine and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.arformoteroldoxepin, arformoterol. 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.arsenic trioxidedoxepin and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.artemetherdoxepin and artemether both increase QTc interval. Avoid or Use Alternate Drug.artemether/lumefantrineartemether/lumefantrine will increase the level or effect of doxepin by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.doxepin and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.benzhydrocodone/acetaminophenbenzhydrocodone/acetaminophen and doxepin both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebenzphetaminedoxepin, benzphetamine. 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.buprenorphinedoxepin and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine buccalbuprenorphine buccal and doxepin both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine subdermal implantbuprenorphine subdermal implant and doxepin both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine subdermal implant and doxepin both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine transdermalbuprenorphine transdermal and doxepin both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine transdermal and doxepin both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine, long-acting injectionbuprenorphine, long-acting injection and doxepin both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine, long-acting injection and doxepin both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuspironedoxepin and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.calcium/magnesium/potassium/sodium oxybatesdoxepin, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.chloroquinedoxepin and chloroquine both increase QTc interval. Avoid or Use Alternate Drug.chlorpromazinechlorpromazine and doxepin both increase QTc interval. Avoid or Use Alternate Drug.citalopramcitalopram and doxepin both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.doxepin and citalopram both increase QTc interval. Avoid or Use Alternate Drug.clarithromycindoxepin and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.clomipramineclomipramine and doxepin both increase QTc interval. Avoid or Use Alternate Drug.clomipramine and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.clonidinedoxepin decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.cyclobenzaprinedoxepin and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.dacomitinibdacomitinib will increase the level or effect of doxepin by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities. desipraminedesipramine and doxepin both increase QTc interval. Avoid or Use Alternate Drug.desipramine and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.desvenlafaxinedoxepin and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.dexfenfluraminedoxepin, dexfenfluramine. 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.dexmethylphenidatedoxepin, dexmethylphenidate. 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.dextroamphetaminedoxepin, dextroamphetamine. 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.dextromethorphandoxepin and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.diethylpropiondoxepin, diethylpropion. 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.dobutaminedoxepin, dobutamine. 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.dofetilidedoxepin and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.dolasetrondolasetron, doxepin. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.dopaminedoxepin, dopamine. 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.dopexaminedoxepin, dopexamine. 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.dronedaronedoxepin and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.droperidoldoxepin and droperidol both increase QTc interval. Avoid or Use Alternate Drug.duloxetineduloxetine and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.encorafenibdoxepin and encorafenib both increase QTc interval. Avoid or Use Alternate Drug.ephedrinedoxepin, ephedrine. 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.epinephrineepinephrine and doxepin both increase QTc interval. Avoid or Use Alternate Drug.doxepin, epinephrine. 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.epinephrine racemicepinephrine racemic and doxepin both increase QTc interval. Avoid or Use Alternate Drug.doxepin, epinephrine racemic. 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.erythromycin basedoxepin and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.erythromycin ethylsuccinatedoxepin and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.erythromycin lactobionatedoxepin and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.erythromycin stearatedoxepin and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.escitalopramescitalopram and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.doxepin and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.fenfluraminedoxepin, fenfluramine. 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.fexinidazolefexinidazole and doxepin both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.fexinidazole will increase the level or effect of doxepin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.fluconazoledoxepin and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.fluoxetinefluoxetine will increase the level or effect of doxepin by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.fluoxetine and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.fluphenazinefluphenazine and doxepin both increase QTc interval. Avoid or Use Alternate Drug.fluvoxaminefluvoxamine and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.formoteroldoxepin and formoterol both increase QTc interval. Avoid or Use Alternate Drug.doxepin, formoterol. 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.fosamprenavirfosamprenavir increases levels of doxepin by decreasing metabolism. Avoid or Use Alternate Drug.givosirangivosiran will increase the level or effect of doxepin by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.glasdegibdoxepin and glasdegib both increase QTc interval. Avoid or Use Alternate Drug.granisetrongranisetron, doxepin. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.guanfacinedoxepin decreases effects of guanfacine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.haloperidolhaloperidol will increase the level or effect of doxepin by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.doxepin and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.hydroxychloroquine sulfatedoxepin and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.imipraminedoxepin and imipramine both increase QTc interval. Avoid or Use Alternate Drug.doxepin and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.inotuzumabdoxepin and inotuzumab both increase QTc interval. Avoid or Use Alternate Drug.iobenguane I 131doxepin will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of