Generic Name and Formulations:
Doxepin (as HCl) 3mg, 6mg; tabs.
Indications for SILENOR:
Treatment of insomnia characterized by difficulty with sleep maintenance.
Individualize. Take within 30mins of bedtime. Do not take within 3 hours of a meal. Initially 6mg once daily. Max: 6mg/day. Elderly, hepatic impairment, tendency to urinary retention: initially 3mg once daily.
During or within 14 days of MAOIs. Untreated narrow angle glaucoma. Severe urinary retention.
Evaluate for co-morbid diagnoses (eg, physical or psychiatric disorders) prior to treatment. Reevaluate if insomnia persists after 7–10 days of use. Monitor for new onset behavioral changes, worsening of depression, or suicidal thinking. Hepatic impairment. Respiratory dysfunction. Severe sleep apnea: not recommended. Poor metabolizers (those with reduced CYP2D6/2C19 activity). Reevaluate periodically. Elderly. Pregnancy (Cat.C). Nursing mothers.
H1 receptor antagonist.
Additive effects with concomitant CNS depressants, antihistamines, or alcohol (avoid); reduce dose. Potentiated by cimetidine. Possible hypoglycemia with tolazamide.
Somnolence, sedation, nausea, upper respiratory tract infection, dizziness, photosensitivity, skin rash; abnormal thinking, behavioral changes, complex behaviors, sleep-driving (discontinue if occurs), amnesia, anxiety, other neuro-psychiatric symptoms.
Tabs—30, 100, 500
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