1. Insomnia pharmacotherapy: Low-dose doxepin
Flavio Guzmán, MD

2. Outline H1 antagonist Indication: sleep maintenance insomnia
Dosed 3-6 mg
Pharmacokinetics, side effects
Comments

3. Mechanism of action

4. Doxepin: antidepressant doses
Markov, D., & Doghramji, K. (2015). Low-Dose Doxepin for Insomnia. In Drug Treatment of Sleep Disorders (pp ). Springer International Publishing.

5. Doxepin: hypnotic doses
H1 antagonist
No antidepressant effects
No anticholinergic effects
Markov, D., & Doghramji, K. (2015). Low-Dose Doxepin for Insomnia. In Drug Treatment of Sleep Disorders (pp ). Springer International Publishing.

6. Indications

7. Indications
Treatment of insomnia characterized by difficulties with sleep maintenance
Silenor (Doxepin) [Prescribing Information] Morristown, NJ: Pernix Therapeutics, LLC

8. Side effects

9. Side effects Side effects Somnolence/sedation Nausea Free from
Anticholinergic effects
Withdrawal syndrome
Rebound insomnia
Silenor (Doxepin) [Prescribing Information] Morristown, NJ: Pernix Therapeutics, LLC
Markov, D., & Doghramji, K. (2015). Low-Dose Doxepin for Insomnia. In Drug Treatment of Sleep Disorders (pp ). Springer International Publishing.

10. Doxepin pharmacokinetics
Fluoxetine
Paroxetine
Tmax: 3.5 hours
Half-life: 15 hours
Markov, D., & Doghramji, K. (2015). Low-Dose Doxepin for Insomnia. In Drug Treatment of Sleep Disorders (pp ). Springer International Publishing.

11. Dosage forms (Silenor)
Dosing
Dosage forms (Silenor)
Tablet
3 mg
6 mg
Dosing
Adults: 6 mg
Elderly: 3 mg
How to dose
30 minutes before bedtime
Silenor (Doxepin) [Prescribing Information] Morristown, NJ: Pernix Therapeutics, LLC

12. Doxepin - Comments Originally approved in 1969
Available in larger doses
Capsules: 10, 25, 50, 75 and 150 mg
Oral solution: 10 mg/ml
Silenor more expensive than generic
Doxepin 6 mg vs 10 mg?
No head-to-head clinical trials
Oral solution can also be dosed at 6 mg
Markov, D., & Doghramji, K. (2010). Doxepin for insomnia. Curr Psychiatry,9(10),

13. End of presentation