Doxepin is a topical antipruritic.
Doxepin hydrochloride is used topically for the short-term (up to 8 days of therapy) relief of moderately severe pruritus associated with various forms of eczematous dermatitis, including atopic dermatitis and lichen simplex chronicus (circumscribed or localized neurodermatitis).1, 2
For systemic uses of doxepin, see the Tricyclic Antidepressants General Statement 28:16.04.24.
Doxepin hydrochloride is applied topically to the skin as a cream.1, 2 The topical cream is intended for external use only and should not be applied to the eyes nor administered orally or intravaginally. 1
Because of the potential risk of enhanced percutaneous absorption, doxepin hydrochloride cream should not be used with occlusive dressings1 and patients should be warned that treated areas of the skin should not be bandaged or otherwise covered or wrapped as to be occlusive.3
The manufacturer states that safety and efficacy of topical doxepin hydrochloride in children have not been established1 but that topical therapy with the drug in a limited number of children 12-18 years of age revealed no evidence of unusual adverse effect.3
For the short-term relief of pruritus associated with various eczematous conditions in adults, a thin film of doxepin hydrochloride 5% cream is applied topically to affected areas of the skin 4 times daily, with an interval of at least 3-4 hours between applications.1
Because clinically important amounts of the drug may be absorbed percutaneously into systemic circulation following topical application, patients should be cautioned about the risk of adverse systemic effects of doxepin, particularly drowsiness, and warned that CNS depressant effects of the drug can be exacerbated by alcohol, and the usual precautions of tricyclic antidepressant therapy should be considered.1 If excessive drowsiness occurs, it may be necessary to reduce the number of daily applications, the amount of cream applied, and/or the percentage of body surface area treated or to discontinue therapy with the drug.1 The risk of systemic toxicity is increased when the cream is applied to more than 10% of body surface area, and it is particularly important that patients receiving such dosages be cautioned about sedation and other potential adverse systemic effects of doxepin.1
The manufacturer states that safety and efficacy of topical doxepin hydrochloride therapy have not been established beyond 8 days.1 Exceeding an 8-day course of topical therapy may result in increased systemic concentrations of the drug.1
Doxepin, a dibenzoxepin-derivative tricyclic compound, is a topical antipruritic.1, 2 While the exact mechanism of antipruritic activity is unknown, doxepin exhibits potent histamine H1- and H2-receptor antagonist activity.1, 2, 4, 5, 6 Although the sedative effect of systemically absorbed doxepin may contribute to the drug's antipruritic activity,1 the antipruritic efficacy of doxepin reportedly does not appear to depend on a sedative effect.2, 3
Additional Information
The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer's labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
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Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Topical | Cream | 5% (4.43% of doxepin) | ||
AHFS® Drug Information. © Copyright, 1959-2025, Selected Revisions April 10, 2024. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, MD 20814.
1. GenDerm Corporation. Zonalon® (doxepin hydrochloride) cream 5% prescribing information. Lincolnshire, IL: 1994 Jan.
2. GenDerm Corporation. Zonalon® cream (doxepin hydrochloride cream), 5%: a clinical review. (Publication No. G0079) Lincolnshire, IL: 1994 Mar.
3. GenDerm, Lincolnshire, IL: Personal communication.
4. Sullivan TJ. Pharmacologic modulation of the whealing response to histamine in human skin: identification of doxepin as a potent in vivo inhibitor. J Allergy Clin Immunol . 1982; 69:260-7. [PubMed 6120966]
5. Bernstein JE, Whitney DH, Soltani K. Inhibition of histamine-induced pruritus by topical tricyclic antidepressants. J Am Acad Dermatol . 1981; 5:582-5. [PubMed 7298924]
6. Richelson E. Tricyclic antidepressants and histamine H1 receptors. Mayo Clin Proc . 1979; 54:669-74. [PubMed 39202]