doxepin (topical)

Contraindicated in:

Untreated angle-closure glaucoma;
Severe urinary retention;
Lactation: Lactation.

Use Cautiously in:

OB: Safety not established in pregnancy;
Geri: Appears on Beers list. ↑ risk of adverse reactions in older adults, including falls secondary to sedative and anticholinergic effects and orthostatic hypotension;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: pruritus

GI: dry mouth

Local: burning, stinging

Neuro: sedation, dizziness, headache

Interactions ⬆ ⬇

Drug-drug:

↑CNS depression with other CNS depressants, including alcohol, antihistamines, opioid analgesics, and sedative/hypnotics.
CYP2D6 inhibitors, including cimetidine, quinidine, amiodarone, and ritonavir, may ↑ levels and risk of toxicity.
May cause hypotension, tachycardia, and potentially fatal reactions when used with MAO inhibitors; avoid concurrent use; discontinue 2 wk prior to doxepin.

Availability ⬆ ⬇

Route/Dosage ⬆ ⬇

(Adults ): Apply 4 times daily (wait 3–4 hr between applications) for up to 8 days.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Exerts antihistaminic actions.

Therapeutic effects:

Decreased pruritus.

Classifications ⬆ ⬇

Therapeutic Classification: none assigned

Pharmacologic Classification: antihistamines

Pharmacokinetics ⬆ ⬇

Absorption: Some systemic absorption follows topical application.

Distribution: Widely distributed to tissues.

Metabolism/Excretion: Metabolized by the liver by the CYP2C19 and CYP2D6 isoenzymes; the CYP2C19 enzyme system exhibits genetic polymorphism; 15–20% of Asian patients and 3–5% of White and Black patients may be poor metabolizers of CYP2C19 and may have significantly ↑ doxepin concentrations and an ↑ risk of adverse effects; the CYP2D6 enzyme system also exhibits genetic polymorphism; ∼7% of population may be poor metabolizers of CYP2D6 and may have significantly ↑ doxepin concentrations and an ↑ risk of adverse effects.Primarily excreted in the urine.

Half-Life: Desmethyldoxepin: 28–52 hr.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
Topical	unknown	unknown	unknown

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of doxepin (topical) to patient. Instruct patient to use as directed and avoid the use of occlusive dressings. Advise patient to read Patient Information before starting therapy.
Instruct patient to notify health care professional immediately if symptoms of acute angle-closure glaucoma (pain or reddening of the eyes with pupil dilation) occur.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other medications. Instruct patient to report use of an MAO inhibitor within the last 14 days.
Rep: Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Indications ⬇

Contraind./Precautions ⬆ ⬇