Doxepin - Interactions

Interactions

  • Irreversible MAOIs: agitation, delirium, coma, hyperpyrexia (high fever), seizures and severe changes in blood pressure. potentially fatal. Treatment-resistant hospitalized patients may be treated concomitantly with an MAO-inhibitor, if they are closely monitored by an expert and the initial dose of both drugs is low.
  • Increased drug actions:
    • other antidepressants, barbiturates, narcotics, sedating antihistaminics, anticonvulsive drugs, alcohol - resulting in increased central depression
    • anticholinergics (antiparkinsonian agents, tri- and tetracyclic antidepressants) - resulting in increased anticholinergic action (dry mouth, obstipation etc.)
    • Cimetidine: impairs the excretion of Doxepin - increased central depression and anticholinergic effects
    • Sympathomimetics (also those used in local anesthetics like Noradrenaline): sympathomimetic effects increased (increased blood pressure, pulse rate, paleness of skin etc.)
    • Nitrates and Antihypertensives (e.g. Beta-Blockers) - increased antihypertensive action with pronounced fall in blood pressure
  • Decreased drug actions:
    • Guanethidine, Reserpine, Guanfacine: antihypertensive effects decreased
    • Clonidine: antihypertensive effects decreased and risk of (massive) rebound hypertension.

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