Patient/caregiver was educated on the side-effects of using Doxepin as follows:
Musculoskeletal side-effects
- Doxepin intake carries the risk of causing seizures, especially in individuals with history of seizures. Individuals can present with sudden episodes of loss of consciousness, intense convulsions with muscle contractions, bowel and bladder incontinence. Do not ignore seizure episodes and report them to your physician promptly for any appropriate measures to be considered.
- Doxepin intake can also induce a life-threatening reaction called Neuroleptic Malignant Syndrome (NMS). Individuals with NMS can present with high fever, episodes of confusion, intense muscle rigidity and contractions, elevated blood pressure, and rapid heart rate.
- Potassium ion usually is maintained within close limits in the blood and body fluids and any sudden increase or decrease in blood potassium levels can lead to severe cardiac arrhythmias. Uncontrolled seizure activity and intense muscle contractions from doxepin use can lead to muscle damage and breakdown. Potassium ion from within the damaged muscle cells can leak out into the blood and body fluids, thus causing an acute increase in blood potassium levels. This acute elevation of potassium levels in the blood from doxepin use can lead to life-threatening cardiac arrhythmias. Individuals can present with episodes of chest pain, intense shortness of breath, altered heartbeat, ineffective heart contractions, dizziness/loss of consciousness from arrhythmias. Report them to your physician promptly for any appropriate measures to be considered.
Genitourinary side-effects
- Action of the neurochemical acetylcholine on urinary bladder results in contraction of bladder, bladder emptying, and urination.
- Doxepin reportedly reduces the release of acetylcholine, thus reducing the action of acetylcholine on the bladder.
- This action of doxepin helps with relaxing the bladder, prevent/reduce episodes of bladder contraction, induce retention of urine in the bladder, and cause difficulty with emptying the bladder. Retention of urine in the bladder is a significant factor contributing to development of UTI. Individuals with history of retention of urine and frequent urinary tract infections must be aware of this side-effect of doxepin, as the medication can exacerbate this risk significantly. Observing compliance with proper hydration measures, compliance with daily fluid intake recommendations, practicing hygiene & timed voiding with other UTI prevention measures can help reduce the risk of urinary retention and prevent development of any UTIs, secondary to doxepin intake
