Patient/caregiver was educated on contraindications for using Doxepin as follows:
- Doxepin use can significant risk for obstruction to the drainage of fluid (aqueous humor) inside the eye. This blockage of fluid in the eye can result in increase in the intraocular pressure, leading to glaucoma. Individuals with glaucoma can present with eye pain, headache, and blurred vision with haloes around light. So, doxepin use is contraindicated in individuals with history of glaucoma or cautiously used with periodical eye exam.
- Serotonin is one chemical in the brain, which in permissible amounts, is believed to reduce anxiety and promote happiness and well-being. Very excessive concentrations of serotonin in the brain can lead to serotonin syndrome. Individuals with serotonin syndrome can present with mania, excitement, hallucinations, agitation, insomnia, pounding heartbeat, very rapid heart rate, overactive reflexes, and diarrhea. Doxepin use, especially along with a few other antidepressants, such as, citalopram, fluoxetine, and sertraline, can significantly increase the serotonin levels in the body, lead to development of serotonin syndrome, and so, is contraindicated. Caution must be exercised even when discontinuing on any of the above mentioned antidepressant medications with potential to increase serotonin levels and starting on doxepin, by observing a window period of atleast 2 weeks, before the transition to doxepin is made. Using doxepin with these medications closely can result in dangerously elevated serotonin in the blood, leading to development of serotonin syndrome.
- Doxepin can interact with many antibacterial and antifungal antibiotics, antiarrhythmic medications, antidepressants, and antipsychotic medications, resulting in development or aggravation of underlying cardiac arrhythmias, leading to debility and sudden cardiac death. Avoid taking doxepin along with medications belonging to the above-mentioned groups, to prevent any dangerous arrhythmias from developing.
