Patient/caregiver was educated on contraindications for using Dothiepin as follows:
- Do not take dothiepin, if you ever manifested any allergic responses to intake of dothiepin or any other medications belonging to the same group as dothiepin, such as, amoxapine, amitriptyline, and desipramine. In the event of an allergic response with any of these medications, check with your physician regarding your safety with intake of dothiepin.
- Dothiepin can interact with a number of other medications and can precipitate serious reactions. If you are being newly started on dothiepin, discuss with your physician regarding all other medications you are currently taking and their safety with dothiepin. Also, if you have been taking dothiepin for long, discuss with your physician regarding your history of dothiepin intake, when you are being started on any new medication.
- Do not take dothiepin with alcohol or opioid pain medications, such as, hydrocodone and codeine, as these products can add to the confusion caused by dothiepin. A number of OTC cough medications, antihistamines, and antianxiety medications, can potentiate the confusion caused by dothiepin and so, must be avoided taking along with dothiepin. Avoid taking any other medications with potential to cause drowsiness along with dothiepin at the same time.
- Dothiepin 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, dothiepin 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. Dothiepin 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 dothiepin, by observing a window period of atleast 2 weeks, before the transition to dothiepin is made. Using dothiepin with these medications closely can result in dangerously elevated serotonin in the blood, leading to development of serotonin syndrome.
