Patient/caregiver was educated on contraindications for using Doxepin as follows:
- Doxepin reportedly reduces the release of acetylcholine, thus reducing the action of acetylcholine on various body tissues. Doxepin must be avoided or used with extreme caution along with any other medications that can have similar spectrum of activity of reducing the action of acetylcholine. Many inhaler medications used in treating breathing disorders and medications used to manage Parkinson’s disease can reduce action of acetylcholine and thus, can potentiate the side-effects of doxepin intake. So, doxepin must be avoided/used with extreme caution in individuals with history of asthma, COPD, and Parkinson’s disease. Discuss with your physician regarding safety with doxepin intake, if you have history of breathing disorders and Parkinson’s disease.
- Doxepin use in mothers can also increase risk for complications in breastfed newborns, as the drug passes into the breast milk. Breastfed newborns of mothers taking doxepin can present with respiratory complications and breathing difficulty. So, doxepin is best avoided for an alternative drug in women breastfeeding the newborn.
- Doxepin is metabolized in the liver and the metabolites are mainly excreted in the urine. If liver function is deficient, the metabolism of Doxepin can be compromised. In individuals with history of compromised renal function, the excretion of doxepin metabolites can be compromised. In either case, doxepin and metabolites stay in the body for prolonged duration of time in comparison to normal leading to increased blood levels of the medication and metabolites for longer periods of time. This can lead to increased risk for side-effects and consequent toxicity. So, Doxepin could be cautiously administered in individuals with hepatic and/or renal dysfunction. Periodical labs for liver and/or renal function could be ordered and individuals monitored for development of any toxic symptoms. Discuss with your physician regarding history of compromised liver or kidney function, if any.
