Doxin
Doxin (Doxepin 10/25/75 mg) — TCA with strongest H1 sedation for depression, anxiety, chronic insomnia, urticaria. 3–6 mg HS for insomnia bypasses TCA-class warnings.
✓ Medically reviewed by Morgan Ellis — Pharmacy Researcher · 8 years experience · Last reviewed: May 2026
⚡ Quick Answer
Doxin (Doxepin 10 / 25 / 75 mg) is a tricyclic antidepressant. Most modern use is at low doses for chronic insomnia (3–6 mg) or full antidepressant doses (75–300 mg) for sedating/anxiolytic depression.
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What Doxin is and how it works
Doxin is a Doxepin-containing tablet supplied by Sun Pharma. Available strengths: 10 / 25 / 75 mg.
Doxepin is unusual among TCAs in that its primary modern use is at low doses (3–6 mg) for chronic insomnia — its profound H1 antihistamine action is the strongest of any tricyclic and produces sleep-maintenance benefit without the addictive profile of benzodiazepines or Z-drugs. At full antidepressant doses (75–300 mg), it functions as a classic mixed serotonin-noradrenaline TCA with sedating, anxiolytic, and analgesic properties.
Tricyclic antidepressants block the reuptake of serotonin and noradrenaline at presynaptic transporters, similar to SSRIs and SNRIs. Their tolerability disadvantage comes from off-target receptor blockade: muscarinic (anticholinergic side effects), histaminergic H1 (sedation, weight gain), and α1-adrenergic (orthostatic hypotension). They also block fast sodium channels in cardiac tissue — the basis for both their analgesic action and their cardiac toxicity in overdose.
The 3–6 mg insomnia indication is the only TCA dose range that does not require ECG and TCA-class anticholinergic counselling — at those doses, systemic exposure is negligible.
Indications and dosing
| Indication | Starting | Target | Max |
|---|---|---|---|
| Major depression / anxiety | 25–75 mg HS | 75–300 mg/day | 300 mg |
| Chronic insomnia (low-dose) | 3 mg HS | 3–6 mg HS | 6 mg |
| Chronic urticaria / pruritus | 10 mg TID | 10–25 mg TID | by tolerability |
| Older adults | 10 mg HS | 30–75 mg/day | 150 mg |
Important safety considerations
TCAs prolong QRS and QT, and overdose is life-threatening — historically the most common cause of antidepressant fatalities. Baseline ECG before initiating in patients with known cardiac disease, on QT-prolonging therapy, or in older adults. Do not start in recent MI, conduction abnormality, uncompensated heart failure, or congenital long QT. Limit dispense quantities in patients at suicide risk — the therapeutic-to-toxic ratio is narrow.
Dry mouth, constipation, blurred vision, urinary hesitancy, cognitive slowing — universal at therapeutic doses. Avoid in narrow-angle glaucoma, BPH with significant retention, and dementia. Pair with chewing gum / sugar-free lozenges, fibre + fluid, and stool softeners.
All antidepressants carry an FDA black-box warning for increased suicidal ideation in patients under 25 — particularly relevant for clomipramine in adolescent OCD.
Common side effects
- Anticholinergic: dry mouth, constipation, blurred vision, urinary hesitancy.
- Sedation: particularly doxepin and clomipramine; bedtime dosing helps.
- Cardiovascular: orthostatic hypotension (α1 block), tachycardia, conduction-interval prolongation.
- Metabolic: weight gain (5–10 kg over 12 months in many patients), increased appetite.
- Sexual: reduced libido, delayed ejaculation (sometimes used clinically for premature ejaculation), erectile difficulty.
- Withdrawal: taper over 4 weeks; abrupt cessation produces flu-like symptoms, GI upset, and sleep disturbance.
Drug interactions
- MAOIs — absolute contraindication. 14-day washout each direction.
- SSRIs / SNRIs — additive serotonergic risk; CYP2D6 inhibition by fluoxetine and paroxetine raises TCA levels.
- QT-prolonging drugs (azoles, macrolides, amiodarone, sotalol, methadone, ondansetron, antipsychotics) — additive risk.
- Other anticholinergics (oxybutynin, benztropine, antihistamines, clozapine, olanzapine) — additive burden in older adults.
- CNS depressants — additive sedation.
- Tramadol, bupropion, fluoroquinolones — lower seizure threshold; additive seizure risk.
Pregnancy, breastfeeding, paediatric
TCAs are FDA pregnancy category C. Late-pregnancy exposure can produce neonatal anticholinergic withdrawal. Lactation: TCAs pass into breast milk in small amounts; nortriptyline and imipramine are the most-studied. Paediatric: imipramine is licensed from age 6 (enuresis) and clomipramine from age 10 (OCD); doxepin in adolescents only with specialist input.
Storage
Store at 15–30 °C, away from direct sunlight, in original packaging. Keep out of reach of children — TCA paediatric ingestion is a medical emergency.
Frequently Asked Questions
How long until Doxin works?
TCAs typically show benefit within 2–4 weeks. The sleep and anxiety improvements often appear in week 1; the antidepressant effect builds over 4–6 weeks.
Why bedtime dosing?
Doxepin, clomipramine, and imipramine are all sedating. Bedtime dosing recruits the sedation as a side-effect benefit (sleep) instead of a side-effect burden (daytime drowsiness). It also reduces orthostatic hypotension by sleeping through the peak.
Is Doxin safe in older adults?
TCAs are on the Beers Criteria list of potentially inappropriate medications in older adults because of anticholinergic burden, orthostatic hypotension, and cardiac risk. They are not absolutely contraindicated but are generally second-line — SSRIs/SNRIs are preferred unless a specific benefit (e.g. pain, sleep) outweighs the risks.
Can I drink alcohol on Doxin?
Alcohol amplifies TCA sedation and orthostatic effects. Limit to occasional and modest consumption; avoid binge drinking entirely. The combination is not usually dangerous in moderation but feels worse than either alone.
What is the overdose risk?
TCAs are among the most lethal classes of medication in overdose — cardiac conduction collapse, seizures, and coma can occur at relatively low multiples of the therapeutic dose. Limit dispense quantities in patients at any suicide risk. If overdose is suspected, present to emergency immediately — sodium bicarbonate is the antidote for the cardiac toxicity but timing matters.
Will Doxin affect my driving?
Sedation and reaction-time impairment are common in the first 1–2 weeks. Avoid driving until steady-state tolerability is known. Some patients tolerate full doses indefinitely without driving impairment; others remain too sedated even at low doses.
Can Doxin be combined with an SSRI?
Generally no — combination raises serotonin syndrome risk and serum TCA levels (particularly with fluoxetine and paroxetine). The combination is sometimes used in refractory OCD or depression under specialist supervision with TDM, never empirically.
How do I taper Doxin?
Reduce by approximately 25–50% of the dose every 2 weeks. Withdrawal (sometimes called “TCA flu”) produces malaise, GI upset, and sleep disturbance — manageable with slower tapers. Talk to the prescriber before stopping.
Does Doxin cause weight gain?
Yes — most TCAs cause meaningful weight gain over 6–12 months, often 5–10 kg. Doxepin and amitriptyline are the worst; nortriptyline less so. If this is a major concern, raise it before initiation — an SSRI/SNRI may be a better fit.
Can Doxin be used for chronic pain?
Yes — TCAs (especially amitriptyline, nortriptyline, and imipramine) at low doses (10–75 mg) are first-line for diabetic peripheral neuropathy, post-herpetic neuralgia, and tension-type chronic headache. Sodium-channel blockade is the dominant mechanism. The analgesic effect is independent of the antidepressant effect and appears earlier (1–2 weeks).
Other Mental Health Medications
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- Doxin (Doxepin TCA)
- Antidep (Imipramine TCA)
- Flunil (Fluoxetine SSRI)
- Duvanta (Duloxetine SNRI)
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Doxin
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