Doxepin
Doxepin is a prescription tricyclic antidepressant (TCA) capsule used to treat depression and anxiety. Doxepin is used for Depression and/or anxiety in psychoneurotic patients and Depression and anxiety associated with alcoholism.
Also called: Zonalon (United States) · Xepin (United Kingdom) · Sinequan (Canada)
Pronunciation: (DOX-eh-pin).
- Generic name
- doxepin
- Drug class
- Tricyclic Antidepressant (TCA)
Availability and supply rules vary by country
Trade names by country: United States · United Kingdom · Canada · India · Nepal
Australia: · Full directory
What doxepin is and how it works
Doxepin is a prescription tricyclic antidepressant (TCA) capsule used to treat depression and anxiety. Low-dose doxepin is also used, as a separate product, for insomnia, and a topical doxepin cream is used for itching associated with certain skin conditions — this page covers the oral capsule (depression/anxiety) product. Doxepin works by affecting natural chemical messengers (neurotransmitters) in the brain, particularly serotonin and norepinephrine, which is thought to help improve mood and anxiety symptoms. As a tricyclic antidepressant, it also blocks histamine receptors, which contributes to sedation. Key points for patients: Doxepin may take several weeks to show full benefits. It carries a boxed warning about an increased risk of suicidal thoughts and behavior in children, adolescents, and young adults. It should be taken exactly as prescribed, and any change to your dose should be made only with your prescriber's guidance. Always inform your doctor about other medications or supplements you are taking to avoid interactions. (2) (1)
Uses, formulations, monitoring, and supply rules can differ by patient, product, and country. Follow the exact local product information and professional advice.
Mechanism of action: how doxepin works
Doxepin is a tricyclic antidepressant that is understood to inhibit the reuptake of serotonin and norepinephrine and to block histamine (H1) receptors, contributing to its antidepressant, anxiolytic, and sedative effects. (2)
What is Doxepin used for?
Depression and/or anxiety in psychoneurotic patients
Depression and/or anxiety in psychoneurotic patients (1)
Depression and anxiety associated with alcoholism
Depression and anxiety associated with alcoholism (1)
Depression associated with organic disease, and psychotic depressive disorders with associated anxiety
Depression associated with organic disease, and psychotic depressive disorders with associated anxiety (1)
Before taking doxepin
Do not take / not appropriate for
- hypersensitivity to doxepin. (Contraindication) (1)
- glaucoma or a tendency toward urinary retention. (Contraindication) (1)
- concurrent use of a monoamine oxidase inhibitor (MAOI) — an MAOI should be discontinued at least 2 weeks before starting doxepin. (Contraindication) (1)
Tell your clinician about
(1)Doxepin dosage and how to take it
- Take doxepin exactly as prescribed. For mild-to-moderate illness, treatment usually starts at 75 mg/day, within an optimal range of 75-150 mg/day; more severely ill patients may need up to 300 mg/day under close prescriber supervision; when given as a single daily dose, the maximum recommended bedtime dose is 150 mg. Elderly patients are usually started at the lower end of the dosing range. Do not change your dose without your prescriber's guidance.
- This page does not provide a dose calculator. Dosing must follow the prescriber, pharmacist, or product label.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1)
Missed dose
Contact your prescriber or pharmacist for advice on what to do if you miss a dose.
Overdose
If an overdose is suspected, seek emergency medical attention immediately. Doxepin overdose is treated by a clinician with an ECG and cardiac monitoring started right away, support for breathing, intravenous access, and gastric decontamination (such as activated charcoal); at least 6 hours of monitoring is needed after a significant overdose. Alcohol increases the danger of a doxepin overdose. (1)
Doxepin side effects
Side effects and their urgency vary; report severe, persistent, or concerning symptoms to a healthcare professional.
Dry mouth, blurred vision, constipation, or urinary retention (anticholinergic effects)
Incidence: Common
Drowsiness (the most common central nervous system effect) or confusion
Incidence: Common
Dizziness
Incidence: Reported in the clinician-authored database; not individually itemized by the external source reviewed in this research pass
Low blood pressure, high blood pressure, or a fast heartbeat
Incidence: Reported
New or worsening mood or behavior changes, or thoughts of self-harm
What to do: Seek medical attention promptly — this needs urgent clinician assessment. (1)
Confusion or hallucinations
What to do: Tell your clinician promptly. (1)
Fast heartbeat
What to do: Seek medical attention promptly. (1)
Any reaction you believe may be a severe allergic reaction after taking doxepin
What to do: Seek immediate emergency care. (1)
Serious warnings
Boxed warning — risk of suicidal thoughts and behavior — serious
Symptoms: Boxed warning — risk of suicidal thoughts and behavior: antidepressants, including doxepin, increased the risk of suicidal thinking and behavior compared with placebo in children, adolescents, and young adults in short-term studies. This increased risk was not seen in adults over 24, and the risk was reduced in adults 65 and older. Anyone starting doxepin should be watched closely for worsening depression or unusual changes in mood or behavior, especially in the first weeks of treatment or after a dose change — seek medical attention promptly for any of these changes, or for thoughts of self-harm, so your clinician can assess urgently and advise on treatment.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (1)
Tell your prescriber before starting doxepin if you have glaucoma, a tendency toward urinary retention, or have taken a monoamine oxidase inhibitor (MAOI) in the last 2 weeks — these require special caution or may make doxepin unsuitable — serious
Symptoms: Tell your prescriber before starting doxepin if you have glaucoma, a tendency toward urinary retention, or have taken a monoamine oxidase inhibitor (MAOI) in the last 2 weeks — these require special caution or may make doxepin unsuitable.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (1)
Heart effects — serious
Symptoms: Heart effects: seek medical attention promptly for a fast heartbeat.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (1)
Allergic reaction — serious
Symptoms: Allergic reaction: doxepin is contraindicated with a known allergy to it. Seek immediate medical attention for any reaction you believe may be allergic or severe.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (1)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| Monoamine oxidase inhibitors (MAOIs) | Concurrent use is contraindicated. Tell your prescriber about any current or recent MAOI use — the label specifies a minimum 2-week gap after stopping an MAOI before doxepin is started, and your prescriber will determine the appropriate timing and whether doxepin is suitable for you. | (1) |
| SSRIs (selective serotonin reuptake inhibitors) | May increase doxepin levels in the blood by inhibiting the CYP2D6 enzyme that breaks it down. | (1) |
| Cimetidine | Can cause clinically significant changes in doxepin blood levels. | (1) |
| Alcohol and other central-nervous-system depressants (sedatives, other sedating medicines) | Increase sedation and increase the danger of overdose. Discuss alcohol use with your prescriber or pharmacist while taking doxepin. | (1) |
| Tolazamide (a diabetes medicine) | Severe low blood sugar (hypoglycemia) has been reported when combined with doxepin. | (1) |
Pregnancy, breastfeeding, kidney/liver function, age
Pregnancy
Safety has not been established in pregnancy. Discuss any pregnancy or plans for pregnancy with your prescriber. (1)
Breastfeeding
A case report describes apnea (pauses in breathing) and drowsiness in a nursing infant whose mother was taking doxepin. Discuss breastfeeding with your prescriber. (1)
Children
Doxepin is not FDA-approved for use in pediatric patients and is not recommended for children under 12 years. The boxed suicidality warning applies to children and adolescents as well as young adults. (1)
Renal Impairment
The FDA label for doxepin capsules does not give a specific numeric renal or hepatic dose-adjustment table. It notes that the extent of renal excretion of doxepin has not been determined, and that elderly patients are more likely to have decreased hepatic, renal, or cardiac function, so dose selection in older adults should generally start at the low end of the range with careful adjustment and close observation. (1)
Hepatic Impairment
The FDA label for doxepin capsules does not give a specific numeric renal or hepatic dose-adjustment table. It notes that the extent of renal excretion of doxepin has not been determined, and that elderly patients are more likely to have decreased hepatic, renal, or cardiac function, so dose selection in older adults should generally start at the low end of the range with careful adjustment and close observation. (1)
Monitoring
(1)Storage
Follow the product label.
Study the drug class: Tricyclic antidepressants (practice MCQs)
Professional information
Clinician-facing context only. This section does not replace current product labeling.
General (US label, oral capsule)
Indication: Depression and/or anxiety
Dose summary: Mild-to-moderate illness: start at 75 mg/day; optimal range 75-150 mg/day. Severely ill patients may require up to 300 mg/day. Maximum recommended once-daily bedtime dose: 150 mg. Elderly patients: start at the lower end of the range.
Renal context: The FDA label states the extent of renal excretion of doxepin has not been determined; because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, generally starting at the low end of the dosing range. No specific numeric renal dose-adjustment table is given. (1)
Frequently asked questions
What is doxepin used for?
Oral doxepin capsules are used to treat depression and/or anxiety, including depression and anxiety associated with alcoholism, depression with organic disease, and psychotic depressive disorders with anxiety. (A separate low-dose product is used for insomnia, and a topical form is used for itching — these are not covered by this page.)
Can I drink alcohol while taking doxepin?
Alcohol increases sedation and increases the danger of a doxepin overdose — discuss alcohol use with your prescriber or pharmacist.
Does doxepin have a boxed warning?
Yes. Like other antidepressants, doxepin carries a boxed warning for an increased risk of suicidal thinking and behavior in children, adolescents, and young adults, especially early in treatment or after a dose change.
Who should not take doxepin?
Doxepin is contraindicated with a known allergy to doxepin, with glaucoma or a tendency toward urinary retention, and with current or recent (within 2 weeks) use of a monoamine oxidase inhibitor (MAOI). Tell your prescriber about these conditions before starting.
What should I do if I notice mood or behavior changes while taking doxepin?
Seek medical attention promptly if you or a family member notices new or worsening mood or behavior changes, or thoughts of self-harm — this needs an urgent clinician assessment.
Is doxepin safe during pregnancy or breastfeeding?
Safety in pregnancy has not been established, and a case report describes breathing pauses and drowsiness in a nursing infant whose mother took doxepin. Discuss risks and benefits with your healthcare provider.
Can children take doxepin?
Doxepin oral capsules are not FDA-approved for pediatric patients and are not recommended for children under 12 years.
What is the mechanism of action of doxepin?
Doxepin is a tricyclic antidepressant that is understood to inhibit the reuptake of serotonin and norepinephrine and to block histamine (H1) receptors, contributing to its antidepressant, anxiolytic, and sedative effects. (2)
What is the generic name of Doxepin?
The generic name is doxepin.
What class of drug is doxepin?
Doxepin is classed as: Tricyclic Antidepressant (TCA).
References
- Doxepin Hydrochloride capsules — prescribing informationU.S. Food and Drug Administration · United States · dated 2026 · accessed 2026-08-06 · source 1
- MedGuideGlobal medicine record — doxepinMedGuideGlobal · Global (internal database) · accessed 2026-08-06 · source 2
- DOXEPIN HYDROCHLORIDE TABLET [GOLDEN STATE MEDICAL SUPPLY, INC.] — US prescribing information (DailyMed SPL)U.S. National Library of Medicine (DailyMed) · US · accessed 2026-08-14 · source 3
- Doxepin Topical — patient drug information (MedlinePlus)U.S. National Library of Medicine (MedlinePlus) · US · accessed 2026-08-14 · source 4
- Doxepin hydrochloride — FDA approval record (Drugs@FDA ANDA214823)U.S. Food and Drug Administration · US · accessed 2026-08-14 · source 5
- doxepin — RxNorm normalized drug concept (RXCUI 203179)U.S. National Library of Medicine (RxNorm) · US · accessed 2026-08-14 · source 6
Brand names by country
Single-ingredient doxepin names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
United States
- Silenortablet · 3 mg, 6 mg · currax pharmaceuticals llcregulator source
- Zonaloncream · 50 mg/g · mylan pharmaceuticals inc.regulator source
- PRUDOXINcream · 50 mg/g · mylan pharmaceuticals inc.regulator source
United Kingdom
- Xepinreference source
Canada
- SINEQUANregulator source
- SILENORregulator source
India
Source-listed products; local stock and regulatory approval have not been confirmed. Check the exact ingredient, strength, and formulation with a pharmacist.
- Spectra 25mg CapsuleCapsule · 25mg · Eris Lifesciences Ltdpharmacy source recorded · checked 2026-09-24
- Galdopin CreamCream · 5% w/w · Galcare Pharmaceutical Pvt Ltdpharmacy source recorded · checked 2026-09-24
- Qipy 10mg CapsuleCapsule · 10mg · Tas Med India Pvt Ltdpharmacy source recorded · checked 2026-09-24
- Doxbrin 25mg CapsuleCapsule · 25mg · Brinton Pharmaceuticals Pvt Ltdpharmacy source recorded · checked 2026-09-24
Nepal
Source-listed products; local stock and regulatory approval have not been confirmed. Check the exact ingredient, strength, and formulation with a pharmacist.
- DoxinCapsule · 25mg · Intas Pharmaceuticals Ltd.reference source · checked 2026-09-24