About Sinequan
Sinequan (doxepin) belongs to a class of similar drugs called tricyclic
antidepressants. Sinequan is prescribed to relieve depression, panic
disorders, depression related to alcoholism or major illness, psychotic
depression, chronic pain from a variety of conditions, fibromyalgia,
reduce the incidence of chronic headache or migraine,
ulcers, itching, and insomnia.
Sinequan generally relieves tension, fear, guilt, and worry, while
improving mood, energy, and sleep.
It may take a few weeks to experience the full benefits of Sinequan
treatment; individuals taking it are encouraged to expect up to
a 30 day wait before seeing improvement. Sinequan's effectiveness
depends on building up a steady dose of the medication in your body
and maintaining it over time. Do not skip doses, even if you feel
you do not need them, as this may reduce the effectiveness of Sinequan.
This medication will commonly be prescribed for no more than 6 months,
at which time your doctor may want to evaluate your treatment or
recommend tests to see if you're having any physical reactions to
the medication you may not be aware of.
Sinequan is available only by prescription.
Sinequan Side Effects
Side effects are most likely during Sinequan treatment, particularly
sleepiness, in the first few days of taking this medication. If
any side effect doesn't clear up within a week, or if you have a
very strong reaction, consult your doctor immediately. Many of the
rare and serious side effects are more common in the elderly or
with higher doses.
Sinequan may cause drowsiness and affect your motor functions.
Be familiar with how you react to this medication before driving
or performing any hazardous task. Speak to your doctor if
you have a paradoxical reaction like increased irritability.
Common Sinequan Side Effects: constipation or difficulty
urinating (more likely in elderly patients), dizziness (try standing
slowly), drowsiness (problems with fatigue may be reduced by taking
Sinequan in the evening or at bedtime), dry mouth (consult dentist
if it lasts longer than two weeks), sensitivity to sunlight (Wear
sunglasses, protective clothing, and sunblock. Do not use sunlamps
or tanning beds.), temperature sensitivity (avoid saunas, jacuzzis,
and exposure to extreme cold), or weight gain.
Occasional Sinequan Side Effects: blood sugar changes, dental
cavities, fainting, headache, hives, increased appetite, indigestion,
nausea, rash, shaking, swollen face or tongue, unsteadiness, weakness.
If you become dizzy or faint when rising from sitting or lying down,
getting up slowly may help. If this condition worsens you should
contact your doctor. Indigestion and nausea may be relieved by taking
Sinequan with food; unless your doctor has instructed you otherwise,
Sinequan is best taken with food in most cases.
Rare Sinequan Side Effects: breast enlargement, breast milk
secretion, brown or red spots on skin, change in sense of taste
or hearing, irritated tongue or mouth, nightmare, sexual side effects
(impotence, difficulty with orgasm), sweating, restless feeling,
vomiting.
Contact your doctor immediately if any of the following
rare side effects occur: confusion, hallucination, heart palpitation,
hepatitis (allergic reaction), intestinal blockage, irregular heartbeat,
liver toxicity (yellow skin and eyes, feeling of illness throughout
the body), mania (sometimes seen in cases of manic-depression),
numbness or tingling in extremities, paranoia (possible in schizophrenia),
seizure, serious eye movement problems, very low blood pressure,
water retention, or weakness in arms or legs. Watch for fatigue
and weakness accompanied by abnormal bleeding or bruises, fever,
or sore throat as this may indicate bone marrow depression. There
is a small chance of developing serotonin syndrome, which may cause
confusion, restlessness, lowered coordination, shivering or trembling,
diarrhea, fever, sweating, twitching, or behaving with an excitement
you can't control.
Side effects of dosage reduction can be minimized by stepping
gradually off your treatment according to your doctor's advice.
Rapidly stopping Sinequan could result in all-over discomfort, headache,
or nausea. While slowly stopping Sinequan, you may experience agitation,
irritability, sleep disturbances, or restlessness.
Cautions: Certain medical conditions, like a recent heart
attack or pregnancy, are contraindications for Sinequan treatment.
But your doctor should be advised of any of the following conditions,
or any history of them, as you may require more careful monitoring
or a dosage adjustment if your doctor decides that Sinequan is right
for you.
- Allergy: Inform your doctor of any allergy to foods,
colorings, or preservatives. If you have ever had an allergic
reaction to another tricyclic antidepressant, or to Tegretol (carbamazepine),
Ludiomil (maprotiline), or Desyrel (trazodone), Sinequan treatment
may not be right for you.
- Bipolar disorder: Sinequan may worsen this condition.
- Blood cell disorder: Sinequan has resulted in rare cases
in bone marrow depression, which may cause anemia or a reduced
ability to fight off infection. Inform your doctor of any history
regarding these conditions, and be alert for signs of unusual
bleeding, bruising, weakness, fever, sore throat, or fatigue that
doesn't go away in the first few days of treatment or with rest.
- Breathing problems: If you have asthma, hay fever, allergies,
or chronic sinus conditions, be aware that some of the medications
used for these conditions may increase the risk of serious heart
complications when combined with Sinequan treatment. If you have
asthma, Sinequan may make this condition worse.
- Diabetes or Hypoglycemia: Sinequan may cause fluctuations
in blood sugar levels. Also, there are rare reports of Sinequan
increasing numbness, tingling, or pain in the extremities. Consult
your doctor about minimizing these effects.
- Difficulty urinating: Consult with your doctor, this
medication may not be right for you.
- Enlarged prostate: Sinequan may worsen this condition.
- Heart problems: Do not take Sinequan if you have had
a recent heart attack. Many heart medications may interact negatively
with Sinequan, and certain medicine combinations may increase
the likelihood of dangerous heart-related side effects. Inform
your doctor of any history of spontaneous rapid heartbeat, irregular
heartbeat, or heart-related chest pain.
- Intestinal blockage: Inform your doctor of any history
of this disorder. Sinequan has, in rare cases, caused this condition.
- Irritable bowel or bladder: Constipation or difficulty
urinating may result from Sinequan treatment, consult your doctor
about minimizing these possible side effects.
- Kidney problems or failure: Your doctor will want to
put you on a lower dose, as a reduction in kidney function decreases
your ability to remove Sinequan from the body as needed. Periodic
blood checks may be recommended.
- Liver problems: Your doctor will want to put you on a
lower dose, as a reduction in liver function decreases your ability
to remove Sinequan from the body as needed. Periodic blood checks
may be recommended.
- Glaucoma: Consult with your doctor, especially with narrow-angle
glaucoma. This condition may be a contraindication for Sinequan
treatment.
- Mental illness: Sinequan may react badly or cause excessive
central nervous system depression in combination with medications
used to treat these conditions.
- Schizophrenia: Sinequan may increase paranoia.
- Seizure disorders: If you have a history of seizure disorders,
or are presently being treated for one, your doctor may want to
monitor you more carefully. Sinequan may interact with certain
seizure treatments, and there is some (rare) risk of seizure as
a side effect.
- Sexual problems: Sinequan may alter the libido, or inhibit
orgasm in men and women. Inform your doctor of any history of
prostate difficulties.
- Surgery: Sinequan may interact with certain medications
used during surgery. Inform your anesthesiologist, dentist, or
surgeon in advance that you take Sinequan, especially if you are
not dealing with your regular doctor. Be aware that certain antibiotics
should not be combined with Sinequan, as you may need antibiotic
treatment after your procedure to reduce the risk of infection.
- Thyroid disorder: Sinequan may interact with your treatment
for overactive or underactive thyroid conditions. Speak with your
doctor about any history of these conditions.
Sinequan Interactions
Sinequan (doxepin) may not mix well with all medications, either
prescription or over the counter. Some medications should not be
mixed at all, and with others your doctor may want to adjust your
dose to decrease the risk of side effects. Consult with your doctor
if you are already taking, or intend to take, any of the following.
- Airway spasm relaxants like Proventil (albuterol) or Sudafed
may increase the risk of heart problems with doxepin.
- Alcohol - Even small amount of alcohol may lead to blackouts
while being treated with doxepin; intoxication and central nervous
system depression and toxicity may be highly amplified. Avoid
cold medications containing ethanol (alcohol).
- Aldomet (methyldopa) may increase the risk of side effects.
- Amphetamines may increase the risk of heart problems.
- Antabuse (disulfiram) - Amitriptyline may amplify the effects
of this medication.
- Antibiotics of the quinolone family like Avelox (moxifloxacin),
Raxar (grepafloxacin), Tequin (gatifloxacin), or Zagam (sparfloxacin)
can result in serious heart related complications. Never combine
these with doxepin treatment.
- Anticoagulants like Coumadin (warfarin) may lead to excessive
bleeding when combined with doxepin.
- Antihistamines like Benadryl (diphenhydramine) and Tavist may
increase the risk of serious side effects.
- Antipsychotics - medications used to treat mental illness increase
the risk of serious side effects from doxepin.
- Antiseizure medication like Cerebyx (fosphenytoin), Dilantin
(phenytoin), or Tegretol (carbamazepine) may decrease levels of
doxepin.
- Antispasmodics such as Bentyl or Donnatal.
- Antithyroid agents used to treat overactive thyroid conditions
may increase the risk of serious side effects.
- Appetite suppressants like Phentermine/Adipex
(fastin), Meridia (sibutramine),
or Xenical (orlistat) may increase the risk of heart complications
when mixed with doxepin.
- Benzodiazepines (a class of antidepressants, anti-panic agents,
sleep medications, and muscle relaxants) such as Ativan
(lorazepam), Dalmane (flurazepam), Valium
(diazepam), Halcion (triazolam),
Restoril (temazepam), Xanax
(alprazolam), Tranxene-SD (clorazepate), Paxipam (halazepam),
ProSom (estazolam), Klonopin
(clonazepam), and others, may increase the risk of serious
side effects, such as loss of motor skills. Amitriptyline may
be combined with Librium(chlordiazepoxide)
for anxiety or depression that resists treatment with one medication.
- Catapres (clonidine) - increases the risks of serious side effects
with doxepin.
- Cylert (pemoline) may increase the risk of side effects.
- Demser (metyrosine) may increase the risk of side effects.
- Diflucan (fluconazole) may result in high levels of doxepin
in the body.
- Ephedrine, pseudoephedrine - may increase the risk of heart
complications, found in certain sinus and cold preparations. Avoid
supplements containing the herb Ephedra.
- Epinephrine (adrenaline) may increase the risk of heart complications.
- Estrogen (oral contraceptives or estrogen replacement) may elevate
blood levels of doxepin.
- Ginseng - Do not take this herb while using doxepin.
- Hylorel (guanadrel) - Amitriptyline may decrease the effectiveness
of this medication.
- Indian snakeroot - Do not take this herb while using doxepin.
- Ismelin (guanethidine) - Amitriptyline may decrease the effectiveness
of this medication.
- Isoprel (isoproterenol) may increase the risk of heart complications
when used with doxepin.
- Lioresal (baclofen) - possible muscle weakness or memory problems.
- Kava kava - Do not take this herb while using doxepin.
- MAO inhibitors - Amitriptyline must never be mixed with MAO
(monoamine oxidase) inhibitors, a class of antidepressants and
antisenility drugs, such as Eldepryl (selegiline), Furoxone (furazolidone),
Nardil (phenelzine), Marplan (isocarboxazid), or Parnate (tranylcypromine).
Never use Sinequan within 2 weeks of starting or stopping an
MAO inhibitor. Patients over 65 should allow a longer wait
period between using doxepin and an MAO, as doxepin may stay in
their system longer than in other patients. This drug combination
could be fatal.
- Metrizamide - increases the risk of seizures.
- Narcotic pain medication like Codeine, Demerol
(meperidine), Buprenex (buprenorphine), Darvon (propoxyphene),
Dilaudid (hydromorphone), MS Contin or Kadian (morphine), nalbuphine,
OxyContin (oxycodone),
Percocet (oxycodone and
acetaminophen), Stadol (butorphanol), Talwin compound (pentazocine),
or Vicodin (hydrocodone and
acetaminophen), Vicoprofen
(hydrocodone and ibuprofen) may increase the central nervous
system or respiratory (breathing) depressant effects of doxepin.
Consult your doctor for advice on how to take these medications
together safely.
- Neo-Synephrine (phenylephrine) may increase risk of serious
heart complications.
- Nicotine - May speed the removal of doxepin from the body, possibly
diminishing it's effectiveness.
- Norflex (orphenadrine)
- Risk of oversedation.
- Orap (pimozide) may increase the risk of side effects.
- Parkinsonism medication like Cogentin or Larodopa
- Phenergan (promethazine) may increase the risk of side effects.
- Placidyl (ethchlorvynol)
- Protease inhibitors such as Agenerase (amprenavir), Norvir (ritonavir),
and perhaps others, may lead to toxic levels of doxepin in the
body.
- Provigil (modafinil) -
May cause toxic buildups of tricyclic antidepressants.
- Quinidex (quinidine)
- Rauwolfia alkaloids such as Rauwiloid (alseroxylon), Harmonyl
(deserpidine), Raudixin (rauwolfia serpentina), or Serpasil (reserpine)
may increase the risk of side effects when mixed with doxepin.
- Reglan (metoclopramide) may increase the risk of side effects.
- Rhythmol (propafenone)
- Ritalin (methylphenidate)
- Sedatives like Fioricet
(butalbital, acetaminophen, and caffeine), Fiorinal,
Phenobarbitol, Seconal, or other barbiturates.
- Selective serotonin reuptake inhibitors (SSRIs) like Celexa
(citalopram), Paxil (paroxetine),
Prozac (fluoxetine), Luvox (fluvoxamine), or Zoloft (sertraline)
should not be mixed with doxepin. They may increase the risk of
serious side effects or lead to elevated levels of doxepin in
the blood.
- Skeletal muscle relaxants such as Flexeril
(cyclobenzaprine), Skelaxin
(metaxalone), Soma (carisoprodol),
or Robaxin (methocarbamol)
may cause oversedation in combination with this medication.
- Sleep medication like Ambien
(zolpidem), Sonata (zaleplon),
or over the counter sleeping pills should be used with doxepin
only as, and if, advised by your doctor.
- St. John's Wort - Do not take this herb while using doxepin.
- Tagamet (cimetidine) - increases risk of serious side effects.
- Tambocor (flecainide)
- Temaril (trimeprazine) may increase the risk of side effects.
- Tenex (guanfacine) - may decrease effectiveness of this medication.
- Thyroid hormones such as Synthroid.
- Tikosyn (dofetilide) - possible heart rhythm problems, do not
mix with doxepin treatment.
- Tranquilizers such as Haldol (haloperidol), Mellaril (thioridazine),
or Thorazine (chlorpromazine) may cause oversedation.
- Tricyclic antidepressants (any other) such as Asendin (amoxapine),
Anafranil (clomipramine), Pertofrane or Norpramin (desipramine),
Elavil (amitriptyline),
Tofranil (imipramine), Aventyl or Pamelor (nortriptyline),
Vivactil (protriptyline), and Surmontil (trimipramine), should
never be mixed with Sinequan (doxepin). If you have ever had an
allergic reaction to any of these medications, you should not
take Sinequan.
- Ultram (tramadol) - increased
risk of seizure, do not mix with doxepin treatment.
- Vascor (bepridil) - possible heart rhythm problems, do not mix
with doxepin treatment.
- Vitamin C - Excessive amounts may interfere with doxepin treatment
and increase the likelihood of appetite increase or weight gain.
- Wellbutrin/Zyban (bupropion)
- Yohimbe - Do not take this herb while using doxepin.
Sinequan is a central nervous system depressant, and should be used
very cautiously in combination with any medication that warns it
'may cause drowsiness,' or increases your level of alertness. Over
the counter medications and herbal supplements should be checked
with your doctor or pharmacist if you are unsure about the safety
of using them while taking Sinequan.
Sinequan Dosages
Sinequan dosage may be different for each individual. Be sure your
doctor has clearly explained your dosage requirements and schedule
to you. Your doctor may want to monitor your Sinequan treatment
during the first few weeks to adjust your dosage gradually upwards
if a lower dose doesn't give you the full expected benefit. A typical
ongoing dose for mood disorders or depression in an average adult
is 25 mg taken 3 times per day, and no more than 150 mg per day
unless you are hospitalized. Children and seniors will likely start
with, and continue to take, lower doses of Sinequan. If your doctor
suggests taking a single dose, instead of divided doses, this should
usually be taken at bedtime to reduce the chance of side effects
during waking hours.
For ongoing treatment of insomnia, the effective dosage will usually
be about 10-25mg per day, taken at bedtime. This drug should be
effective for treating your insomnia within a couple days of use,
if it will help at all. Some people with insomnia find that this
medication either does not work, or significantly affects them the
next day.
Sinequan Directions
If you miss a dose of Sinequan, take it as soon as you remember.
If you take Sinequan once a day at bedtime, your doctor may advise
you not to take the missed dose in the morning as certain side effects
may be disturbing to you in the daytime. If you don't remember until
it's time to take the next dose, skip the missed dose and resume
your regular schedule. Do not take double doses of Sinequan, as this
increases the risk of side effects.
Take Sinequan with food or milk, even if you take it just before
bed, to decrease the risk of nausea. Take Sinequan on an empty stomach
only if so advised by your doctor.
For the oral solution, take with water, milk, citrus juice, tomato
juice, or prune juice. Do not mix with grape juice or any carbonated
beverage, as this could decrease the effectiveness of the medication.
Take immediately after mixing, do not store or allow to stand.
Inform your doctor, dentist, or anesthesiologist that you are taking
Sinequan before any kind of surgery or medical test. This medication
may interfere with certain test results. Sinequan should not be combined
with certain medications given during surgery, or some antibiotics
given after surgery.
Store Sinequan away from direct light and heat. Store in a dry location;
avoid storing it in the bathroom, near sinks, or other areas where
it may become damp. Do not freeze the liquid version of Sinequan.
Do not use after the expiration date.
Keep Sinequan away from children; both when storing it, and when discarding any unused medication.
Sinequan may cause drowsiness or disorientation. Be cautious if you plan to drive or operate heavy machinery, avoid these activities if you find yourself feeling tired or experience slowed reactions.
Sinequan and Pregnancy
Sinequan has not been adequately studied in pregnant and nursing women. Advise your doctor if you are pregnant or plan to become pregnant. Your doctor may advise you not to breastfeed while you are taking Sinequan.
Sinequan and Children
Sinequan is not recommended in patients under 12 years of age.
Use and dosage for older children would be determined individually
by your doctor.
Sinequan and Seniors
Increased risk of side effects, particularly confusion, hallucination,
or symptoms similar to Parkinson's disease. Individuals over 60
may also be more likely to experience drowsiness or unsteadiness.
Symptoms will likely show in the first two weeks, careful monitoring
is advised. Seniors may be more likely to take medications that
react with Sinequan, they are advised to carefully check the warnings
that accompany any other medications they take.
Seniors usually start at the lower dose of 25mg per day, taken
at bedtime, to reduce the risk of side effects.
Sinequan is a trademark of Pfizer
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This document is provided for information only. It is not a substitute for consultation with a physician, either to diagnose symptoms or prescribe treatment. Any dosages mentioned are general guidelines only, please follow the directions of your doctor or pharmacist exactly when taking medication. We have made every effort to ensure that this information is accurate, but only your doctor can say if a medication, or drug combination, is safe for you. Information intended for US residents only.
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