Adverse Effects
Although some of the adverse reactions included in the following list have not been reported with doxepin pharmacological similarities among the tricyclic antidepressants require that each of the reactions be considered when prescribing doxepin.
Behavioral:
Drowsiness, fatigue, excitement, agitation, restlessness, insomnia, nightmares, hypomania, anxiety, confusion, disorientation, disturbed concentration, delusions, hallucinations, activation of latent psychosis.
Neurological:
Seizures, alteration in EEG patterns, dizziness, tremors, extrapyramidal symptoms, numbness, tingling, paresthesias of the extremities, peripheral neuropathy, tinnitus, syndrome of inappropriate ADH (antidiuretic hormone) secretion.
Cardiovascular:
Hypotension, hypertension, tachycardia, palpitations. A quinidine-like effect and other reversible ECG changes such as flattening or inversion of T-waves, bundle branch block, depressed S-T segments, prolonged conduction time and asystole, arrhythmias, heart block, fibrillation, myocardial infarction, stroke and unexpected death in patients with cardiovascular disorders have been reported with other tricyclic antidepressants.
Autonomic:
Dry mouth, blurred vision, disturbances of accommodation, mydriasis, constipation, nasal stuffiness, delayed micturition, sublingual adenitis, paralytic ileus, urinary retention, dilation of the urinary tract, precipitation of latent and aggravation of existing glaucoma, vertigo.
Endocrine:
Increased or decreased libido, impotence, menstrual irregularity, testicular swelling, breast enlargement and galactorrhea in the female, gynecomastia in the male, elevation and lowering of blood sugar levels.
Allergic or Toxic:
Pruritus, skin rash, photosensitization, edema, drug fever, leukopenia, urticaria, petechiae, obstructive jaundice and bone marrow depression, including agranulocytosis, eosinophilia, purpura and thrombocytopenia.
Gastrointestinal:
Nausea, epigastric distress, vomiting, flatulence, abdominal pain, diarrhea, peculiar taste, stomatitis.
Miscellaneous:
Weakness, headache, weight gain or loss, excessive appetite, anorexia, increased perspiration, urinary frequency, lacrimation, alopecia, parotid swelling, black tongue, hepatitis.
Withdrawal Symptoms:
Abrupt cessation of treatment with tricyclic antidepressants after prolonged administration may produce nausea, headache and malaise. These symptoms are not indicative of addiction.