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Doxepin

A tricyclic antidepressant. Highly selective 5 HT uptake inhibitor. Better tolerated by elderly patients because of lesser anti cholinergic activity. It has a quick onset of action and chances of cardio-vascular complications less.

Indications: Anxiety with depression. Psychoneurosis and psychotic depression, a typical depression.

Contradictions: Patients with hepatic impairment, epilepsy, patients with enlarged prostate.

Safety Profile: Elderly: Adjust the dose according to tolerance and requirement.

Adverse Effects: Orthostatic hypotension, Insomnia, nervousness, fatigue, impaired alertness, epileptic form seixures, ataxia, jaundice, decreased libido, impotence, gynaecomastia, galactorrhoea.

Drug Interactions: Alcohol: enhances sedative effect, clonidine, reserpine, guanethidine, methyldopa reduced anti hypertensive activity. Combination with MAOI should be avoided; hyperpyrexia and convulsions can be precipitate.

Dosage: Adults: 75 mg in 3 divided dose. Increasing slowly to 50mg t.i.d. Elderly: Start with 10-50 mg daily.