Drug/Small Molecule:
doxepin

last updated 01/16/2013

CPIC Dosing Guideline for doxepin and CYP2C19, CYP2D6

Summary

Tricyclic antidepressants have comparable pharmacokinetic properties, it may be reasonable to apply the CPIC Dosing Guideline for amitriptyline and CYP2C19, CYP2D6 to other tricyclics including doxepin. In the guideline for amitriptyline, an alternative drug is recommended for CYP2D6 or CYP2C19 ultrarapid metabolizers and for CYP2D6 poor metabolizers. Consider a 50% dose reduction for CYP2C19 poor metabolizers and a 25% dose reduction for CYP2D6 intermediate metabolizers.

Annotation

Guidelines regarding the use of pharmacogenomic tests in dosing for tricyclic antidepressants have been published in Clinical Pharmacology and Therapeutics by the Clinical Pharmacogenetics Implementation Consortium (CPIC).

Download: article and supplement

Excerpt from the dosing guidelines:

Amitriptyline and nortriptyline are used as model drugs for this guideline because the majority of pharmacogenomic studies have focused on these two drugs. Because the tricyclics have comparable pharmacokinetic properties, it may be reasonable to apply this guideline to other tricyclics including doxepin (Supplementary Table S16), with the acknowledgement that there are fewer data supporting dose adjustments for these drugs than for amitriptyline or nortriptyline.

See amitriptyline for excerpts and tables that summarize CYP2D6-based and CYP2C19-based dosing recommendations for amitriptyline when higher initial starting doses are warranted (article).


last updated 08/10/2011

Dutch Pharmacogenetics Working Group Guideline for doxepin and CYP2D6

Summary

The Dutch Pharmacogenetics Working Group Guideline for doxepin recommends to reduce the dose by 60% for CYP2D6 poor metabolizers and by 20% for intermediate metabolizers. Select an alternative drug for CYP2D6 ultrarapid metabolizers.

Annotation

The Royal Dutch Pharmacists Association - Pharmacogenetics Working Group has evaluated therapeutic dose recommendations for doxepin based on CYP2D6 genotypes (PMID:21412232). They recommend lower dose for patients carrying the poor metabolizer (PM) alleles and intermediate metabolizer alleles and alternative drug for patients carrying the ultrarapid metabolizer (UM) allleles.

Phenotype (Genotype) Therapeutic Dose Recommendation Level of Evidence Clinical Relevance
PM (two inactive (*3-*8, *11-*16, *19-*21, *38, *40, *42) alleles) Reduce dose by 60%. Adjust maintenance dose in response to (nor)doxepin plasma concentration Published controlled studies of moderate quality* relating to phenotyped and/or genotyped patients or healthy volunteers, and having relevant pharmacokinetic or clinical endpoints. Clinical effect (S): death; arrhythmia; unanticipated myelosuppression.
IM (two decreased-activity (*9, *10, *17, *29, *36, *41) alleles or carrying one active (*1, *2, *33, *35) and one inactive (*3-*8, *11-*16, *19-*21, *38, *40, *42) allele, or carrying one decreased-activity (*9, *10, *17, *29, *36, *41) allele and one inactive (*3-*8, *11-*16, *19-*21, *38, *40, *42) allele) Reduce dose by 20%. Adjust maintenance dose in response to (nor)doxepin plasma concentration. Published controlled studies of moderate quality* relating to phenotyped and/or genotyped patients or healthy volunteers, and having relevant pharmacokinetic or clinical endpoints. Minor clinical effect (S): QTc prolongation (<450 ms female, <470 ms male); INR increase < 4.5 Kinetic effect (S)
UM (a gene duplication in absence of inactive (*3-*8, *11-*16, *19-*21, *38, *40, *42) or decreased-activity (*9, *10, *17, *29, *36, *41) alleles) Select alternative drug (citalopram, sertraline) or increase dose by 100%. Adjust maintenance dose in response to (nor)doxepin plasma concentration. Published controlled studies of moderate quality* relating to phenotyped and/or genotyped patients or healthy volunteers, and having relevant pharmacokinetic or clinical endpoints. Minor clinical effect (S): QTc prolongation (<450 ms female, <470 ms male); INR increase < 4.5 Kinetic effect (S).
  • *See Methods or PMID: 18253145 for definition of "good" and "moderate" quality.
  • S: statistically significant difference.

PharmGKB gathers information regarding PGx on FDA drug labels from the FDA's "Table of Pharmacogenomic Biomarkers in Drug Labels", and from FDA-approved FDA and EMA-approved (European Medicines Agency) EMA labels brought to our attention. Excerpts from the label and downloadable highlighted label PDFs are manually curated by PharmGKB.

Please note that some drugs may have been removed from or added to the FDA's "Table of Pharmacogenomic Biomarkers in Drug Labels" without our knowledge. We periodically check the table for additions to this table and update PharmGKB accordingly.

There is currently no such list for European drug labels - we are working with the EMA to establish a list of European Public Assessment Reports (EPAR)s that contain PGx information. We are constructing this list by initially searching for drugs for which we have PGx-containing FDA drug labels - of these 44 EMA EPARs were identified and are being curated for pgx information.

We welcome any information regarding drug labels containing PGx information approved by the FDA, EMA or other Medicine Agencies around the world - please contact feedback.


last updated 10/25/2013

FDA Label for doxepin and CYP2D6

This label is on the FDA Biomarker List
Actionable PGx

Summary

Doxepin is primarily metabolized by hepatic cytochrome P450 isozymes CYP2C19 and CYP2D6. The drug label notes that CYP2D6 and CYP2C19 poor metabolizers have higher than expected plasma concentrations of doxepin when given typical doses. Additionally, inhibitors of these CYP isozymes may increase the exposure of doxepin.

Annotation

Doxepin hydrochloride is a tricyclic psychotherapeutic agent (TCA). It is recommended for the treatment of psychoneurotic patients with depression and/or anxiety. Doxepin is primarily metabolized by CYP2D6.

Excerpts from the Doxepin drug label:

Silenor is primarily metabolized by hepatic cytochrome P450 isozymes CYP2C19 and CYP2D6, and to a lesser extent, by CYP1A2 and CYP2C9. Inhibitors of these isozymes may increase the exposure of doxepin.

Since doxepin is metabolized by CYP2C19 and CYP2D6, inhibitors of these CYP isozymes may increase the exposure of doxepin. ...A maximum dose of doxepin in adults and elderly should be 3 mg, when doxepin is co-administered with cimetidine.

Poor metabolizers of CYP2C19 and CYP2D6 may have higher doxepin plasma levels than normal subjects.

For the complete drug label text with sections containing pharmacogenetic information highlighted, see the Doxepin drug label PDF.

*Disclaimer: The contents of this page have not been endorsed by the FDA and are the sole responsibility of PharmGKB.

Full label available at DailyMed

Genes and/or phenotypes found in this label

  • Depression
    • Indications & usage section, Warnings section, Adverse reactions section
    • source: PHONT
  • Depression, Postpartum
    • Warnings section, Adverse reactions section
    • source: PHONT
  • CYP2C19
    • Drug interactions section, Abuse section, Pharmacokinetics section, metabolism/PK
    • source: FDA Label
  • CYP2D6
    • Drug interactions section, Pharmacokinetics section, metabolism/PK
    • source: FDA Label

Clinical Variants that meet the highest level of criteria, manually curated by PharmGKB, are shown below.

To see more Clinical Variants with lower levels of criteria, click the button at the bottom of the page.

Disclaimer: The PharmGKB's clinical annotations reflect expert consensus based on clinical evidence and peer-reviewed literature available at the time they are written and are intended only to assist clinicians in decision-making and to identify questions for further research. New evidence may have emerged since the time an annotation was submitted to the PharmGKB. The annotations are limited in scope and are not applicable to interventions or diseases that are not specifically identified.

The annotations do not account for individual variations among patients, and cannot be considered inclusive of all proper methods of care or exclusive of other treatments. It remains the responsibility of the health-care provider to determine the best course of treatment for a patient. Adherence to any guideline is voluntary, with the ultimate determination regarding its application to be made solely by the clinician and the patient. PharmGKB assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of the PharmGKB clinical annotations, or for any errors or omissions.

? = Mouse-over for quick help

This is a non-comprehensive list of genetic tests with pharmacogenetics relevance, typically submitted by the manufacturer and manually curated by PharmGKB. The information listed is provided for educational purposes only and does not constitute an endorsement of any listed test or manufacturer.

A more complete listing of genetic tests is found at the Genetic Testing Registry (GTR).

PGx Test Variants Assayed Gene?
Roche AmpliChip CYP450 Test CYP2D6*1, CYP2D6*10A, CYP2D6*10B, CYP2D6*11, CYP2D6*15, CYP2D6*17, CYP2D6*19, CYP2D6*20, CYP2D6*29, CYP2D6*2A, CYP2D6*2B, CYP2D6*2D, CYP2D6*3, CYP2D6*40, CYP2D6*41, CYP2D6*4A, CYP2D6*4B, CYP2D6*4D, CYP2D6*4J, CYP2D6*4K, CYP2D6*5, CYP2D6*6A, CYP2D6*6B, CYP2D6*6C, CYP2D6*7, CYP2D6*8, CYP2D6*9 , Variant in CYP2C19 , CYP2D6*1XN , CYP2D6*2XN , CYP2D6*4XN , CYP2D6*10XN , CYP2D6*17XN , CYP2D6*35XN , CYP2D6*41XN , *35 , *36
DMET Plus (Affymetrix, Inc) Variant in CYP2C19 , Variant in CYP2D6
VeraCode ADME Core Panel (Illumina, Inc) Variant in CYP2C19 , Variant in CYP2D6
TaqMan Drug Metabolism Genotyping Assay Sets (Applied Biosystems, Inc) Variant in CYP2C19 , Variant in CYP2D6
Laboratory Corporation of America Variant in CYP2C19 , Variant in CYP2D6
Quest Diagnostics, Inc Variant in CYP2D6
iPLEX ADME PGx (Sequenom, Inc) CYP2C19*1, CYP2C19*12, CYP2C19*17, CYP2C19*2, CYP2C19*3, CYP2C19*4, CYP2C19*5A, CYP2C19*5B, CYP2C19*6, CYP2C19*7, CYP2C19*8
AmpliChip CYP450 Test (Roche Molecular Systems, Inc) CYP2C19*2, CYP2C19*3
eSensor 2C19 Genotyping Test (GenMark Diagnostics, Inc) CYP2C19*10, CYP2C19*13, CYP2C19*17, CYP2C19*2, CYP2C19*3, CYP2C19*4, CYP2C19*5, CYP2C19*6, CYP2C19*7, CYP2C19*8, CYP2C19*9
iPLEX ADME PGx (Sequenom, Inc) CYP2D6*11, CYP2D6*12, CYP2D6*14A, CYP2D6*14B, CYP2D6*15, CYP2D6*17, CYP2D6*18, CYP2D6*19, CYP2D6*1A, CYP2D6*20, CYP2D6*21A, CYP2D6*21B, CYP2D6*3, CYP2D6*30, CYP2D6*38, CYP2D6*4, CYP2D6*40, CYP2D6*41, CYP2D6*42, CYP2D6*44, CYP2D6*4M, CYP2D6*56A, CYP2D6*56B, CYP2D6*58, CYP2D6*6, CYP2D6*64, CYP2D6*69, CYP2D6*7, CYP2D6*8, CYP2D6*9 , Indistinguishable haplotypes with the current ADME core SNP: (CYP2D6*2A,CYP2D6*31,CYP2D6*51), (CYP2D6*2L,CYP2D6*35,CYP2D6*71), (CYP2D6*10,CYP2D6*36,CYP2D6*37,CYP2D6*47,CYP2D6*49,CYP2D6*52,CYP2D6*54,CYP2D6*57,CYP2D6*65,CYP2D6*72), CNV Assay: CYP2D6*5, CYP2D6*NxN (Haplotypes are identified manually)
Luminex xTAG CYP2D6 Assay CYP2D6*1, CYP2D6*10, CYP2D6*11, CYP2D6*15, CYP2D6*17, CYP2D6*2, CYP2D6*29, CYP2D6*3, CYP2D6*4, CYP2D6*41, CYP2D6*5, CYP2D6*6, CYP2D6*7, CYP2D6*8, CYP2D6*9 , CYP2D6*XN , *35
INFINITI CYP2C19 (AutoGenomics, Inc) CYP2C19*17, CYP2C19*2, CYP2C19*3 , rs12248560 , rs4986893 , rs4244285
INFINITI CYP450 2C19+ (AutoGenomics, Inc) CYP2C19*10, CYP2C19*17, CYP2C19*2, CYP2C19*3, CYP2C19*4, CYP2C19*5, CYP2C19*6, CYP2C19*7, CYP2C19*8, CYP2C19*9 , rs12248560 , rs28399504 , rs41291556 , rs72552267 , rs17884712 , rs4986893 , rs6413438 , rs4244285 , rs72558186 , rs56337013
Cytochrome P450 2D6 (CYP2D6) CYP2D6*2, CYP2D6*5, CYP2D6*8 , rs28371725 , rs5030867 , rs5030656 , rs35742686 , rs3892097 , rs5030865 , rs5030655 , rs61736512 , rs28371706 , rs5030862 , rs1065852
GenoChip CYP2D6 (PharmGenomics, GmbH) CYP2D6*5 , rs59421388 , rs28371725 , rs5030867 , rs5030656 , rs35742686 , rs3892097 , rs5030865 , rs5030655 , rs28371706 , rs5030863 , rs1065852 , *xN (gene duplication)
INFINITI CYP450 2D6I (AutoGenomics, Inc) CYP2D6*10, CYP2D6*12, CYP2D6*17, CYP2D6*2, CYP2D6*29, CYP2D6*3, CYP2D6*4, CYP2D6*41, CYP2D6*5, CYP2D6*6, CYP2D6*7, CYP2D6*8, CYP2D6*9 , rs28371725 , rs5030867 , rs5030656 , rs35742686 , rs3892097 , rs5030865 , rs5030655 , rs61736512 , rs28371706 , rs5030862 , rs1065852 , CYP2D6*XN , *14

The table below contains information about pharmacogenomic variants on PharmGKB. Please follow the link in the "Variant" column for more information about a particular variant. Each link in the "Variant" column leads to the corresponding PharmGKB Variant Page. The Variant Page contains summary data, including PharmGKB manually curated information about variant-drug pairs based on individual PubMed publications. The PMIDs for these PubMed publications can be found on the Variant Page.

The tags in the first column of the table indicate what type of information can be found on the corresponding Variant Page.

Links in the "Gene" column lead to PharmGKB Gene Pages.

Gene ? Variant?
(138)
Alternate Names / Tag SNPs ? Drugs ? Alleles ?
(+ chr strand)
Function ? Amino Acid?
Translation
No VIP available CA No VIP available CYP2C9 *1 N/A N/A N/A
No VIP available CA VA CYP2C9 *3 N/A N/A N/A
VIP CA VA CYP2D6 *1 N/A N/A N/A
No VIP available CA VA CYP2D6 *1XN N/A N/A N/A
VIP CA VA CYP2D6 *2 N/A N/A N/A
No VIP available CA VA CYP2D6 *2XN N/A N/A N/A
VIP CA VA CYP2D6 *3 N/A N/A N/A
VIP CA VA CYP2D6 *4 N/A N/A N/A
No VIP available CA VA CYP2D6 *5 N/A N/A N/A
VIP No VIP available No VIP available CYP2D6 *6 N/A N/A N/A
VIP No VIP available No VIP available CYP2D6 *9 N/A N/A N/A
VIP No VIP available No VIP available CYP2D6 *10 N/A N/A N/A
VIP No VIP available No VIP available CYP2D6 *17 N/A N/A N/A
VIP No VIP available No VIP available CYP2D6 *29 N/A N/A N/A
No VIP available No VIP available VA CYP2D6 *35 N/A N/A N/A
VIP No VIP available No VIP available CYP2D6 *41 N/A N/A N/A
rs1065852 100C>T, 21917263G>A, 42526694G>A, 5190C>T, CYP2D6:100C>T, Pro34Ser, part of CYP2D6*4 and CYP2D6*10
G > A
Missense
Pro34Ser
VIP No Clinical Annotations available No Variant Annotations available
rs16947 21914512A>G, 42523943A>G, 733C>C, 7941C>C, 886C>C, Arg245=, Arg296=, CYP2D6:2850C>T
A > G
Not Available
rs28371706 21916341G>A, 320C>T, 42525772G>A, 6112C>T, CYP2D6:1023 C>T, Thr107Ile
G > A
Missense
Thr107Ile
rs28371725 21914374C>T, 42523805C>T, 8079G>A, 832+39G>A, 985+39G>A, CYP2D6*41, CYP2D6:2988G>A, part of CYP2D6*41
C > T
Intronic
rs35742686 21914813delT, 42524244delT, 622delA, 7640delA, 775delA, Arg208Glyfs, Arg259Glyfs
A > T
A > -
Frameshift
Arg208Gly
rs3892097 21915516C>T, 353-1G>A, 42524947C>T, 506-1G>A, 6937G>A, CYP2D6*4, CYP2D6:1846G>A, part of CYP2D6*4
C > T
Acceptor
No VIP available CA VA
rs4244285 24154G>A, 24154G>C, 47346080G>A, 47346080G>C, 681G>A, 681G>C, 96541616G>A, 96541616G>C, CYP2C19*2, CYP2C19:681G>A, CYP2C19:G681A, Pro227=
G > C
G > A
Synonymous
Pro227Pro
rs5030655 21915655delA, 353-140delT, 42525086delA, 454delT, 6798delT, CYP2D6*6, CYP2D6:1707 del T, Trp152Glyfs, part of CYP2D6*6
T > A
T > -
Intronic
Trp152Gly
rs5030656 21914745_21914747delCTT, 42524176_42524178delCTT, 688_690delAAG, 7706_7708delAAG, 841_843delAAG, Lys230del, Lys281del
CTT > -
CTT > TTC
Non-synonymous
rs59421388 1012G>A, 21914179C>T, 3271G>A, 42523610C>T, 8274G>A, 859G>A, CYP2D6: 3183G>A, Val287Met, Val338Met
G > T
G > C
Missense
Val287Met
rs61736512 1747G>A, 21915703C>T, 353-188G>A, 406G>A, 42525134C>T, 6750G>A, CYP2D6: 1659G>A, Val136Met
G > T
G > C
Intronic
Val136Met
Alleles, Functions, and Amino Acid Translations are all sourced from dbSNP 138
2D structure from PubChem
provided by PubChem

Overview

Generic Names
  • Doxepin Hcl
  • Doxepin, Hydrochloride
  • Doxepina [INN-Spanish]
  • Doxepine
  • Doxepinum [INN-Latin]
Trade Names
  • Adapin
  • Aponal
  • Curatin
  • Quitaxon
  • Sinequan
  • Triadapin
  • Zonalon
Brand Mixture Names

PharmGKB Accession Id:
PA449409

Description

Doxepin hydrochloride is a dibenzoxepin-derivative tricyclic antidepressant (TCA). TCAs are structurally similar to phenothiazines. They contain a tricyclic ring system with an alkyl amine substituent on the central ring. In non-depressed individuals, doxepin does not affect mood or arousal, but may cause sedation. In depressed individuals, doxepin exerts a positive effect on mood. TCAs are potent inhibitors of serotonin and norepinephrine reuptake. Tertiary amine TCAs, such as doxepin and amitriptyline, are more potent inhibitors of serotonin reuptake than secondary amine TCAs, such as nortriptyline and desipramine. TCAs also down-regulate cerebral cortical beta-adrenergic receptors and sensitize post-synaptic serotonergic receptors with chronic use. The antidepressant effects of TCAs are thought to be due to an overall increase in serotonergic neurotransmission. TCAs also block histamine H 1 receptors, alpha 1-adrenergic receptors and muscarinic receptors, which accounts for their sedative, hypotensive and anticholinergic effects (e.g. blurred vision, dry mouth, constipation, urinary retention), respectively. Doxepin has less sedative and anticholinergic effects than amitriptyline. See toxicity section below for a complete listing of side effects. Doxepin may be used to treat depression and insomnia. Unlabeled indications include chronic and neuropathic pain, and anxiety. Doxepin may also be used as a second line agent to treat idiopathic urticaria.

Source: Drug Bank

Indication

Labeled indications: depression and insomnia. Unlabeled indications: chronic and neuropathic pain, anxiety, idiopathic urticaria.

Source: Drug Bank

Other Vocabularies

Information pulled from DrugBank has not been reviewed by PharmGKB.

Pharmacology, Interactions, and Contraindications

Mechanism of Action

The mechanism of action of doxepin is not completely understood. It is thought that Like amitriptyline, doxepin enhances the actions of norepinephrine and serotonin by blocking their reuptake at the neuronal membrane. Doxepin may also act on histamine H 1-receptors, resulting in sedative effects, and beta-adrenergic receptors.

Source: Drug Bank

Pharmacology

Doxepin, a tricyclic antidepressant of the dibenzoxepin type, is used to treat depression and anxiety and, topically, pruritus associated with eczema. Doxepin has substantial anticholinergic and sedative effects.

Source: Drug Bank

Food Interaction

Avoid St.John's Wort.|Avoid alcohol.|Avoid excessive quantities of coffee or tea (caffeine).|Take with food to reduce irritation.

Source: Drug Bank

Absorption, Distribution, Metabolism, Elimination & Toxicity

Biotransformation

Extensively metabolized in the liver via the same pathways as other TCAs. N-demethylation produces an active metabolite, N-desmethyldoxepin.

Source: Drug Bank

Protein Binding

Highly bound to plasma proteins.

Source: Drug Bank

Absorption

Well-absorbed from the GI tract. Peak plasma concentrations occur within 2 hours of oral administration.

Source: Drug Bank

Half-Life

6 - 24.5 hours

Source: Drug Bank

Toxicity

LD 50=26 (mg/kg) (in mice, iv); LD 50=16 (mg/kg) (in rats, iv); Cardiac dysrhythmias, severe hypotension, convulsions, and CNS depression, including coma. Changes in the electrocardiogram, particularly in QRS axis or width, are clinically significant indicators of tricyclic antidepressant toxicity.
Side effects include: sedation, hypotension, blurred vision, dry mouth, constipation, urinary retention, postural hypotension, tachycardia, hypertension, ECG changes, heart failure, impaired memory and delirium, and precipitation of hypomanic or manic episodes in bipolar depression.
Withdrawal symptoms include gastrointestinal disturbances, anxiety, and insomnia.

Source: Drug Bank

Chemical Properties

Chemical Formula

C19H21NO

Source: Drug Bank

Isomeric SMILES

CN(C)CCC=C1c2ccccc2COc3c1cccc3

Source: OpenEye

Canonical SMILES

[H]C(CCN(C)C)=C1C2=CC=CC=C2COC2=CC=CC=C12

Source: Drug Bank

Average Molecular Weight

279.3761

Source: Drug Bank

Monoisotopic Molecular Weight

279.162314299

Source: Drug Bank

PharmGKB Curated Pathways

Pathways created internally by PharmGKB based primarily on literature evidence.

  1. Doxepin Pathway, Pharmacokinetics
    Stylized liver cell showing candidate genes involved in the metabolism of the tricyclic doxepin.

External Pathways

Links to non-PharmGKB pathways.

PharmGKB contains no links to external pathways for this drug. To report a pathway, click here.

Genes that are associated with this drug in PharmGKB's database based on (1) variant annotations, (2) literature review, (3) pathways or (4) information automatically retrieved from DrugBank, depending on the "evidence" and "source" listed below.

Curated Information ?

Drug Targets

Gene Description
ADRA1A (source: Drug Bank)
ADRA1B (source: Drug Bank)
ADRA1D (source: Drug Bank)
ADRA2A (source: Drug Bank)
ADRA2B (source: Drug Bank)
ADRA2C (source: Drug Bank)
CHRM1 (source: Drug Bank)
CHRM2 (source: Drug Bank)
CHRM3 (source: Drug Bank)
CHRM4 (source: Drug Bank)
CHRM5 (source: Drug Bank)
DRD2 (source: Drug Bank)
HRH1 (source: Drug Bank)
HRH2 (source: Drug Bank)
HTR1A (source: Drug Bank)
HTR2A (source: Drug Bank)
HTR2B (source: Drug Bank)
HTR2C (source: Drug Bank)
SLC6A2 (source: Drug Bank)
SLC6A4 (source: Drug Bank)

Drug Interactions

Drug Description
doxepin Increases the effect and toxicity of tricyclics (source: Drug Bank)
doxepin Atazanavir may increase the effect and toxicity of the tricyclic antidepressant, doxepin, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of doxepin if atazanavir if initiated, discontinued or dose changed. (source: Drug Bank)
doxepin The tricyclic increases the effect of carbamazepine (source: Drug Bank)
doxepin Carbamazepine may decrease the serum concentration of the tricyclic antidepressant, doxepin, by increasing its metabolism. Monitor for changes in the therapeutic and adverse effects of doxepin if carbamazepine is initiated, discontinued or dose changed. (source: Drug Bank)
doxepin Increases the effect of tricyclic agent (source: Drug Bank)
doxepin Cimetidine may increase the effect of tricyclic antidepressant, doxepin, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of doxepin if cimetidine is initiated, discontinued or dose changed. (source: Drug Bank)
doxepin Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
doxepin Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
doxepin The tricyclic decreases the effect of clonidine (source: Drug Bank)
doxepin The tricyclic antidepressant, doxepin, decreases the effect of clonidine. (source: Drug Bank)
doxepin Possible antagonism of action (source: Drug Bank)
doxepin Possible antagonism of action (source: Drug Bank)
altretamine Risk of severe hypotension (source: Drug Bank)
altretamine Risk of severe hypotension (source: Drug Bank)
atazanavir Atazanavir increases the effect and toxicity of tricyclics (source: Drug Bank)
atazanavir Atazanavir may increase the effect and toxicity of the tricyclic antidepressant, doxepin, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of doxepin if atazanavir if initiated, discontinued or dose changed. (source: Drug Bank)
carbamazepine The tricyclic increases the effect of carbamazepine (source: Drug Bank)
carbamazepine Carbamazepine may decrease the serum concentration of the tricyclic antidepressant, doxepin, by increasing its metabolism. Monitor for changes in the therapeutic and adverse effects of doxepin if carbamazepine is initiated, discontinued or dose changed. (source: Drug Bank)
cimetidine Cimetidine increases the effect of tricyclic agent (source: Drug Bank)
cimetidine Cimetidine may increase the effect of the tricyclic antidepressant, doxepin, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of doxepin if cimetidine is initiated, discontinued or dose changed. (source: Drug Bank)
cisapride Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
cisapride Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
clonidine The tricyclic decreases the effect of clonidine (source: Drug Bank)
clonidine The tricyclic antidepressant, doxepin, decreases the effect of clonidine. (source: Drug Bank)
dobutamine The tricyclic increases the sympathomimetic effect (source: Drug Bank)
dobutamine The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of dobutamine. (source: Drug Bank)
donepezil Possible antagonism of action (source: Drug Bank)
donepezil Possible antagonism of action (source: Drug Bank)
dopamine The tricyclic increases the sympathomimetic effect (source: Drug Bank)
dopamine The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of dopamine. (source: Drug Bank)
ephedra The tricyclic increases the sympathomimetic effect (source: Drug Bank)
ephedra The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of ephedra. (source: Drug Bank)
ephedrine The tricyclic increases the sympathomimetic effect (source: Drug Bank)
ephedrine The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of ephedrine. (source: Drug Bank)
fenoterol The tricyclic increases the sympathomimetic effect (source: Drug Bank)
fenoterol The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of fenoterol. (source: Drug Bank)
fluoxetine Fluoxetine increases the effect and toxicity of tricyclics (source: Drug Bank)
fluoxetine The SSRI, fluoxetine, may increase the serum concentration of the tricyclic antidepressant, doxepin, by decreasing its metabolism. Additive modulation of serotonin activity also increases the risk of serotonin syndrome. Monitor for development of serotonin syndrome during concomitant therapy. Monitor for changes in the therapeutic and adverse effects of doxepin if fluoxetine is initiated, discontinued or dose changed. (source: Drug Bank)
fluvoxamine Fluvoxamine increases the effect and toxicity of tricyclics (source: Drug Bank)
fluvoxamine The SSRI, fluvoxamine, may increase the serum concentration of the tricyclic antidepressant, doxepin, by decreasing its metabolism. Additive modulation of serotonin activity also increases the risk of serotonin syndrome. Monitor for development of serotonin syndrome during concomitant therapy. Monitor for changes in the therapeutic and adverse effects of doxepin if fluvoxamine is initiated, discontinued or dose changed. (source: Drug Bank)
galantamine Possible antagonism of action (source: Drug Bank)
galantamine Possible antagonism of action (source: Drug Bank)
grepafloxacin Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
grepafloxacin Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
guanethidine The tricyclics decreases the effect of guanethidine (source: Drug Bank)
guanethidine The tricyclic antidepressant, doxepin, decreases the effect of guanethidine. (source: Drug Bank)
isocarboxazid Possibility of severe adverse effects (source: Drug Bank)
isocarboxazid Possibility of severe adverse effects (source: Drug Bank)
isoproterenol The tricyclic increases the sympathomimetic effect (source: Drug Bank)
isoproterenol The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of isoproterenol. (source: Drug Bank)
mephentermine The tricyclic increases the sympathomimetic effect (source: Drug Bank)
mephentermine The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of mephentermine. (source: Drug Bank)
mesoridazine Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
mesoridazine Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
metaraminol The tricyclic increases the sympathomimetic effect (source: Drug Bank)
metaraminol The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of metaraminol. (source: Drug Bank)
methoxamine The tricyclic increases the sympathomimetic effect (source: Drug Bank)
methoxamine The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of methoxamine. (source: Drug Bank)
moclobemide Possible severe adverse reaction with this combination (source: Drug Bank)
moclobemide Possible severe adverse reaction with this combination (source: Drug Bank)
norepinephrine The tricyclic increases the sympathomimetic effect (source: Drug Bank)
norepinephrine The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of norepinephrine. (source: Drug Bank)
orciprenaline The tricyclic increases the sympathomimetic effect (source: Drug Bank)
orciprenaline The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of orciprenaline. (source: Drug Bank)
phenelzine Possibility of severe adverse effects (source: Drug Bank)
phenelzine Possibility of severe adverse effects (source: Drug Bank)
phenylephrine The tricyclic increases the sympathomimetic effect (source: Drug Bank)
phenylephrine The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of phenylephrine. (source: Drug Bank)
phenylpropanolamine The tricyclic increases the sympathomimetic effect (source: Drug Bank)
phenylpropanolamine The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of phenylpropanolamine. (source: Drug Bank)
pirbuterol The tricyclic increases the sympathomimetic effect (source: Drug Bank)
pirbuterol The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of pirbuterol. (source: Drug Bank)
procaterol The tricyclic increases the sympathomimetic effect (source: Drug Bank)
procaterol The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of procaterol. (source: Drug Bank)
pseudoephedrine The tricyclic increases the sympathomimetic effect (source: Drug Bank)
pseudoephedrine The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of pseudoephedrine. (source: Drug Bank)
quinidine Quinidine increases the effect of tricyclic agent (source: Drug Bank)
quinidine Quinidine increases the effect of tricyclic agent (source: Drug Bank)
quinidine Quinidine barbiturate increases the effect of tricyclic antidepressant, doxepin. (source: Drug Bank)
rasagiline Possibility of severe adverse effects (source: Drug Bank)
rasagiline Possibility of severe adverse effects (source: Drug Bank)
rifabutin The rifamycin decreases the effect of tricyclics (source: Drug Bank)
rifabutin The rifamycin, rifabutin, may decrease the effect of the tricyclic antidepressant, doxepin, by increasing its metabolism. Monitor for changes in the therapeutic and adverse effects of doxepin if rifabutin is initiated, discontinued or dose changed. (source: Drug Bank)
rifampin The rifamycin decreases the effect of tricyclics (source: Drug Bank)
rifampin The rifamycin, rifampin, may decrease the effect of the tricyclic antidepressant, doxepin, by increasing its metabolism. Monitor for changes in the therapeutic and adverse effects of doxepin if rifampin is initiated, discontinued or dose changed. (source: Drug Bank)
ritonavir Ritonavir increases the effect and toxicity of tricyclics (source: Drug Bank)
ritonavir Ritonavir may increase the effect and toxicity of the tricyclic antidepressant, doxepin, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of doxepin if ritonavir if initiated, discontinued or dose changed. (source: Drug Bank)
rivastigmine Possible antagonism of action (source: Drug Bank)
rivastigmine Possible antagonism of action (source: Drug Bank)
salbutamol The tricyclic increases the sympathomimetic effect (source: Drug Bank)
salbutamol The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of salbutamol. (source: Drug Bank)
sibutramine Increased risk of CNS adverse effects (source: Drug Bank)
sibutramine Increased risk of CNS adverse effects (source: Drug Bank)
sparfloxacin Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
sparfloxacin Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
terbutaline The tricyclic increases the sympathomimetic effect (source: Drug Bank)
terbutaline The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of terbutaline. (source: Drug Bank)
terfenadine Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
terfenadine Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
thioridazine Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
thioridazine Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
tranylcypromine Possibility of severe adverse effects (source: Drug Bank)
tranylcypromine Possibility of severe adverse effects (source: Drug Bank)
doxepin The tricyclic increases the sympathomimetic effect (source: Drug Bank)
doxepin The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of epinephrine. (source: Drug Bank)
doxepin The tricyclic increases the sympathomimetic effect (source: Drug Bank)
doxepin The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of fenoterol. (source: Drug Bank)
doxepin Fluoxetine increases the effect and toxicity of tricyclics (source: Drug Bank)
doxepin The SSRI, fluoxetine, may increase the serum concentration of the tricyclic antidepressant, doxepin, by decreasing its metabolism. Additive modulation of serotonin activity also increases the risk of serotonin syndrome. Monitor for development of serotonin syndrome during concomitant therapy. Monitor for changes in the therapeutic and adverse effects of doxepin if fluoxetine is initiated, discontinued or dose changed. (source: Drug Bank)
doxepin Fluvoxamine increases the effect and toxicity of tricyclics (source: Drug Bank)
doxepin The SSRI, fluvoxamine, may increase the serum concentration of the tricyclic antidepressant, doxepin, by decreasing its metabolism. Additive modulation of serotonin activity also increases the risk of serotonin syndrome. Monitor for development of serotonin syndrome during concomitant therapy. Monitor for changes in the therapeutic and adverse effects of doxepin if fluvoxamine is initiated, discontinued or dose changed. (source: Drug Bank)
doxepin Possible antagonism of action (source: Drug Bank)
doxepin Possible antagonism of action (source: Drug Bank)
doxepin Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
doxepin Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
doxepin The tricyclic decreases the effect of guanethidine (source: Drug Bank)
doxepin The tricyclic antidepressant, doxepin, decreases the effect of guanethidine. (source: Drug Bank)
doxepin Possibility of severe adverse effects (source: Drug Bank)
doxepin Possibility of severe adverse effects (source: Drug Bank)
doxepin Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
doxepin Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
doxepin Possible severe adverse reaction with this combination (source: Drug Bank)
doxepin Possible severe adverse reaction with this combination (source: Drug Bank)
doxepin The tricyclic increases the sympathomimetic effect (source: Drug Bank)
doxepin The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of orciprenaline. (source: Drug Bank)
doxepin Possibility of severe adverse effects (source: Drug Bank)
doxepin Possibility of severe adverse effects (source: Drug Bank)
doxepin The tricyclic increases the sympathomimetic effect (source: Drug Bank)
doxepin The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of phenylephrine. (source: Drug Bank)
doxepin The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of phenylpropanolamine. (source: Drug Bank)
doxepin The tricyclic increases the sympathomimetic effect (source: Drug Bank)
doxepin The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of pseudoephedrine. (source: Drug Bank)
doxepin Quinidine increases the effect of the tricyclic agent (source: Drug Bank)
doxepin Additive QTc-prolonging effects may occur. Quinidine may also increase the serum concentration of the tricyclic antidepressant, doxepin, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of amitriptyline if doxepin is initiated, discontinued or dose changed. Monitor for the development of torsades de pointes during concomitant therapy. (source: Drug Bank)
doxepin Possibility of severe adverse effects (source: Drug Bank)
doxepin The rifamycin decreases the effect of tricyclics (source: Drug Bank)
doxepin The rifamycin, rifabutin, may decrease the effect of the tricyclic antidepressant, doxepin, by increasing its metabolism. Monitor for changes in the therapeutic and adverse effects of doxepin if rifabutin is initiated, discontinued or dose changed. (source: Drug Bank)
doxepin The rifamycin decreases the effect of tricyclics (source: Drug Bank)
doxepin The rifamycin, rifampin, may decrease the effect of the tricyclic antidepressant, doxepin, by increasing its metabolism. Monitor for changes in the therapeutic and adverse effects of doxepin if rifampin is initiated, discontinued or dose changed. (source: Drug Bank)
doxepin The therapeutic effects of the central acetylcholinesterase inhibitor, Tacrine, and/or the anticholinergic, Doxepin, may be reduced due to antagonism. The interaction may be beneficial when the anticholinergic action is a side effect. Monitor for decreased efficacy of both agents. (source: Drug Bank)
doxepin The therapeutic effects of the central acetylcholinesterase inhibitor, Tacrine, and/or the anticholinergic, Doxepin, may be reduced due to antagonism. The interaction may be beneficial when the anticholinergic action is a side effect. Monitor for decreased efficacy of both agents. (source: Drug Bank)
doxepin Additive QTc-prolongation may occur increasing the risk of serious ventricular arrhythmias. Concomitant therapy should be used with caution. (source: Drug Bank)
doxepin Telithromycin may reduce clearance of Doxepin. Consider alternate therapy or monitor for changes in the therapeutic/adverse effects of Doxepin if Telithromycin is initiated, discontinued or dose changed. (source: Drug Bank)
doxepin Terbinafine may reduce the metabolism and clearance of Doxepin. Consider alternate therapy or monitor for therapeutic/adverse effects of Amytriptyline if Doxepin is initiated, discontinued or dose changed. (source: Drug Bank)
doxepin The tricyclic increases the sympathomimetic effect (source: Drug Bank)
doxepin The tricyclic antidepressant, doxepin, increases the sympathomimetic effect of terbutaline. (source: Drug Bank)
doxepin Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
doxepin Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
doxepin The strong CYP1A2 inhibitor, Thiabendazole, may increase the effects and toxicity of Doxepin by decreasing Doxepin metabolism and clearance. Monitor for changes in the therapeutic and adverse effects of Doxepin if Thiabendazole is initiated, discontinued or dose changed. (source: Drug Bank)
doxepin Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
doxepin Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank)
doxepin May cause additive QTc-prolonging effects. Increased risk of ventricular arrhythmias. Consider alternate therapy. Thorough risk:benefit assessment is required prior to co-administration. (source: Drug Bank)
doxepin May cause additive QTc-prolonging effects. Increased risk of ventricular arrhythmias. Consider alternate therapy. Thorough risk:benefit assessment is required prior to co-administration. (source: Drug Bank)
doxepin Additive QTc-prolongation may occur, increasing the risk of serious ventricular arrhythmias. Consider alternate therapy. A thorough risk:benefit assessment is required prior to co-administration. (source: Drug Bank)
doxepin Tramadol increases the risk of serotonin syndrome and seizures. (source: Drug Bank)
doxepin Increased risk of serotonin syndrome. Concomitant therapy should be avoided. A significant washout period, dependent on the half-lives of the agents, should be employed between therapies. (source: Drug Bank)
doxepin Increased risk of serotonin syndrome. The 2D6 inhibitor, Trazodone, may also increase the efficacy of Doxepin by decreasing Doxepin metabolism and clearance. Monitor for symptoms of serotonin syndrome and changes in Doxepin efficacy if Trazodone is initiated, discontinued or dose changed. (source: Drug Bank)
doxepin Increased risk of serotonin syndrome. Monitor for symptoms of serotonin syndrome. (source: Drug Bank)
doxepin Trimethobenzamide and Doxepin, two anticholinergics, may cause additive anticholinergic effects and enhance their adverse/toxic effects. Monitor for enhanced anticholinergic effects. (source: Drug Bank)
doxepin Increased risk of serotonin syndrome. Monitor for symptoms of serotonin syndrome. Additive QTc-prolongation may also occur, increasing the risk of serious ventricular arrhythmias. Concomitant therapy should be used with caution. (source: Drug Bank)
doxepin Triprolidine and Doxepin, two anticholinergics, may cause additive anticholinergic effects and enhance their adverse/toxic effects. Additive CNS depressant effects may also occur. Monitor for enhanced anticholinergic and CNS depressant effects. (source: Drug Bank)
doxepin Triprolidine and Doxepin, two anticholinergics, may cause additive anticholinergic effects and enhance their adverse/toxic effects. Additive CNS depressant effects may also occur. Monitor for enhanced anticholinergic and CNS depressant effects. (source: Drug Bank)
doxepin Trospium and Doxepin, two anticholinergics, may cause additive anticholinergic effects and enhanced adverse/toxic effects. Monitor for enhanced anticholinergic effects. (source: Drug Bank)
doxepin Increased risk of serotonin syndrome. Monitor for symptoms of serotonin syndrome. (source: Drug Bank)
doxepin Additive QTc prolongation may occur. Voriconazole, a strong CYP3A4 inhibitor, may also increase the serum concentration of doxepin by decreasing its metabolism. Consider alternate therapy or monitor for QTc prolongation and changes in the therapeutic and adverse effects of doxepin if voriconazole is initiated, discontinued or dose changed. (source: Drug Bank)
doxepin Additive QTc prolongation may occur. Consider alternate therapy or monitor for QTc prolongation as this can lead to Torsade de Pointes (TdP). (source: Drug Bank)
doxepin Additive QTc-prolonging effects may increase the risk of severe arrhythmias. Concomitant therapy is contraindicated. (source: Drug Bank)
doxepin Use of two serotonin modulators, such as zolmitriptan and doxepin, increases the risk of serotonin syndrome. Consider alternate therapy or monitor for serotonin syndrome during concomitant therapy. (source: Drug Bank)
doxepin Additive QTc prolongation may occur. Consider alternate therapy or use caution and monitor for QTc prolongation as this can lead to Torsade de Pointes (TdP). (source: Drug Bank)

Curated Information ?

Relationships from National Drug File - Reference Terminology (NDF-RT)

May Treat
Contraindicated With

Publications related to doxepin: 41

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Challenges in pharmacogenetics. European journal of clinical pharmacology. 2013. Cascorbi Ingolf, et al. PubMed
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Clinical Pharmacogenetics Implementation Consortium Guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Tricyclic Antidepressants. Clinical pharmacology and therapeutics. 2013. Hicks J K, et al. PubMed
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Prolonged toxicity after amitriptyline overdose in a patient deficient in CYP2D6 activity. Journal of medical toxicology : official journal of the American College of Medical Toxicology. 2011. Smith Jennifer Cohen, et al. PubMed
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Pharmacogenetics: From Bench to Byte- An Update of Guidelines. Clinical pharmacology and therapeutics. 2011. Swen J J, et al. PubMed
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Pharmacogenetics and gender association with psychotic episodes on nortriptyline lower doses: patient cases. ISRN pharmaceutics. 2011. Piatkov Irina, et al. PubMed
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KCNH2 pharmacogenomics summary. Pharmacogenetics and genomics. 2010. Oshiro Connie, et al. PubMed
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Coprescription of tamoxifen and medications that inhibit CYP2D6. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2010. Sideras Kostandinos, et al. PubMed
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Association between CYP2C19*17 and metabolism of amitriptyline, citalopram and clomipramine in Dutch hospitalized patients. The pharmacogenomics journal. 2010. de Vos A, et al. PubMed
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Cytochrome P450 2D6. Pharmacogenetics and genomics. 2009. Owen Ryan P, et al. PubMed
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Life-threatening dextromethorphan intoxication associated with interaction with amitriptyline in a poor CYP2D6 metabolizer: a single case re-exposure study. Journal of pain and symptom management. 2008. Forget Patrice, et al. PubMed
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Association of graded allele-specific changes in CYP2D6 function with imipramine dose requirement in a large group of depressed patients. Molecular psychiatry. 2008. Schenk P W, et al. PubMed
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Influence of the CYP2D6*4 polymorphism on dose, switching and discontinuation of antidepressants. British journal of clinical pharmacology. 2008. Bijl Monique J, et al. PubMed
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The CYP2D6 polymorphism in relation to the metabolism of amitriptyline and nortriptyline in the Faroese population. British journal of clinical pharmacology. 2008. Halling Jónrit, et al. PubMed
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A fatal doxepin poisoning associated with a defective CYP2D6 genotype. The American journal of forensic medicine and pathology. 2007. Koski Anna, et al. PubMed
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Inhibition of the HERG potassium channel by the tricyclic antidepressant doxepin. Biochemical pharmacology. 2007. Duncan R S, et al. PubMed
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A poor metabolizer for cytochromes P450 2D6 and 2C19: a case report on antidepressant treatment. CNS spectrums. 2006. Johnson Maria, et al. PubMed
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CYP2D6 and CYP2C19 genotypes and amitriptyline metabolite ratios in a series of medicolegal autopsies. Forensic science international. 2006. Koski Anna, et al. PubMed
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Serotonin transporter polymorphisms and side effects in antidepressant therapy--a pilot study. Pharmacogenomics. 2006. Popp Johannes, et al. PubMed
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Adverse drug reactions following nonresponse in a depressed patient with CYP2D6 deficiency and low CYP 3A4/5 activity. Pharmacopsychiatry. 2006. Stephan P L, et al. PubMed
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The complexity of active metabolites in therapeutic drug monitoring of psychotropic drugs. Pharmacopsychiatry. 2006. Hendset M, et al. PubMed
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Pharmacogenetics of tamoxifen biotransformation is associated with clinical outcomes of efficacy and hot flashes. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2005. Goetz Matthew P, et al. PubMed
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Impact of the CYP2D6 ultra-rapid metabolizer genotype on doxepin pharmacokinetics and serotonin in platelets. Pharmacogenetics and genomics. 2005. Kirchheiner Julia, et al. PubMed
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Amitriptyline or not, that is the question: pharmacogenetic testing of CYP2D6 and CYP2C19 identifies patients with low or high risk for side effects in amitriptyline therapy. Clinical chemistry. 2005. Steimer Werner, et al. PubMed
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Allele-specific change of concentration and functional gene dose for the prediction of steady-state serum concentrations of amitriptyline and nortriptyline in CYP2C19 and CYP2D6 extensive and intermediate metabolizers. Clinical chemistry. 2004. Steimer Werner, et al. PubMed
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Clomipramine, fluoxetine and CYP2D6 metabolic capacity in depressed patients. Human psychopharmacology. 2004. Vandel P, et al. PubMed
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Impact of CYP2D6 intermediate metabolizer alleles on single-dose desipramine pharmacokinetics. Pharmacogenetics. 2004. Furman Katherine D, et al. PubMed
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No evidence of increased adverse drug reactions in cytochrome P450 CYP2D6 poor metabolizers treated with fluoxetine or nortriptyline. Human psychopharmacology. 2004. Roberts Rebecca L, et al. PubMed
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Trimipramine pharmacokinetics after intravenous and oral administration in carriers of CYP2D6 genotypes predicting poor, extensive and ultrahigh activity. Pharmacogenetics. 2003. Kirchheiner Julia, et al. PubMed
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Effects of polymorphisms in CYP2D6, CYP2C9, and CYP2C19 on trimipramine pharmacokinetics. Journal of clinical psychopharmacology. 2003. Kirchheiner Julia, et al. PubMed
Contributions of CYP2D6, CYP2C9 and CYP2C19 to the biotransformation of E- and Z-doxepin in healthy volunteers. Pharmacogenetics. 2002. Kirchheiner Julia, et al. PubMed
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The N-demethylation of the doxepin isomers is mainly catalyzed by the polymorphic CYP2C19. Pharmaceutical research. 2002. Härtter Sebastian, et al. PubMed
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CYP2D6 genotyping with oligonucleotide microarrays and nortriptyline concentrations in geriatric depression. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology. 2001. Murphy G M, et al. PubMed
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Role of cytochrome P450 2D6 (CYP2D6) in the stereospecific metabolism of E- and Z-doxepin. Pharmacogenetics. 2000. Haritos V S, et al. PubMed
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Clomipramine dose-effect study in patients with depression: clinical end points and pharmacokinetics. Danish University Antidepressant Group (DUAG). Clinical pharmacology and therapeutics. 1999. PubMed
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CYP2D6 phenotype-genotype relationships in African-Americans and Caucasians in Los Angeles. Pharmacogenetics. 1998. Leathart J B, et al. PubMed
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10-Hydroxylation of nortriptyline in white persons with 0, 1, 2, 3, and 13 functional CYP2D6 genes. Clinical pharmacology and therapeutics. 1998. Dalén P, et al. PubMed
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Steady-state plasma levels of nortriptyline and its 10-hydroxy metabolite: relationship to the CYP2D6 genotype. Psychopharmacology. 1996. Dahl M L, et al. PubMed
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Single-dose kinetics of clomipramine: relationship to the sparteine and S-mephenytoin oxidation polymorphisms. Clinical pharmacology and therapeutics. 1994. Nielsen K K, et al. PubMed
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Debrisoquine hydroxylation phenotypes of patients with high versus low to normal serum antidepressant concentrations. Journal of clinical psychopharmacology. 1992. Tacke U, et al. PubMed
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Analysis of the CYP2D6 gene in relation to debrisoquin and desipramine hydroxylation in a Swedish population. Clinical pharmacology and therapeutics. 1992. Dahl M L, et al. PubMed
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The clinical application of tricyclic antidepressant pharmacokinetics and plasma levels. The American journal of psychiatry. 1980. Amsterdam J, et al. PubMed

LinkOuts

Web Resource:
Wikipedia
National Drug Code Directory:
0378-1049-01
DrugBank:
DB01142
ChEBI:
4710
KEGG Compound:
C06971
PubChem Compound:
667477
PubChem Substance:
158785
IUPHAR Ligand:
1225
Drugs Product Database (DPD):
1913425
Therapeutic Targets Database:
DAP000177
FDA Drug Label at DailyMed:
1533343b-f1ed-4c3a-bb36-23a748452b05

Clinical Trials

These are trials that mention doxepin and are related to either pharmacogenetics or pharmacogenomics.

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