6 Psychiatric Medications That May Make You Gain Weight

I had been on the drug Zyprexa (olanzapine) for four weeks and had already gained 15 pounds which, you know, didn’t help my depression. After going to a wedding and catching a side view of myself, I called my doctor and told him that my name was now Violet Beauregarde, the gum chewer in “Charlie and the Chocolate Factory” who floats to the ceiling as blueberry balloon. Except that when I rose to the top of the room I was crying.

“The two most common questions that patients ask me are, ‘Will I become dependent on the medications?’ and ‘Will I gain weight?’” says Everyday Health contributor Sanjay Gupta, M.D in a Johns Hopkins Depression and Anxiety Bulletin. It’s a serious concern for people considering taking any kind of psychiatric medicine, and a sensitive subject among patients who are currently on meds. “A rapidly expanding waistline is one of the major reasons why patients prematurely discontinue an otherwise effective treatment, fall back into depression, and experience a poor outcomes,” says Gupta.

He ranks various drugs for weight-gain potential and comes up with these six (in order of waist busters):

1. Clozaril (clozapine)
2. Zyprexa (olanzapine)
3. Remeron (mirtazapine)
4. Seroquel (quetiapine)
5. Depakote (divalproex)
6. Paxil (paroxetine)

A few important points:

• Clazaril, Seroquel, and Zyprexa are antipsychotic medications that increase insulin resistance, and therefore lead to weight gain.
• Remeron is an alpha-2 receptor blocker, an antidepressant that is sometimes administered to people—emaciated folks–who need to gain weight. One set of studies indicated that most patients gain weight on Remeron after the first four weeks of treatment.
• Depakote is an acidic chemical compound used as an anticonvulsant and mood-stabilizing drug to treat bipolar disorder.
• Paxil is an SSRI more likely than any other SSRI to put on pounds, especially when used for a year or longer. One study indicated that 25 percent of Paxil users gained some serious weight compared with 7 percent of Prozac users and 4 percent of Zoloft users.
• Among the older antidepressants, the tricyclics such as Sinequan (doxepin), Tofranil (imipramine), and Pemelor (nortriptyline) can cause short- and long-term weight.
• Monoamine oxidase inhibitors (MAOIs) such as Nardil (phenelzine), Parnate (tranylcypromine), and Marplan (isocarboxazid) may also necessitate a new wardrobe.

That’s the bad news. And boy is it bad news. Have a weight loss or weight maintenance plan ready to go.

The good news is these drugs are peculiar. A compound that makes my sister’s pants split doesn’t do anything to me. And what makes me shriek at a side view in the mirror is easy on her metabolism. Even though we’re twins. So it’s just a painful trial and error – like everything in recovery – until you find the right drug that will help you function through the day AND allow you to pull on your jeans up without help.

Join Therese Borchard at one of three free private screenings of “Happy,” a film that explores what makes us happy, plus a discussion on depression and happiness, and a book signing.  The events, which are produced in partnership with Everyday Health and funded by an advertising sponsor, are in Washington, D.C. (May 21), New York City (May 22), and Chicago (May 30).

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Common and Rare Side Effects for doxepin oral

COMMON side effects

If experienced, these tend to have a Severe expression i

Sorry, we have no data available. Please contact your doctor or pharmacist.

If experienced, these tend to have a Less Severe expression i

• dry mouth
• drowsiness
• dizziness
• taste impairment
• weight gain
• increased hunger
• headache

INFREQUENT side effects

If experienced, these tend to have a Severe expression i

• confusion
• abnormal sexual function
• a type of movement disorder called parkinsonism
• blurred vision
• slow heartbeat
• abnormal heart rhythm
• low blood pressure
• the inability to have an erection
• hallucinations
• muscle tremors
• difficult or painful urination
• nervousness

If experienced, these tend to have a Less Severe expression i

• altered interest in having sexual intercourse
• a common cold
• constipation
• difficulty sleeping
• excessive sweating
• vomiting
• heartburn
• diarrhea

RARE side effects

If experienced, these tend to have a Severe expression i

• a disorder with excess antidiuretic hormone called syndrome of inappropriate antidiuretic hormone
• large purple or brown skin blotches
• very low levels of granulocytes, a type of white blood cell
• increased eosinophils in the blood
• a blood disorder
• mental problems from taking the drug
• panic disorder
• suicidal thoughts
• serotonin syndrome, a type of disorder with high serotonin levels
• ringing in the ears
• a heart attack
• a type of slowed heart rhythm disorder called heart block
• abnormal heart electrical signals
• rapid ventricular heartbeat
• ventricular fibrillation, a heart rhythm disorder
• prolonged QT interval on EKG
• a stroke
• swelling of the testicles
• enlarged breasts
• breastmilk production not associated with childbirth or nursing
• increased sensitivity of the skin to the sun
• inflammation of the skin due to an allergy
• itching
• hair loss
• seizures
• a skin rash
• high amount of bilirubin in the blood
• abnormal liver function tests
• a type of allergic reaction called angioedema
• secondary angle-closure glaucoma, a type of eye disorder
• accidental falls
• fast heartbeat

If experienced, these tend to have a Less Severe expression i

• delusions
• nightmares
• agitation
• aggressive behavior
• feelings of hostility
• dilated pupils
• high blood pressure
• decreased appetite
• heart throbbing or pounding
• nausea
• a feeling of pins and needles on skin
• irritability
• an inability to control impulsive behavior
• anxious feelings

Therapeutic rationale for low dose doxepin in insomnia patients

Asian Pac J Trop Dis. 2013 Aug; 3(4): 331–336.

,¹,²,³,¹ and ^1,*

¹All Saints University, College of Medicine, Kingstown, St. Vincent and the Grenadines

²All Saints University, School of Medicine, Roseau, Dominica

³Medical Services Department, Intas Pharmaceuticals Limited, Ahmadabad, India

Jigar Katwala

¹All Saints University, College of Medicine, Kingstown, St. Vincent and the Grenadines

Ananda K Kumar

²All Saints University, School of Medicine, Roseau, Dominica

Jaykumar J Sejpal

³Medical Services Department, Intas Pharmaceuticals Limited, Ahmadabad, India

Marcelle Terrence

¹All Saints University, College of Medicine, Kingstown, St. Vincent and the Grenadines

Manish Mishra

¹All Saints University, College of Medicine, Kingstown, St. Vincent and the Grenadines

Reviewed by Kamlakar Tripathi, MD, D.M., F.R.C.P.Professor, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India., Tel: +91-9839044027, Fax: +91-5422307521, E-mail: ni.oc.oohay@ihtapirt_rakalmak*Corresponding author: Dr. Manish Mishra, Assistant Professor, All Saints University, College of Medicine, Kingstown, St. Vincent and the Grenadines. Tel: +1-784-492-5497, Fax: +1-784-458-4151.E-mail: moc.liamg@hsinamcmn

Received 2013 Jun 7; Accepted 2013 Jul 10.

Copyright © 2013 by the Asian Pacific Journal of Tropical Disease. All rights reserved.

Abstract

Histamine is an excitatory neurotransmitter in central nervous system. It plays an important role in the regulation of the sleep-wake cycle. Antidepressant with sleep-promoting effects, for example, doxepin, promotes sleep not through a sedative action but through resynchronisation of circadian cycle. The stimulation of the h2 receptor is thought to play an important role in mediating arousal. Doxepin has a high affinity for the h2 receptor, making it a selective h2 antagonist at low dose and it has been shown to display sedating properties. Compared to other sedative antidepressant, low dose doxepin is the only tricyclic drug which has been evaluated by well-designed, randomised, double blind, placebo controlled studies in both adult and elderly patients. Doxepin is not designated as controlled substance/unscheduled drugs and thus may be of special advantage to use in patients with a history of substance abuse. Hence, well-documented therapeutic efficacy, tolerability and lack of important adverse effects make the low dose doxepin as a unique, rational drug for the treatment of insomnia in adult and elderly patients.

Keywords: Insomnia, Doxepin, Histamine

1. Insomnia

1.1. A general idea

Insomnia is a most common sleep disorder. Insomnia is widespread, affecting more than 25% of the adult population. Approximately 10% of adults presented with insomnia symptoms have associated day time impairment. US national health interview survey and US national co-morbidity survey showed that there was a high rate of morbidity associated between chronic insomnia and medical disorder (e.g. pain) and heart disorder (e.g. heart failure) and psychiatric disorder (e.g. depression, mood, anxiety, and substance abuse disorder)[1]–[3].

1.2. Precipitating factors

There are multiple factors related with patients which make insomnia a vulnerable condition for them. These factors are divided into three category such as predisposing factors (e.g. middle-age, old age, female), personality factors (e.g. hyper excitability, anxious personality), and past and family history (e.g. medical or psychiatric illness) and genetic factors. Many times, psychological and behavioural factors also worsen insomnia (e.g. unexpected loss of loved one, loss of job)[1],[4]–[8].

2. Classification of insomnia

Insomnia has been classified as two ways: by the duration of the insomnia or by its etiology. Based on duration, insomnia is classified as transient insomnia (lasting no longer than 7 d), short-term insomnia (lasting for less than 3 weeks), and chronic insomnia. Transient and short-term insomnias are common during emotional distress. Chronic insomnia lasts for longer duration of usually more than 3 weeks, and some even more than 30 d. The other category of insomnia is based on etiology which includes primary insomnia (occurring without any specific physical and mental conditions) and secondary insomnia (associated with other medical and psychiatric illness, medications, or other sleep disorders)[8],[9].

The International Classification of Sleep Disorder (ICSD) has categorized insomnia as adjustment insomnia, behavioural insomnia of childhood, idiopathic, paradoxical, psychophysiological, and inadequate sleep hygiene, insomnia due to drug or substance, medical condition or mental disorder[10].

3. Symptoms and definition

Various working groups on sleep disorder such as The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10), Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and ICSD-2, agree on three main diagnostic criteria to define insomnia. These three chief complaints include difficulty initiating sleep, difficulty maintaining sleep, and waking up too early. Patient has a poor quality or non-restorative sleep. A consequent impairment in daytime functioning and associated subjective symptoms such as fatigue, daytime sleepiness, low energy level, mood irritability, difficulties in cognitive activity (e.g. concentration, memory and attention), lack of motivation, constant worry for sleep and tension headache[10]–[12].

4. Definition

According to the DSM-IV-TR diagnostic criteria for primary insomnia requires[12]:

(i) A predominant complaint of difficulty in initiating or maintaining sleep, or nonrestorative sleep, for at least one month.

(ii) The sleep disturbance (or associated daytime fatigue) causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

(iii) The sleep disturbance does not occur exclusively during the course of another sleep disorder (narcolepsy, breathing-related sleep disorder, etc).

(iv) The disturbance is not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or another psychiatric or general medical condition.

5. Currently available treatments for insomnia

The British Association for Psychopharmacology guidelines recommended that it is extremely necessary to treat insomnia because the condition causing poor quality of life, is associated with impaired functioning in many areas, and leads to increased risk of psychological disorder (e.g. depression, anxiety) and possibly cardiovascular disorders. Main goals of insomnia treatment are to produce less suffering and to improve daytime function[4].

There are various methods of psychological and behavioural intervention for treatment of insomnia, including the sleep hygiene, stimulus control, sleep restriction, relaxation techniques, feedback, cognitive therapy, “chronotherapy”, and phytotherapy[5]. The British Association for Psychopharmacology Consensus, American Academy of Sleep Medicine, and the 2005 US National Institute of Health State-of Science Conference on insomnia concluded that cognitive behavioural therapy (CBT) and benzodiazepine receptor agonist have level a evidence for short-term treatment of chronic insomnia. CBT is effective for individual or a group of people[4],[6],[13]. The current mainstay for the pharmacotherapy of insomnia is as below[4]–[9],[13],[14]:

1. Enhancing the inhibitory wake-promoting neurotransmitter gamma amino benzoic acid (GABA).

A. Benzodiazepine receptors agonist: triazolam, temazepam, lorazepam, and flurazepam.

B. Non-benzodiazepine receptor agonist (Z-drug): zolpidem, zaleplon, eszopiclone.

2. Melatonin, ramelteon, almorexant.

3. Other agents.

A. Over the counter (OTC) products: diphenhydramine hydrochloride, diphenhydramine citrate, doxylamine succinate.

B. Tricyclic anti-depressant agents (TCAs): amitriptyline, nortriptyline, doxepin, trazodone.

6. Limitations of current therapies

6.1. Benzodiazepines and non-benzodiazepines agents

These hypnotic agents act by enhancing sleep promoting neurotransmitter (GABA). It causes high degree of inhibition of arousal. Therefore, the wake-promoting systems mediated via norepinephrine, acetylcholine, histamine, dopamine and serotonin are inhibited by GABA mechanisms. There is a balance between these two systems for safe functioning, such as driving, walking to the bathroom in dark without falling[9].

These compounds have reported efficacy and safety in terms of improvement in sleep quality. However, they are associated with numerous adverse events such as daytime sedation or next-day residual effects, motor incoordinataion, reduced psychomotor performance, cognitive impairment and related concerns about increases in risk of motor vehicle accidents and injuries from fall[9],[14].

Chronic administration of benzodiazepines agonists agent produces tolerance, psychological dependence. The adaptive changes in GABA receptor cause withdrawal, characterized by neurological, physical and cognitive symptoms, and rebound insomnia[4],[9],[14],[15].

These agents have also been associated with the potential for abuse and dependence in at risk populations, which led the US Drug Enforcement Agency to classify them as Schedule IV substances[16],[17].

6.2. Melatonin, ramelteon and almorexant

Newer approaches include ramelteon, the first and only nonscheduled drug approved by the US FDA for the treatment of insomnia, and in the future possibly by the orexin system, through agents such as almorexant. Ramelteon produces sleep through activation of melatonin 1 and melatonin 2 receptors in the suprachiasmatic nucleus of the hypothalamus. Almorexant produces selective antagonism of orexin OX1 and OX2 receptor. There is no adequate evidence that they are effective in the treatment of insomnia[15],[18].

6.3. Other agents

Anti-histaminics are the active ingredients of OTC sleep aids available in market (i.e. diphenhydramine, doxylamine). Disadvantages of the current OTC antihistamines are their relatively long duration of action and next-morning drowsiness, potential side effects, and insufficient receptor selectivity has risk of undesired anticholinergic side effect (i.e. dry mouth, dry eye, retention of urine, constipation)[16].

The most commonly used anti-depressants for co-morbid insomnia include sedating tricyclics anti-depressants (TCAs), such as amitriptyline, doxepin, and nortriptyline, and 5HT2 antagonist trazodone. They are effective for inducing sleep and improving sleep continuity. The TCAs can alter sleep architecture by reducing rapid eye movement (REM) sleep. In general, sedating properties of anti-depressant agents are related to antagonism of serotonin 5HT2, histamines, and α-1 adrenergic receptors[14]–[16].

Because of their non-selective antagonist action on 5HT2, histamines, and α-1 adrenergic receptors, these agents produce side effects such as anticholinergic, adrenergic blockade, and prolong cardiac conduction. These agents also cause potential side effects such as weight gain, increased suicidal ideation, hypomania or mania in patients with bipolar disorder.

There is short of evidence which proves that sedative anti-depressants are effective in the treatment of insomnia. Although due to lack of abuse potential, they are considered as unscheduled drug. They are cheaper and well studied drugs. Therefore, they are drug of choice for patients with co-morbid insomnia who is suffering from depression.

Although, the treatment of insomnia is widely used, many agents that block the histamine h2 receptor are considered to have therapeutic limitations, including the development of next-day carryover sedation, as well as problems with chronic use, such as the development of tolerance to sedative-hypnotic action and weight gain. TCAs like doxepin exert such potent histamine h2 blockade that it has been possible to optimize their hypnotic activity by using very low dose. Since March 2010, the US FDA has approved low dose doxepin for the indication of insomnia[19].

In this review, we have discussed the further details of role of histamine for wakefulness and blockade of histamine by doxepin to reduce the wakefulness. Effectiveness and safety of doxepin for the patients who have complaint of sleep maintenance and sleep onset insomnia.

7. Emerging trends

Recent research has revisited one of the oldest approaches to insomnia, namely by using anti-depressant and antihistaminic properties. Anti-histaminic such as diphenhydramine and doxylamine are used as sleep promoting agents. They are available as over the counter products. Anti-depressants with histamine antagonist action such as trazodon, doxepin, mirtazapine and antipsychotic with antihistaminic properties like quetiapine are used for the treatment of insomnia with co-morbid psychiatric condition like depression[14],[15].

7.1. Arousal pathway

Histamine is the key neurotransmitter for arousal. It is synthesized in the hypothalamus. It drives the wakefulness known as “wake-promoting” neurotransmitter. The major site of histaminic neurones is tuberomammillary nucleus (TMN). The distribution of histamine receptors in brain is very dense. Histamine h2 receptors are of high density in the cortex and in the limbic system, while histamine h3 receptors have high density in the striatum, cerebral cortex, and also in the limbic system; and finally, histamine h4 receptors, the autoreceptors, are dense in the striatum and the cortex. Histamine produces its action via direct and indirect stimulation of arousal pathway. Direct pathway causes stimulation of histamine receptor travelling via the ascending histaminergic neurones from hypothalamus to thalamic h2 and h3 receptors or in the cortex via histamine h2 receptor. The release of histamine causes calm wakefulness (i.e. well-rested state, the ability to focus on cognitive task, problem solving, learning, creativity). Secondly, histamine also produces indirect activation of basal forebrain cholinergic neurone via histamine h2 receptors. This stimulation causes release of acetylcholine which stimulated arousal (i.e. anxiety, fright, external vigilance) ()[14],[15],[20]–[22].

Arousal pathway and mechanism of action of hypnotic drugs.

Among anti-depressants, doxepin has the highest binding capacity to histamine receptors. Its potency to bind histamine is even stronger than classical antihistaminic. Doxepin had high binding to histamine in frontal cortex, amygdale, temporal cortex, and the hippocampus[20].

Low dose doxepin acts via blocking h2 receptors, which is very unique among the currently approved FDA drugs for the treatment of insomnia. Doxepin, 3 mg and 6 mg, were approved by USFDA in March, 2010 in both adult and elderly patients suffering from short and long term insomnia[19].

8. Low dose doxepin for insomnia

Doxepin is a three-decade old tricyclic anti-depressant agent. It is approved for the treatment of depression, depression with insomnia and anxiety disorders. Anti-depressant action produces with ≥25 mg of doxepin. Lower dosage produces anti-anxiety effect. Anti-depressant action of doxepin is because of reuptake inhibition of nor-epinephrine and serotonin. Higher dose ≥25 mg of doxepin is nonslective and responsible for undesired side effects such as anticholinergic, antiadrenergic, and potentiation of cardiac conduction ()[23],[24].

Chemical structure of doxepin hydrochloride.

Lower dose doxepin has a very high selectivity for h2 receptor. It binds with histamine receptors for 100 times more than that of nor-epinephrine and serotonin receptors. Antagonism of histamine receptors in TMN nucleus inhibits the arousal pathway. This produces hypnotic action. Thus low dose of doxepin (1, 3, 6 mg) can produce selective h2 blockade[19],[20],[23],[24],.

Low dose doxepin is advantages for the patients with complaint of objective and subjective measures of sleep maintenance and sleep onset insomnia. Sleep effects seem to be dose dependent, and among the very low-dose preparations being studied, the 3 mg and 6 mg doses appeared the most effective in adult as well as elderly patients; doxepin (@roneliS) has been approved for insomnia treatment in USA[19].

9. Clinical efficacy and safety of 1, 3, and 6 mg doxepin in insomnia

9.1. Efficacy

Doxepin 1, 3, and 6 mg is widely studied in both adult and elderly patients with difficulty in sleep onset and sleep maintenance insomnia. There were 1 423 subjects, with chronic insomnia (n=858) or transient (n=565) insomnia participated in 6 randomised, double-blind studied. These studies were up to 3 months in duration and included patients of both sex between 18 and 93 years of age.

Compared to placebo, all three Doxepin doses, 1, 3, and 6 mg produced significant improvement in sleep parameters such as wake time after sleep onset, total sleep time and sleep efficiency. These improvements were sustained throughout the duration of studies[19],[25]–[30].

In the 3-month clinical trial, the 3 mg dose produces significant improvement in sleep latency without evidence of next-day residual sedation[27]. In elderly patients, the 4-week study of 6 mg doxepin significantly improved total sleep time and sleep quality versus placebo and these improvements were sustained throughout the trial[25]. Clinical trial in transient insomnia patients (n=565) also demonstrated the effectiveness of doxepin 6 mg in sleep onset, sleep maintenance, sleep duration and sleep quality[28]. Thus doxepin is useful for both sleep maintenance and sleep onset or difficulty in falling sleep. It decreases the frequent waking at night and increase the total duration of sleep.

9.2. Tolerability

Low dose doxepin had an incidence of adverse effects compared to placebo. There were no reported anticholinergic effects, no memory impairment and no evidence of next day residual effects. Doxepin should be avoided in patients who take anti-depresants, alcohol and sedating antihistaminic. Doxepin is metabolized by CYP isoenzymes, co-administration of cimetidine and sertraline like CYP inhibitors may increase the plasma concentration of doxepin[19],[25]–[30].

9.3. Safety

Low dose doxepin is safe drug for short term and long term insomnia. Low dose doxepin is different from other anti-depressants in three effects. First, low dose doxepin has no reports of suicide in clinical trial. Therefore, low dose doxepin does not have a boxed warning for suicide risk. Second, doxepin is not associated with abuse potential in animals or in human. Third, there is no report of weight gaining or appetite increasing. The most common adverse reactions reported were sedation, somnolence, nausea and upper respiratory tract infection[19],[25]–[30]. During the clinical trial, there is no report for rebound insomnia/withdrawal syndrome after doxepin discontinuation. Thus doxepin does not produce physical dependence[19],[25]–[30]. Cardiac safety study showed no prolongation of QT interval with 50 mg dose of doxepin[31]. Doxepin is pregnancy category C drug. It is not a controlled substance like benzodiazepine drugs. In the elderly population and patients with hepatic insufficiency, 3 mg of starting dose is recommended. Mild renal impairment does not required dose adjustment. It should be avoided in patients with severe urinary retention, narrow angle glaucoma and who are currently taking monoamine oxidase inhibitors or has used MAOI for the past two weeks. The uncontrolled insomnia after 7-10 days of treatment may indicate possibility of secondary insomnia or co-morbid insomnia[19].

9.4. Dose administration

Doxepin dosage is very simple for insomnia patients. It is available in strength of 3 mg and 6 mg immediate release oral tablet. The recommended dose of doxepin for adults is 6 mg once daily. The starting dose for the elderly patients >65 years old is 3 mg once daily. The daily dose can be increased to 6 mg, if clinically required. It should be taken within 30 min of bedtime. To minimize the potential for next day effects, doxepin should not be taken within 3 h of a meal[19].

10. Benefits of low dose doxepin therapy for insomnia

Low doses doxepin 3 mg and 6 mg have several distinctive advantages over other available hypnotic agents for several reasons[19],[25]–[30].

1. It does not directly interfere with the other arousal systems[14],[15],[20].

2. The finding of trials confirmed that doxepin 3 mg and 6 mg is efficacious in improving sleep latency, sleep maintenance and sleep quality. Moreover, these improvements are sustained for long duration of 3 months.

3. It does not cause daytime sedation (no next-day sedation).

4. Published clinical trials demonstrated that it is effective in adult as well as elderly patients with primary insomnia and current data suggest that it is also safe and well tolerated at 6 mg dose[19],[25],[27],[29].

5. No incidence of withdrawal syndrome or rebound insomnia after discontinuing doxepin 3 mg or 6 mg[25]–[27].

6. Use of low dose doxepin is not associated with tolerance, and anti-cholinergic side effect. Further, it is not associated with weight gain and cardiac re-polarization[19],[25]–[30].

7. It is a non-controlled substance that enjoys virtually no risk of addiction or dependence[19]. This allows easier prescribing with fewer prescribing restrictions, as well as being potentially effective in high-risk patient populations (e.g. history of alcohol or drug abuse) and those who require a pharmacologic agent on a more chronic basis.

11. Conclusion

In conclusion, doxepin at low doses of 3 mg and 6 mg is effective and well tolerated. It is also safe and non-habit forming option for patients with insomnia. Doxepin is not a controlled substance and it has no risk of abuse. Unlike GABA agonists, low dose doxepin selectively blocks histaminergic action and its arousal property resulting in natural sleep. Low dose doxepin is a new armamentarium for managing chronic primary insomnia and transient insomnia characterized by difficulties with sleep maintenance in adult and elderly patients.

Notes

Comments

Background

Insomnia is an iceberg disease. Prevalence of insomnia is high among the adults as well as the elders. Majority of time, primary insomnia patients are unidentified, as the patients are ignorant to the sleep problems and avoid to visit the physicians. Insomnia is characterized by difficulty in initiating or maintaining sleep. Insomnia is associated with nonrestorative sleep and daytime fatigue, malaise, irritability and decreased memory and concentration. Morbidity of insomnia patients increased when they have associated co-morbid condition such as depression, psychosis and cardiac disease. Traditional hypnotic medications, benzodiazepines and nonbenzodiazepines, act via GABA inhibitory pathway in brain and they are associated with adverse events such as abuse potential, withdrawal syndrome on discontinuation of medication and rebound insomnia. They also developed tolerance and dependence. While, TCAs and anti-depressant agents have proven their effectiveness in improvement of sleep onset and sleep maintenance in healthy subjects as well as depressant patients even after long term use. During the clinical studies, these agents had low abuse potential and dependence. An old TCAs, doxepin, approved to treat depression and anxiety disorder. It also effectively cures insomnia patients with depression. Its potent h2 receptors blocking action is useful for sleep disorder. Low dose doxepin has open new frontier to treat primary insomnia and chronic insomnia patients. Doxepin in 3 mg and 6 mg doses was approved by USFDA in 2010 to treat sleep onset and sleep maintenance in adult and elderly with chronic insomnia.

Research frontiers

The review highlights new and important aspects of insomnia treatment. The authors performed a good review for the role of histamine receptors and their blockade with doxepin to treat insomnia. This approach is a novel compare to traditional therapy. This article focuses on recent developments in insomnia treatment and will be helpful for physician to decide their preferential hypnotic to treat insomnia patients.

Related reports

Zisapel, Loachimescu et al. and Sullivan recently discussed the emerging drugs for insomnia. They reported the advantage of unique action of doxepin when used in 3 mg and 6 mg. In this review, the authors also concluded that low dose doxepin is effective and safe in primary insomnia patients. They also discussed detailed pathophysiology of insomnia and described potential of histamine pathway to induce sleep, which was not the part of previously published articles of the other authors.

Innovations & breakthroughs

This review adds additional support to the use of low dose doxepin in primary insomnia. The authors had wisely covered pathophysiology and clinical data of low dose doxepin. It is a good article for physician for quick guide to hypnotic.

Applications

This review provides a glimpse on recent developments in insomnia treatment and it will be definitely helpful for physician to decide their preferential medication to treat insomnia patients.

Peer review

It is an appropriate review article which highlights newer pharmacological treatment option for insomnia. The authors had nicely discussed pathophysiology of sleep and their basis for developing new agent for insomnia. The pros and cons of low dose doxepin in insomnia are well evaluated. Over all it is a good article for clinician to decide their daily choice of agent for insomnia patients.

Footnotes

Conflict of interest statement: We declare that we have no conflict of interest.

References

2. Roth T, Jaeger S, Jin R, Kalsekar A, Stang PE, Kessler RC. Sleep problems, comorbid mental disorders, and role functioning in the national comorbidity survey replication. Biol Psychiatry. 2006;60:1364–1371. [PMC free article] [PubMed] [Google Scholar]3. Pearson NJ, Johnson LL, Nahin RL. Insomnia, trouble sleeping, and complementary and alternative medicine: analysis of the 2002 national health interview survey data. Arch Intern Med. 2006;166:1775–1782. [PubMed] [Google Scholar]4. Wilson SJ, Nutt DJ, Alford C, Argyropoulos SV, Baldwin DS, Bateson AN, et al. et al. British association for psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. J Psychopharmacol. 2010;24:1577–1600. [PubMed] [Google Scholar]5. Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4:487–504. [PMC free article] [PubMed] [Google Scholar]6. Morgenthaler T, Kramer M, Alessi C, Friedman L, Boehlecke B, Brown T, et al. et al. Practice parameters for the psychological and behavioral treatment of insomnia: an update. Sleep. 2006;29:1415–1419. [PubMed] [Google Scholar]8. Galimi R. Insomnia in the elderly: an update and future challenges. G Gerontol. 2010;58:231–247. [Google Scholar]9. Charles AC, Winkelman JW, Richardson GS. Sleep disorders. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, editors. Harrison’s internal medicine. 17th ed. New York: McGraw-Hill Publishing; 2005. pp. 153–161. [Google Scholar]10. American Academy of Sleep Medicine . International classification of sleep disorders: diagnostic and coding manual. 2nd ed. Westchester: American Academy of Sleep Medicine; 2005. [Google Scholar]11. World Health Organization . Geneva: WHO; 1992. The ICD-10 classification of mental and behavioral disorders: Clinical descriptions and diagnostic guidelines[R] [Google Scholar]12. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 4th ed. Washington DC: The American Psychiatric Association; 2000. [Google Scholar]14. Stahl SM. Selective histamine h2 antagonism: novel hypnotic and pharmacologic actions challenge classical notions of antihistamines. CNS Spectr. 2008;13:1027–1038. [PubMed] [Google Scholar]15. Owen RT. Selective histamine H (1) antagonism: A novel approach to insomnia using low-dose doxepin. Drugs Today (Barc) 2009;45:261–267. [PubMed] [Google Scholar]16. Pinto LR, Jr, Alves RC, Caixeta E, Fontenelle JA, Bacellar A, Poyares D, et al. et al. New guidelines for diagnosis and treatment of insomnia. Arq Neuropsiquiatr. 2010;68:666–675. [PubMed] [Google Scholar]17. Zammit G. Comparative tolerability of newer agents for insomnia. Drug Saf. 2009;32:735–748. [PubMed] [Google Scholar]18. Mets MA, van Deventer KR, Olivier B, Verster JC. Critical appraisal of ramelteon in the treatment of insomnia. Nat Sci Sleep. 2010;2:257–266. [PMC free article] [PubMed] [Google Scholar]21. Slats D, Claassen JA, Verbeek MM, Overeem S. Reciprocal interactions between sleep, circadian rhythms and Alzheimer’s disease: focus on the role of hypocretin and melatonin. Ageing Res Rev. 2013;12:188–200. [PubMed] [Google Scholar]23. Goforth HW. Low-dose doxepin for the treatment of insomnia: emerging data. Expert Opin Pharmacother. 2009;10:1649–1655. [PubMed] [Google Scholar]24. Markov D, Doghramji K. Doxepin for insomnia. Curr Psychiatry. 2010;9:67–77. [Google Scholar]25. Lankford A, Rogowski R, Essink B, Ludington E, Heith Durrence H, Roth T. Efficacy and safety of doxepin 6 mg in a four-week outpatient trial of elderly adults with chronic primary insomnia. Sleep Med. 2012;13:133–138. [PubMed] [Google Scholar]26. Krystal AD, Lankford A, Durrence HH, Ludington E, Jochelson P, Rogowski R, et al. et al. Efficacy and safety of doxepin 3 and 6 mg in a 35-day sleep laboratory trial in adults with chronic primary insomnia. Sleep. 2011;34:1433–1442. [PMC free article] [PubMed] [Google Scholar]27. Krystal AD, Durrence HH, Scharf M, Jochelson P, Rogowski R, Ludington E, et al. et al. Efficacy and safety of doxepin 1 mg and 3 mg in a 12-week sleep laboratory and outpatient trial of elderly subjects with chronic primary insomnia. Sleep. 2010;33:1553–1561. [PMC free article] [PubMed] [Google Scholar]28. Roth T, Heith Durrence H, Jochelson P, Peterson G, Ludington E, Rogowski R, et al. et al. Efficacy and safety of doxepin 6 mg in a model of transient insomnia. Sleep Med. 2010;11:843–847. [PubMed] [Google Scholar]29. Scharf M, Rogowski R, Hull S, Cohn M, Mayleben D, Feldman N, et al. et al. Efficacy and safety of doxepin 1 mg, 3 mg, and 6 mg in elderly patients with primary insomnia: a randomized, double-blind, placebocontrolled crossover study. J Clin Psychiatry. 2008;69:1557–1564. [PubMed] [Google Scholar]30. Roth T, Rogowski R, Hull S, Schwartz H, Koshorek G, Corser B, et al. et al. Efficacy and safety of doxepin 1 mg, 3 mg, and 6 mg in adults with primary insomnia. Sleep. 2007;30:1555–1561. [PMC free article] [PubMed] [Google Scholar]31. Mansbach RS, Ludington E, Rogowski R, Kittrelle JP, Jochelson P. A placebo- and active-controlled assessment of 6- and 50-mg oral doxepin on cardiac repolarization in healthy volunteers: A thorough QT evaluation. Clin Ther. 2011;33:851–862. [PubMed] [Google Scholar]

Doxepin – an overview | ScienceDirect Topics

Despite a relative lack of data and no FDA indication for insomnia, sedating antidepressants, such as the tricyclics, trazodone and mirtazapine, are some of the most commonly used agents for treating chronic insomnia. In general, there are relatively few efficacy data regarding the use of these agents in primary insomnia.

Tricyclic antidepressants (TCAs)

Amitriptyline and doxepin are some of the more commonly used TCAs in the treatment of insomnia (Walsh, 2004a). Their therapeutic effects in depression are related to inhibition of serotonin and norepinephrine reuptake, whereas their effects on sleep are probably mediated by their antagonistic effects on histamine type 1 (h2), serotonin type 2 (5HT₂) and α-adrenergic type 1 receptors. TCAs have long half-lives, which often leads to daytime sedation and other adverse effects. In general, when used to promote sleep they are prescribed at doses lower than those recommended for treating depression.

The effects of TCAs on sleep have been studied more frequently in patients with major depressive disorder, where they have been shown to reduce latency to sleep onset and increase sleep efficiency (Roth et al., 1982; Shipley et al., 1985). PSG studies in adults and elderly adults with primary insomnia showed that low doses of doxepin (1, 3, or 6 mg) led to improvements in objective sleep and subjective sleep maintenance and duration in comparison with placebo, with no evidence of side-effects such as anticholinergic effects, hangover, or memory impairment (Roth et al., 2007; Scharf et al., 2008). TCAs at higher doses have profound effects on sleep architecture, most notably suppression of REM sleep (Obermeyer and Benca, 1996; Mayers and Baldwin, 2005). REM sleep rebound and sleep disturbance may thus occur following abrupt discontinuation of TCAs, making them less attractive for intermittent dosing.

TCAs can also have adverse effects on sleep, including the exacerbation of restless legs syndrome or periodic limb movements, or precipitation of REM behavior disorder (Wilson and Argyropoulos, 2005). They can also induce hypomania or mania in patients with underlying bipolar disorder, which is generally associated with severe insomnia.

All tricyclics have significant anticholinergic effects, which leads to many of their side-effects, including dry mouth, constipation, urinary retention, and sweating, although amitriptyline has the strongest effects. Orthostatic hypotension can result from α₁-receptor antagonism, increasing the risk of falls. The TCAs also have quinidine-like effects on cardiac conduction, which can result in prolongation of the QT interval; cardiotoxicity is a major concern and these drugs have a high risk of fatality in overdosage.

Although there are relatively few studies documenting its effects on sleep, trazodone has been one of the most frequently prescribed drugs for insomnia, and is probably used almost exclusively for this purpose at present, usually in doses of up to 100 mg at bedtime. Its popularity is probably due to its low cost, low abuse potential, and lack of restrictions on long-term use. Its effects on sleep are probably due to its antihistaminergic effects at the H₁ receptor, α₁-receptor antagonism, and 5HT₂ receptor antagonism. In several studies in depressed patients, trazodone administration resulted in reduced sleep latency, and increased sleep efficiency and total sleep (Mendelson, 2005). In the one double-blind, placebo-controlled study that has been performed in primary insomnia, trazodone 50 mg and zolpidem 10 mg were compared with placebo over a 2-week period (Walsh et al., 1998). During the first week, trazodone and zolpidem led to subjective reductions in sleep latency, increases in total sleep and sleep quality, and decreased wakefulness after sleep onset, but zolpidem produced a greater reduction in sleep latency than trazodone. During the second week, trazodone did not differ from placebo, whereas zolpidem still produced a significantly shorter sleep latency and more total sleep. There are insufficient data to conclude that trazodone does not lead to tolerance or rebound insomnia.

Trazodone is associated with a number of frequent adverse effects, including daytime sedation/drowsiness, dizziness, dry mouth, gastrointestintal upset, blurred vision, and headache; these have led to fairly high discontinuation rates in clinical trials (Mendelson, 2005). Although less common, significant cardiovascular effects, such as orthostatic hypotension, prolonged QT interval, and cardiac arrhythmias may occur. Priapism, although quite rare, is a medical emergency and can occur even with low doses. One of the major metabolites of trazodone, meta-chlorophenylpeperazine (m-CPP), has serotonergic effects and may contribute to serotonin syndrome (confusion/delirium, hyperreflexia, autonomic instability) when trazodone is used in combination with other serotonergic agents. These potential side-effects raise concerns about using trazodone in elderly or medically ill populations.

Mirtazapine tends to be used at low doses (7.5–15 mg) as a sleep-inducing agent and probably affects sleep through antagonism of H₁ receptors, 5HT₂ receptors, and α₁-adrenergic receptors. It is generally believed that lower doses of mirtazapine are more sedating than higher doses, but there are few objective clinical data to support this or other efficacy claims for mirtazapine. Common side-effects of mirtazapine include drowsiness, daytime sedation, dry mouth, increased appetite, and weight gain. Its low toxicity is an advantage over some of the other sedating antidepressants.

Does Doxepin Cause Weight Loss Recipes

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DOXEPIN SIDE EFFECTS: COMMON, SEVERE, LONG TERM – …

2020-10-21  · Along with its needed effects, doxepin may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Check with your doctor immediately if any of the following side effects occur …
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DOXEPIN USES, DOSAGE FOR SLEEP OR INSOMNIA AND DOXEPIN …

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DOXEPIN AND WEIGHT GAIN | PHOENIX RISING ME/CFS FORUMS

2015-06-21  · Interesting post and discussion. I’ve been on doxepin longer than any other drug – 20 years. I take 50 mg a night. It hasn’t caused me any weight gain. I’ve had more problems with losing weight than gaining weight over the last 15 years, because of chronic nausea. (I’ve also taken every drug mentioned in this thread, lyrica, ambien, halcyon …
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WILL 20 MG OF DOXEPIN CAUSE WEIGHT GAIN? I HAD GASTRIC BY …

2008-09-24  · Hello, Welcome to Justanswer.com and I am happy to assist you. Doxepin is a Tricyclic Antidepressant. One of the side effects is weight gain. This side effect is probably ( but not definitely) dose dependent, which means that the amount of weight one gains on this medication is proprotional to their dose,i.e, the higher the dose the more weigt they gain. 20 mg is a low dose but you still have …
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DOXEPIN (ORAL ROUTE) SIDE EFFECTS – MAYO CLINIC

loss in sexual ability, desire, drive, or performance redness or other discoloration of the skin severe sunburn swelling of the breasts or breast soreness in both females and males swelling of the testicles unexpected or excess milk flow from breasts weight loss Other side effects not listed may also occur in some patients. If you notice any …
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DOXEPIN (ORAL ROUTE) DESCRIPTION AND BRAND NAMES – MAYO CLINIC

Doxepin is used to treat anxiety or depression. It is also used to treat insomnia (trouble with sleeping). Doxepin is a tricyclic antidepressant (TCA). It works on the central nervous system (CNS) to increase levels of certain chemicals in the brain. This medicine is available only with your doctor’s prescription.
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DRUGS THAT BLOCK WEIGHT LOSS – DR. WILLIAM DAVIS

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weight gain or loss, low blood pressure when rising from a sitting position (orthostatic hypotension), rash, hives, rapid or irregular heart rates, seizures, and ; hepatitis. Doxepin also can cause elevated pressure in the eyes of some patients withglaucoma. Doxepin may dilate pupils which may trigger an angle closure attack in a patient with angle closure glaucoma. If antidepressants …
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In a study of two breastfeeding mothers, one of whom received 150 mg and the other 75 mg of doxepin daily, an average of 0.3–1% of the maternal weight-related dose, including the metabolite, N-desmethyldoxepin, are reported for the infant (Kemp 1985). Another breastfed baby has been treated for depressed breathing and sedation. Values of 2.2 μg/L doxepin are measured in his plasma and …
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Doxepin did make me sleepy but it is a crap drug. sluggish the next day and rapid weight gain. Still felt tired. Was taking it in conjunction with 3mg Lunesta. I told my doctor I want off and just to take 4.5mg of Lunesta. M: 56 3 weeks: 20 MG 1X D 9/4/2018 Email: 5: depression and anxiety: weight gain which I needed but my breasts hurt and are …
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2020-12-09  · weight gain or loss, low blood pressure when rising from a sitting position (orthostatic hypotension), rash, hives, rapid or irregular heart rates, seizures, and ; hepatitis. Doxepin also can cause elevated pressure in the eyes of some patients withglaucoma. Doxepin may dilate pupils which may trigger an angle closure attack in a patient with angle closure glaucoma. If antidepressants …
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DOXEPIN CAPSULES: USAGE, DOSAGE AND SIDE EFFECTS

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16 ANTIDEPRESSANTS THAT CAUSE WEIGHT GAIN

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DOXEPIN WITHDRAWAL, DOXEPIN WITHDRAWAL SYMPTOMS – POINT OF …

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DOXEPIN MEDICATION AND WEIGHT GAIN | DIABETES CONTROL VIEW …

Conference Series LLC is glad to invite you to 12 th World Congress on Obesity Doxepin Medication And Weight Gain to be held during August 24-25 3-19-08: Windy City Times: “UIC Holds First LGBT Research Forum”. DOI: 10. FAST FOOD DIABETES ] The REAL cause of Diabetes (and the solution) Skip to content. Tip: If you are pregnant have a knee …
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Does DOXEPIN HCL Interact with other Medications? Severe Interactions . These medications are not usually taken together. Consult your healthcare professional (e.g., doctor or pharmacist) for more …
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IS DOXEPIN SAFE AND EFFECTIVE IN TREATING ITCHING AND HIVES?

2021-06-08  · Doxepin helps for itching and hives. However, Doxepin causes some strong side effects and thus it should be taken with caution. Doxepine is at the same time a tricyclic antidepressant medical drug and a powerful antihistamine medical drug. It is commonly used for treating chronic itching and hives. Although Doxepin is good for treating hives and itching, it must be used with caution and under …
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DOXEPIN HYDROCHLORIDE AND WEIGHT LOSS, A PHASE IV CLINICAL …

Summary: Weight loss is found among people who take Doxepin hydrochloride, especially for people who are female, 50-59 old, have been taking the drug for 1 – 6 months. The phase IV clinical study analyzes which people take Doxepin hydrochloride and have Weight loss. It is created by eHealthMe based on reports of 964 people who have side effects …
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Compare Tofranil vs Doxepin – Iodine.com

Improves your mood and stops bedwetting in children.

Tofranil (imipramine hydrochloride) is one of the first choice medicines used to treat depression, but it can cause weight gain and sleepiness.

Treats depression and anxiety.

doxepin can treat depression and anxiety, but it’s not a first choice medication because of its many side effects.

Upsides

• Tofranil (imipramine hydrochloride) is part of the first choice of medicines used to treat depression.
• Available in generic.
• Tofranil (imipramine hydrochloride) is usually taken only once a day.
• Available in 3 different strengths.

• doxepin has been consistently shown to improve symptoms of depression and anxiety.
• doxepin has been used to treat depression for over forty years.

Downsides

• Tofranil (imipramine hydrochloride) can lower your sex drive and cause more weight gain than other similar medicines for depression.
• You might be more sensitive to the sun and have a higher risk for heat stroke while taking Tofranil (imipramine hydrochloride).
• If you have a history of heart conditions, your symptoms might get worse with Tofranil (imipramine hydrochloride). Talk to your doctor to see if Tofranil (imipramine hydrochloride) is right for you.

• doxepin can make you very sleepy. Try taking it at bedtime if you need to be alert during the day.
• You shouldn’t drink alcohol with doxepin. It can worsen side effects like drowsiness.
• You have to take it daily, especially if you are feeling better, for the medicine to do its job.
• It can have more side effects than other antidepressants, like weight gain and increased appetite, decreased libido, and sleepiness.
• It’s not unusual for people to try different antidepressants until they find one that works for them.

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Reviews

Side effects

The Tofranil (imipramine hydrochloride) FDA package insert doesn’t have numbers about how common side effects are.

The doxepin FDA package insert doesn’t have numbers about how common side effects are.

Risks and risk factors

Many Psychiatric Drugs Have Serious Effects on Body Weight

Unexpectedly losing a loved one launched 18-year-old Debra* into an episode of major depression, triggering dangerous delusions that landed her in a hospital. Her doctor immediately started her on an antidepressant and on risperidone (Risperdal), an antipsychotic. In little more than a month, her weight shot up by 15 pounds. “Gaining weight made it even more difficult for me to want to leave my house because I felt self-conscious,” Debra says.

In the medical community, antipsychotics are well known to cause significant weight gain. Gains of 20 to 35 pounds or more over the course of a year or two are not unusual. Debra’s doctor never warned her, though, leaving her feeling like she was losing herself both mentally and physically. The situation is not uncommon, according to psychiatrist Matthew Rudorfer, chief of the somatic treatments program at the National Institute of Mental Health, who points out that although the U.S. Food and Drug Administration carefully tracks acute side effects such as seizures, it pays less attention to longer-term complications such as weight change. Perhaps taking their cue from the FDA, doctors tend to downplay weight-related risks that accompany many psychiatric drugs, Rudorfer says. But for Debra and many others, these side effects are not trivial. The three types of psychiatric drugs that can seriously affect body weight are reviewed below.

Antipsychotics

According to a 2014 review of eight studies, as many as 55 percent of patients who take modern antipsychotics experience weight gain—a side effect that appears to be caused by a disruption of the chemical signals controlling appetite. Olanzapine (Zyprexa) and clozapine (Clozaril) are the top two offenders; studies have shown that on average these drugs cause patients to gain more than eight pounds in just 10 weeks. These two drugs also bear the highest risk of metabolic syndrome, which encompasses weight gain and other related disorders, including type 2 diabetes, according to a 2011 study of 90 people with schizophrenia. Although most antipsychotics are associated with weight gain, aripiprazole (Abilify) and ziprasidone (Geodon) stand out for their lower risk.

As Debra’s case demonstrates, antipsychotics are by no means reserved for treating people with schizophrenia. A growing body of evidence supports the use of antipsychotics in combination with antidepressants for addressing treatment-resistant depression.

Studies show that metformin, a diabetes drug, and topiramate, an anticonvulsant, can be effective at reducing antipsychotic-induced weight gain. Behavioral interventions may also help people maintain their weight while on these drugs, according to a 2015 study of 200 people with severe mental illness who had been taking an antipsychotic for at least one month and were overweight or obese. The study found that a personalized diet and exercise plan was helpful to 40 percent of the participants, who dropped at least 5 percent of their body weight after six months of dieting and exercise and six months of maintenance.

Antidepressants

A massive 2014 study of 22,610 people revealed that antidepressants generally cause more modest weight gain than antipsychotics, although the outcome varies greatly from one drug to the next. Of the 11 antidepressants analyzed, mirtazapine (Remeron) caused the greatest weight gain, followed by paroxetine (Paxil). A quarter of those who took mirtazapine for a year gained more than 7 percent of their initial weight. Only one antidepressant, bupropion (Wellbutrin and other brands), was associated with a small degree of weight loss.

Depression itself, however, is linked with an increased risk of becoming obese, according to a 2010 analysis that included more than 58,000 people. The reverse holds true as well, the study found; obese people are more likely to suffer from depression. As a result, “it is easy to misattribute the weight gain to a medicine when, in fact, it may largely be related to the illness being treated,” cautions Richard Shelton, a professor of psychiatry at the University of Alabama at Birmingham.

Stimulants

Typically used to treat attention-deficit disorders, stimulants such as Ritalin are consistently associated with weight loss. Many stimulants are specifically marketed as antiobesity drugs, including phentermine and lisdexamfetamine dimesylate (Vyvanse), which earlier this year became the first drug approved for the treatment of binge-eating disorder. Although the evidence is limited, early studies have shown that some young adults abuse prescription stimulants for weight-loss purposes. About 12 percent of the 705 undergraduate participants in a 2013 study reported that they had attempted to lose weight by taking a stimulant without a doctor’s prescription.

For people who are prescribed stimulants to treat psychiatric conditions such as ADHD, however, weight loss comes as a side effect. A 2014 study that included 163,820 children between the ages of three and 18 showed that those taking stimulants to treat their ADHD had slower rates of growth from early childhood to the middle years compared with control subjects who had no history of ADHD or stimulant use. Yet the authors noted that stimulant-treated youngsters with ADHD experienced a growth rebound in late childhood, resulting in a higher weight-to-height ratio in adolescence compared with controls. This association may explain the previously observed link between ADHD in childhood and obesity in adulthood.

*Real name withheld for privacy

90,000 Does antidepressants really gain weight?

Why antidepressants make you gain weight is still not known. It is known that some drugs are more likely to cause weight gain than others.

Also on the topic: 7 most common types of depression

From which antidepressants gain weight

• Selective serotonin reuptake inhibitors (SSRIs), which are most often prescribed. They have few side effects, but some drugs, such as paroxetine, can cause weight gain.
• Tricyclic and tetracyclic antidepressants such as amitriptyline, imipramine and doxepin. They are used less frequently than SSRIs because they have more side effects. Among them are constipation, drowsiness, weight gain.
• Monoamine oxidase inhibitors such as phenelzine. They have many side effects, including weight gain. Those who take them have to avoid certain medications and foods, such as cheeses, sausages, soy, and other foods high in tyramine and tyrosine.
• Atypical antidepressants are medicines that are not classified in other groups. One of them, mirtazapine, increases appetite and promotes weight gain. Not all drugs in these categories lead to weight gain. For example, bupropion, an atypical antidepressant, does not have this side effect.

Why does weight increase

Weight is influenced not only by antidepressants, but also by a person’s condition.

The symptoms of depression in humans are manifested in different ways.For example, someone overeats, so they gain weight. Someone, on the contrary, does not want to eat – and he loses weight. And then he starts taking antidepressants, so mood improves, appetite appears, which leads to natural weight gain.

Sometimes weight gain is not associated with depression or medication. Adults tend to gain weight with age.

People with depression often experience lifestyle changes. The strength for sports, walks disappears, it is even difficult to get yourself out of bed.If there are fewer activities and more food, then the weight can increase. Because a person consumes more calories than they burn during the day.

Allergic rash (Urticaria; urticaria rash) – Ministry of Health PMR

Allergic rash

(Urticaria; urticaria)

Allergic rash is a red, itchy, slightly raised swelling. Itching can be severe. An allergic rash can have well-defined borders and a pale area in the center.Typically, urticaria rashes come and go. One nodule may persist for several hours, then disappear, and later another may appear elsewhere. After the nodule disappears, the skin usually looks completely normal. The swelling is caused by the release of chemicals (such as histamine) from the mast cells in the skin, which cause temporary leakage of fluid from small blood vessels.

Angioedema

An allergic rash can develop with Quincke’s edema, which, like an allergic rash, is accompanied by swelling.However, the swelling caused by Quincke’s edema is under the skin, not on the surface. Quincke’s edema sometimes affects the face, lips, throat, tongue, and airways. It can be life-threatening if the swelling interferes with breathing.

Causes of allergic rash

Urticaria and Quincke’s edema are common allergic reactions.

Hives can occur by inhalation, ingestion, injecting or touching certain chemicals. These chemicals can be present in the environment, food, drugs, insects, plants, or other sources.They are harmless to most people. However, if people are sensitive to them, these chemicals (called provoking factors or allergens) can cause an allergic reaction. This means that the immune system is reacting to chemicals.

However, urticaria is not always part of an allergic reaction. For example, it can result from autoimmune diseases. In these diseases, a dysfunction of the immune system causes an incorrect recognition of the body’s own tissues as foreign and their attack.In addition, some drugs directly cause hives without causing an allergic reaction. Emotional stress and certain physical stimuli (such as heat or light) can cause hives for reasons that are not well understood.

Urticaria usually lasts less than 6 weeks and is classified as acute. If the urticaria lasts more than 6 weeks, then it is classified as chronic.

Acute urticaria most often caused by:

Allergic reactions are often caused by food such as eggs, fish, shellfish, nuts and fruits, or insect bites.Eating even small amounts of certain foods can suddenly trigger hives. But when consuming other foods (for example, strawberries), an allergic reaction occurs only after consuming large quantities of them. Many medications, especially antibiotics, can cause hives. Immediate allergic reactions can also occur when a substance comes into direct contact with the skin (such as latex), after an insect bite, or as a reaction to a substance that is inhaled into the lungs or through the nose.

Non-allergic causes of an allergic rash include infections, certain medications, certain physical irritants (eg pressure or cold), certain emotional stimuli (eg stress), and certain dietary supplements.

Although acute urticaria usually has specific causes, in half of cases the cause cannot be identified.

Chronic urticaria most often caused by:

Sometimes the cause is easily overlooked, such as when people regularly consume a food that is not known to be the cause of the reaction (for example, a preservative or color in food or penicillin in milk).Often, despite best efforts, the cause remains unknown.

Chronic urticaria can last from several months to several years, sometimes disappearing for no apparent reason.

Evaluation of allergic rash

Not every episode of urticaria requires immediate medical evaluation. The following information can help you decide if you need to see a doctor and what to expect when you see a doctor.

Warning signs

Certain symptoms and characteristics are cause for concern:

• Swelling of the face, lips, throat, tongue or respiratory tract (Quincke’s edema)

• Difficulty breathing, including wheezing

• Urticaria, which is intensely colored, in which open ulcers form, or last more than 48 hours

• Fever, swollen lymph nodes, jaundice, weight loss and other symptoms of general (systemic) disease

When to see a doctor

You need to call an ambulance if:

• A person has difficulty breathing or wheezing.

• The person feels as if his throat is closing.

You should go to the emergency department or doctor’s office as soon as possible if:

• Symptoms are severe.

• The person feels increasing weakness or dizziness, or experiences severe fever or chills.

• The person develops vomiting or abdominal pain or diarrhea.

You need to see a doctor if:

• Bee sting causes hives (to seek treatment advice if another bee sting occurs).

• The person has other symptoms such as fever, joint pain, weight loss, swollen lymph nodes, or night sweats.

• Urticaria is repeated without the influence of a provoking factor.

• Symptoms last more than 2 days.

If a child has urticaria, which appears suddenly, quickly disappears and does not recur, then a medical examination is usually not required. The cause is usually a viral infection.

What a doctor does

Doctors first ask questions about symptoms and medical history. They then do a physical examination. As a rule, familiarity with the medical history and physical examination can identify the possible cause of the disease and determine what tests are needed.

Doctors ask the person to describe in detail each episode of hives and any other symptoms they have experienced (for example, itching, difficulty breathing, or swelling of the face and tongue). They ask about the person’s activities before and during the episode and about possible exposure to substances that can cause allergic reactions, including medications taken. The person is also asked about specific symptoms that might point to the cause, previous allergic reactions, and recent travel.

The provoking factor is not always possible to establish on the basis of medical history (often because the provoking factor is something that could have been transferred earlier).

During the physical examination, doctors first check to see if the patient has swelling of the lips, tongue, throat, or airways. If there is edema, treatment is started immediately. Doctors then look at what the hives looks like, determine which parts of the body are affected, and check for other symptoms that may help confirm the diagnosis.Doctors can use a variety of physical stimuli to see if they might trigger hives. For example, they may apply light pressure, heat and cold to the skin, or stroke the skin.

Analyzing

In general, testing is not required for a single episode of urticaria unless symptoms indicate a specific condition that requires treatment (eg, some infections). However, if urticaria is unusual, recurs, or persists, testing is usually done.

Typically, tests include a complete blood count and blood tests to measure electrolyte, sugar (glucose) and thyroid-stimulating hormone levels and to determine how well the kidneys and liver are functioning. Skin tests, such as a skin scarification test, are done by an allergist (a doctor who specializes in allergic diseases) to check for specific allergens. Imaging tests and other blood tests are done based on your medical history and physical examination.If the results suggest that a disease affecting the entire body is the cause, careful evaluation is necessary to identify it.

A skin biopsy is performed if the diagnosis is unclear or if the rash persists for more than 48 hours.

Treatment of allergic rash

• Avoiding provocative factors

• Ways to relieve itching

• Medicines

Urticaria often resolves without intervention in a day or two.If a cause is obvious, or if a doctor identifies a cause, people should avoid it if possible. If the cause is not obvious, people should stop taking all nonessential medications until the urticaria resolves.

Symptoms can be relieved by bathing and showering using only cool water, refraining from scratching, and wearing loose clothing.

Medicines

Antihistamines for oral administration are used for the treatment of allergic rash.These drugs relieve some of the itching and reduce swelling. To be effective, they should be taken regularly, not as needed. Several antihistamines, including cetirizine, diphenhydramine, and loratadine, are available over the counter. Diphenhydramine is the oldest drug that is more likely to cause drowsiness than the other two. Other antihistamines include desloratidine, fexofenadine, hydroxyzine, and levocetirizine. Creams and lotions containing an antihistamine are usually not used because they can make the skin more sensitive and increase itching

If symptoms are severe and other treatments fail, use oral corticosteroids (such as prednisone).They are taken for as short a period of time as possible. When taken by mouth for more than 3 to 4 weeks, corticosteroids cause many, sometimes serious, unwanted effects (see Table: Corticosteroids Uses and Side Effects). Corticosteroid creams don’t help.

People admitted to hospital with severe reactions or Quincke’s edema are injected with epinephrine . People with such severe reactions should have an epinephrine self-injecting pen (epinephrine self-injecting syringe) and should use it immediately if a reaction occurs.

In about half of people with chronic urticaria, it disappears without treatment within 2 years. In some adults, the antidepressant doxepin, which is also a powerful antihistamine, can help relieve chronic hives. For people with a chronic allergic rash that recurs despite other treatments, omalizumab, a monoclonal antibody, can be used.

Essentials for older people: Allergic rash

Older people are more likely to develop unwanted effects when they take older antihistamines (eg hydroxyzine and diphenhydramine).In addition to drowsiness, these drugs can lead to confusion and delirium, and can also cause difficulty starting and during urination. Usually, older people should not take these drugs to relieve hives.

KEY POINTS

• Urticaria may or may not be an allergic reaction.

• If the urticaria has lasted less than 6 weeks, the cause is usually an allergic reaction to a specific substance, an acute infection, or a non-allergic reaction to a specific substance.

• If the urticaria lasts 6 weeks or more, the cause usually cannot be identified (idiopathic) or an autoimmune disorder is the cause.

• People should call an ambulance if they have difficulty breathing or if they feel like their throat is closing.

• People with mild symptoms should avoid any known or suspected triggers and may take antihistamines to relieve symptoms.

• People with severe reactions should have a self-injecting epinephrine pen and if a reaction occurs, use it immediately.

Weight gain drugs – The mind is perfect

Many psychiatric drugs can cause weight gain or weight loss with associated complications.

Weight gain from psychotropic drugs is one of the most worrying side effects.90,052 patients taking these drugs. This is a delicate issue that should be approached with special attention. In this sense, changes in body weight vary greatly depending on the patient and treatment; therefore, it is sometimes difficult to generalize and establish general criteria.

You can see well only with your heart. what is important is invisible to the eye

Many drugs used to treat disorders such as anxiety, depression, bipolar disorder, schizophrenia, or epilepsy can cause weight gain but also weight loss with associated complications.

Proven that I procedures that lead to weight gain also have the highest dropout rate . In these cases, it is necessary to prevent this side effect with an adequate combination of diet and exercise.

Occasionally, a specialist may change the treatment, dose or dosage to correct this change and the associated complications, which in some cases can be quite serious.

There are also many psychotropic drugs that have the opposite effect, that is, weight loss.While this should also be of concern, it has been found that this side effect is not seen as a problem for most patients.

Weight gain from psychotropic drugs

Antidepressants

We often hear that “antidepressants make you fat.” It is true that weight gain is one of the possible side effects of treatment with most antidepressants. However, Some drugs used to treat depression are more likely to cause weight gain than others. For example:

• Tricyclic antidepressants such as amitriptyline, imipramine and doxepin.
• Alcuni IMAO (monoamine oxidase inhibitors) such as phenelzine.
• Mirtazapine , an atypical antidepressant.
• Multiple ISRS (Selective Serotonin Reuptake Inhibitors) Eat Paroxetine.

It is important to keep this in mind Antidepressants do not always directly cause weight gain. In fact, during the treatment of depression, many factors influence and may equally contribute to this undesirable effect.

In some cases, depression itself causes weight gain. due to inactivity, sedentary lifestyle or anxiety about food, which many patients suffer in this situation. In other cases, depression causes weight loss, and antidepressant treatment improves mood as well as increases appetite and therefore body weight.

Therefore, even if it is true that weight gain is a side effect of some antidepressants, it must also be emphasized that this is not always the direct effect of these drugs. You should always consult a healthcare professional before making any rash decisions or discontinuing certain medications.

Antipsychotics

Weight gain and changes in the body’s metabolism are the side effects of greatest concern to patients taking antipsychotics. These reactions are especially important because of their negative impact on adherence to treatment.

Classical antipsychotics usually cause weight gain. The same happens with other molecules such as clozapine, olanzapine, quetiapine, risperidone, or ziprasidone. Lithium, carbamazepine, and valproic acid, used for bipolar disorder, can also cause weight gain.

I wasted my life

In addition, schizophrenia is directly related to metabolic changes. Patients with psychotic problems are more likely to be obese , among other ailments.

Weight gain, even if it is a consequence of illness or treatment, this can be balanced with lifestyle interventions such as increased physical activity or dietary changes. In other cases, it is necessary to prescribe other drugs that promote weight loss.

Weight gain from psychotropic drugs: conclusions

Weight gain from psychotropic drugs is a side effect of this type of drug treatment.However, can be dealt with or even avoided in most cases. If you think you have this problem, see your doctor.

In adherence to treatment, it is important to avoid possible relapses, especially in disorders requiring the prescription of psychotropic drugs. Changing treatment is always a better option than stopping it entirely.

Antipsychotics: Mechanism of Action and Types

Typical and atypical antipsychotics treat the symptoms of schizophrenia.Let’s find out how they work and what are the side effects.

Bibliography

• de Morentin Aldabe, B.E.M., de Eguilas, M.H.R., Diez, S.P., & Hernandez, J.A.M. (2013). The effect of taking psychotropic drugs on weight gain. Spanish Journal of Human Nutrition and Dietetics , 17 (1), 17-26.
• Rios, P.B., & Rodriguez, R.K. (2008). The effect of psychotropic drugs on body weight. Eating disorder , 8 , 813-832.
• Mukundan, A., Faulkner, G., Cohn, T., Remington, G. (2010). Switching to antipsychotic drugs for people with schizophrenia who have weight or metabolic problems caused by antipsychotics. Cochrane Database of Systematic Reviews. Issue 12. Art. No .: CD006629.

Drugs

Drugs

1. Azaleptin
2. Amizol
3. Aminazin
4. Amitriprilin
5. Galoper
6. Haloperidol
7. desipramine
8. Desmetilimipramin
9. Doxepin
10. Zyprexa
11. Zoloft
12. imipramine
13. Clozapine
14. leponeks
15. Ludiomil
16. Maprotiline
17. Melipramine
18. Meprobamate
19. Meprotan
20. Mirtazapine
21. Moditen
22. Nozepam
23. Olanzapine
24. Paxiletin
25. Sodium
26. Sertraline
27. Sonapax
28. Stelazine
29. Tazepam
30. Thioridazine
31. Thioridazine
32. Trazodone Azona
33. Trifluoperazine

9000 9 Fevarin

34. Fluvoxamine
35. Fluoxetine
36. Fluphenazine
37. Chlorpromazine

Amitriprilin Amisole

Amitriprilin is used for the treatment of depression, but we do not recommend using it among antidepressants.If you need to take antidepressants, choose desmethylimipramine.

The amount of time required for the full effect of the drug to develop may overlap the self-healing time for depression, especially if it is situational – caused by the death of loved ones or other external circumstances. Most people get out of depression with the help of friends or physical exercise, work, reading, games, art, travel, spiritual practices. If depression is not overcome by these measures, see a psychotherapist or psychiatrist.Antidepressants should only be used for severe depression that cannot be cured by psychotherapy alone.

The elderly are especially sensitive to the dangerous effects of antidepressants. These medications should not be taken unless absolutely necessary. Mental effects: disorientation in time and space, delirium, impairment of short-term memory, weakening of attention. Physical effects: dry mouth, constipation, difficulty urinating (especially in men with an enlarged prostate gland), blurred vision, decreased sweating combined with fever, sexual dysfunction, worsening glaucoma.

If you are taking amitriptyline, ask your doctor to prescribe another antidepressant for you. Do not stop taking this drug abruptly. Your doctor should work out a schedule for you to gradually taper the dose to prevent withdrawal symptoms, which include symptoms such as headaches, mood changes, nausea, vomiting, diarrhea or insomnia, and dreams that are too vivid.

Clozapine Azaleptin Leponex

Clozapine is used to treat schizophrenia.He is the first atypical antipsychotic. All antipsychotics usually improve the patient’s condition for symptoms such as agitation, delirium, hallucinations, suspicion, atypical antipsychotics improve the condition for symptoms such as apathy, disorientation, emotional decline, lack of satisfaction better than earlier antipsychotics. Atypical antipsychotic drugs do not exclude the risk of developing movement disorders, but such drugs have a lower risk of such disorders, especially at high doses.

The most serious risk from this drug is a decrease in the number of white blood cells – agranulocytosis. Clozapine should be given in amounts sufficient to be taken for only one week to monitor white blood cells, and the dose is adjusted as needed. Dry mouth or excessive saliva can cause dental problems. Elderly people are prone to dizziness. Rare, sometimes fatal effects include neuroleptic malignant syndrome (NMS).Symptoms include fever, profuse sweat, and muscle stiffness. Clozapine is not recommended for women who are pregnant or breastfeeding and for children under 16 years of age.

Before using this drug, tell your doctor if you have or have had: allergies, including lactose and iodine intolerance, blood disorders, bone marrow diseases, central nervous system depression, glaucoma (narrow field of view), gastrointestinal diseases, an enlarged prostate or difficulty urinating, diseases of the cardiovascular system, liver, kidneys, malnutrition, pregnancy or breastfeeding, epileptic seizures.

Tell your healthcare provider about any medications you are taking, including aspirin, herbs, vitamins, and other medications.

Do not drink alcohol or take other drugs that may cause drowsiness.

Do not smoke.

Until you find out how you react to this drug, do not drive or engage in other activities that require increased attention.

This drug may cause dizziness when lifting from a sitting or lying position.When getting out of bed, you should first dangle your legs and stay in this position for several minutes, and then gently rise. When lifting from a chair, you should get up slowly and stand next to the chair for a while until you are sure that you are not dizzy.

For dry mouth, use sugarless gum or ice.

Call your doctor before you stop taking clozapine. Ask for a schedule to gradually taper the dose.

If you are planning any surgery, including dental surgery, tell your doctor that you are taking this drug.

Take this medicine as prescribed by your doctor.

If you miss a dose, take the drug as soon as you remember, but skip it if it is almost time for your next dose. Do not take a double dose.

Store at room temperature below 30 ° C. Do not store in the bathroom. Do not expose to heat, moisture and direct sunlight.

Drugs that depress the central nervous system, drugs containing alcohol, antidepressants, antihistamines, some antihypertensive drugs (reserpine, methyldopa, beta-blockers), drugs used for diseases of the organs of movement, muscle relaxants, narcotic analgesics, sedatives, hypnotics and tranquilizers cause “clinically significant” or “clinically significant” interactions when used together with this drug.Other drugs that can interact with clozapine are: drugs that suppress the hematopoietic function of the bone marrow, diazepam, erythromycin, fluvoxamine, lithium drugs. Some other drugs, especially those belonging to the same groups as those listed below, can cause serious side effects when interacting with the described drug. As the number of new drugs recommended for sale increases, so does the risk of adverse interactions when used together, which are often identified with older drugs.Be carefull. Be sure to tell your doctor about all the drugs you are taking, and pay special attention to the doctor if you are taking any of the drugs that interact with the drug in question.

Trazodone Azona

Trazodone is used to treat severe depression that is not caused by other drugs, alcohol, or severe stress (such as the death of loved ones). It should not be taken for anxiety or mild depression, or as a sleeping pill.These drugs have significant adverse effects when compared to desmethylimipramine.

If you are over 60 years old, you should usually take 1/3 to 1/2 of the usual therapeutic dose. If the starting dose is insufficient and needs to be increased, do so very slowly.

Trazodone can cause painful prolonged erection of the penis (priapism) in men. If you experience this reaction, stop taking the drug and see your doctor.

The amount of time it takes to develop the full effect of a drug may overlap the spontaneous recovery time, especially if the depression is situational – caused by the death of loved ones or other external circumstances.Most people get out of depression with the help of friends or physical exercise, work, reading, games, art, travel, spiritual practices. If depression is not overcome by these measures, see a psychotherapist or psychiatrist. Antidepressants should only be used for severe depression that cannot be cured by psychotherapy alone.

The elderly are especially sensitive to the dangerous effects of antidepressants. These medications should not be taken unless absolutely necessary.Mental effects: disorientation in time and space, delirium, impairment of short-term memory, weakening of attention. Physical effects: dry mouth, constipation, difficulty urinating (especially in men with an enlarged prostate gland), blurred vision, decreased sweating combined with fever, sexual dysfunction, worsening glaucoma.

Before taking this drug, tell your doctor if you have or have had any: drug allergy, alcohol dependence, kidney or liver disease, difficulty urinating or an enlarged prostate, irregular heartbeat, fever, or sore throat.

Tell your healthcare provider about any medications you are taking, including aspirin, herbs, vitamins, and other medications.

Ask your doctor to measure your blood pressure while lying down and two minutes after you get up, do an electrocardiogram.

Do not stop taking the drug abruptly. Your doctor will schedule a gradual dose reduction for you to prevent the development of unwanted symptoms such as headaches, mood swings, nausea, vomiting, diarrhea, insomnia, and dreams that are too vivid.

Until you find out how you react to this drug, do not drive or engage in other activities that require increased attention.

It may take several weeks before you feel the effect of the drug. If you feel the effect, discuss with your doctor a gradual dose reduction.

Do not smoke. Smoking can increase the cardiotoxicity of the drug.

Do not drink alcohol or take other drugs that may cause drowsiness.

This drug may cause dizziness when lifting from a sitting or lying position. When getting out of bed, you should first dangle your legs and stay in this position for several minutes, and then gently rise. When lifting from a chair, you should get up slowly and stand next to the chair for a while until you are sure that you are not dizzy.

Tell your doctor about any other drugs you are taking.

The effects of these drugs may last for up to a week after you stop taking them.Avoid drinking alcohol and take all other precautions during this period.

If you are planning any surgery, including dental surgery, tell your doctor that you are taking one of these drugs.

To reduce stomach irritation, take with food.

If you are taking any other drug, take it 1 to 2 hours before taking your antidepressant.

Do not store the drug in the bathroom.Do not expose it to heat, moisture or direct sunlight.

If you miss a dose, you should take the drug as soon as you remember, but if there are less than four hours before your next dose, skip the dose. Do not take double doses.

Drugs that depress the central nervous system, drugs containing alcohol, antidepressants, antihistamines, some antihypertensive drugs (reserpine, methyldopa, beta-blockers), drugs used for diseases of the organs of movement, muscle relaxants, narcotic analgesics, sedatives, hypnotics and tranquilizers cause “clinically significant” or “clinically significant” interactions when used together with this drug.Some other drugs, especially those belonging to the same groups as those listed below, can cause serious side effects when interacting with the described drug. As the number of new drugs recommended for sale increases, so does the risk of adverse interactions when used together, which are often identified with older drugs. Be carefull. Be sure to tell your doctor about all the drugs you are taking, and pay special attention to the doctor if you are taking any of the drugs that interact with the drug in question.

Call your healthcare professional immediately if you have any signs of an overdose: confusion, extreme drowsiness, fever, hallucinations, restlessness and agitation, seizures, shortness of breath, difficulty breathing, heart rhythm disturbances, unusual fatigue, weakness, nausea and vomiting. Call your doctor immediately if you experience: painful erection, tremors, fainting, skin redness, unusual agitation.

Call your doctor if you have the following symptoms consistently for a long time: dizziness, dry mouth, headache, bad taste in the mouth, blurred vision, constipation, diarrhea, muscle pain.

Ask your doctor which of the following tests you should have periodically while taking this drug: CBC, blood pressure measurements, tests, heart function measurements such as an electrocardiogram (EKG), white blood cell counts.

During pregnancy, the drug should be used only if absolutely necessary. If you are pregnant or if you suspect that you are pregnant, you should inform your doctor before taking this drug.

Chlorpromazine. Aminazine. Fluphenazine Moditen. Thioridazine. Sonapax. Trifluoperazine. Stelazin

These drugs belong to the group of phenotizans and are effective in the treatment of all types of psychosis, including schizophrenia. They should not be used to treat common anxiety or mental impairment (such as Alzheimer’s) in people who do not have psychosis. Also, they should not be used as a sedative in patients with chronic anxiety or any other non-psychotic illness.They should only be used in the treatment of depression in the elderly, as tardive dyskinesia (involuntary movements of body parts) is a common side effect of antipsychotic drugs when used as antidepressants (60% of patients).

Antipsychotic drugs can cause severe adverse effects, including tardive dyskinesia, drug-induced parkinsonism, nervousness, weakness, and muscle weakness.

The elderly are particularly sensitive to the harmful effects of antipsychotic drugs such as haloperidol.These medications should not be taken unless absolutely necessary. Mental effects: disorientation in time and space, delirium, impairment of short-term memory, weakening of attention. Physical effects: dry mouth, constipation, difficulty urinating (especially in men with an enlarged prostate gland), blurred vision, decreased sweating combined with fever, sexual dysfunction, worsening glaucoma.

Inform your doctor if you have or have experienced: drug allergies, alcohol dependence, blood diseases, breast cancer, enlarged prostate or difficulty urinating, cardiovascular diseases, Parkinson’s disease, lung diseases, glaucoma, epilepsy, ulcers stomach, liver disease, Reye’s syndrome.

Tell your healthcare provider about any medications you are taking, including aspirin, herbs, vitamins, and other medications.

It may take two to three weeks before you feel the effect of taking the drug.

Do not stop taking the drug abruptly. Your doctor should schedule a gradual dose reduction for you to prevent the development of unwanted symptoms such as nausea, vomiting, and stomach pain.

Until you find out how you react to this drug, do not drive or engage in other activities that require increased attention.This drug may cause blurred vision, drowsiness, and unconsciousness.

Do not drink alcohol or use other drugs that cause drowsiness.

This drug may cause dizziness when lifting from a sitting or lying position. When getting out of bed, you should first dangle your legs and stay in this position for a few minutes, and then gently rise. When rising from a chair, you should get up slowly and stand next to the chair for a while until you are sure that you are not dizzy.

If you are planning any surgery, including dental surgery, tell your doctor that you are taking one of these drugs.

Take with food or with a full glass (250 g) of milk or water to prevent stomach irritation.

Do not store the drug in the bathroom. Do not expose to heat, moisture or direct sunlight. Do not freeze the liquid dosage form of the drug.

If you are taking antacids or fixing drugs, take them two hours apart after taking the antipsychotics.

Swallow the extended-release chlorpromazine capsules whole.

If you miss a dose of the drug, you should take it as soon as possible, but if you have to take the next dose soon, skip it. Do not take double doses.

Alcohol, amphetamines, bromocriptine, captopril, carbamazepine, cimetidine, desipramine, guanitidine, lithium preparations, polymyxin B, propranolol, rifampin cause “clinically high” or “clinically significant” interactions when used together with this drug.Some other drugs, especially those belonging to the same groups as those listed below, can cause serious side effects when interacting with the described drug. As the number of new drugs recommended for sale increases, so does the risk of adverse interactions when used together, which are often identified with older drugs. Be carefull. Be sure to tell your doctor about all the drugs you are taking, and pay special attention to the doctor if you are taking any of the drugs that interact with the drug in question.

Tell your doctor immediately if you have any signs of tardive dyskinesia: taste on the lips, chewing movements, swelling of the cheeks, quick, hasty tongue movements, uncontrolled leg movements; signs of parkinsonism: difficulty speaking or swallowing, loss of stability, face mask, stiff legs, tremors of the limbs, unusual circular movements of the body; signs of restless legs (akathisia): the need for constant walking, a feeling of excitement; signs of akinesia: weakness, muscle fatigue, indifference.Although akinesia is often confused with real depression, it belongs to a more general group of negative effects – extrapyramidal disorders.

Tell your doctor immediately if you experience: change or blurred vision, difficulty urinating, fever and sore throat, yellowing of the eyes or skin, skin rash, fainting, abnormal bleeding or bruising, mouth or gum ulcers, obsessive dreams …

Tell your doctor if you have any of the following symptoms for a long time: blurred vision, change in color vision or blurred vision, difficulty speaking or swallowing, fainting, eye paralysis, vestibular disorders, abdominal pain, muscle pain and joints, confusion, fever or chills, muscle weakness, nausea, vomiting or diarrhea, painful erection, discoloration of the skin, severe itching, sore throat, fever, yellowing of the eyes or skin, dry mouth, skin sensitivity to sunlight (photosensitivity ).

Ask your healthcare professional which of the following tests you should periodically do while taking this drug: CBC, blood pressure, eye exam, liver function test, tracking early signs of tardive dyskinesia, reevaluating drug intake, urine test for bile and bilirubin.

These drugs can cause a decrease in sweating, which leads to an increase in your body temperature.Be careful not to overheat during exercise and in warm weather if you are taking any of these medications, as overheating can lead to heatstroke. In addition, hot baths and saunas while taking this drug may cause dizziness and fainting.

These drugs can reduce the body’s ability to adapt to low temperatures. Dress warmly in cold weather. Use caution when exposed to cold temperatures for long periods of time, such as winter sports or cold bathing.

Haloperidol. Galloper.

Haloperidol is effective in treating mental illnesses such as all types of psychosis, including schizophrenia. It should not be used to treat common anxiety or mental impairment (such as Alzheimer’s) in people who are not psychotic. It should also not be used as a sedative in patients with chronic anxiety or any other non-psychotic illness.Haloperidol should only be used as monotherapy for depression in the elderly, as tardive dyskinesia (involuntary movements of body parts) is a common side effect of antipsychotic drugs when used as antidepressants (60% of patients).

Antipsychotic drugs can cause severe adverse effects, including tardive dyskinesia, drug-induced parkinsonism, nervousness, weakness, and muscle weakness.

The elderly are particularly sensitive to the harmful effects of antipsychotic drugs such as haloperidol.These medications should not be taken unless absolutely necessary. Mental effects: disorientation in time and space, delirium, impairment of short-term memory, weakening of attention. Physical effects: dry mouth, constipation, difficulty urinating (especially in men with an enlarged prostate gland), blurred vision, decreased sweating combined with fever, sexual dysfunction, worsening glaucoma.

Inform your doctor if you have or have experienced: drug allergy, alcohol dependence, glaucoma, cardiovascular disease, Parkinson’s disease, epilepsy, kidney or liver disease, thyrotoxicosis, difficulty urinating, lung disease.

Tell your healthcare provider about any medications you are taking, including aspirin, herbs, vitamins, and other medications.

It may take two to three weeks before you feel the effect of the drug.

Do not stop taking the drug abruptly. Your doctor will schedule a gradual dose reduction for you to prevent the development of unwanted symptoms such as headaches, mood swings, nausea, vomiting, diarrhea, insomnia, and dreams that are too vivid.

Until you find out how you react to this drug, do not drive or engage in other activities that require increased attention. Taking this drug may cause blurred vision, drowsiness, and loss of consciousness.

Do not drink alcohol or use other drugs that cause drowsiness.

This drug may cause dizziness when lifting from a sitting or lying position. When getting out of bed, you should first dangle your legs and stay in this position for several minutes, and then gently rise.When lifting from a chair, you should get up slowly and stand next to the chair for a while until you are sure that you are not dizzy.

If you are planning any surgery, including dental surgery, tell your doctor that you are taking this drug.

Take with food or with a full glass (250 g) of milk or water to prevent stomach irritation.

Do not store the drug in the bathroom. Do not heat, expose to moisture or direct sunlight.Do not freeze the liquid form of the drug.

If you are taking antacids or anchorage medications, take them two hours apart from the antipsychotic medication.

If you miss a dose, you should take the drug as soon as you remember, but if there are less than two hours left before taking your next dose, skip the dose. Do not take double doses.

Alcohol, carbamazepine, levodopa, lithium preparations, pergolide, Drugs that depress the central nervous system, drugs containing alcohol, antidepressants, antihistamines, some antihypertensive drugs (reserpine, methyldopa, beta-blockers), drugs used for diseases of the organs of movement, muscle relaxants , narcotic analgesics, sedatives, hypnotics and tranquilizers cause “clinically highly significant” or “clinically significant” interactions when used together with this drug.Some other drugs, especially those belonging to the same groups as those listed below, can cause serious side effects when interacting with the described drug. As the number of new drugs recommended for sale increases, so does the risk of adverse interactions when used together, which are often identified with older drugs. Be carefull. Be sure to tell your doctor about all the drugs you are taking, and pay special attention to the doctor if you are taking any of the drugs that interact with the drug in question.

Call your doctor immediately if you experience signs of a haloperidol overdose: severe breathing problems, dizziness, extreme drowsiness, muscle stiffness or twitching, unusual tiredness or weakness; signs of tardive dyskinesia: smack on the lips, chewing movements, swelling of the cheeks, rapid, rapid movements of the tongue, uncontrolled movements of the legs; signs of parkinsonism: difficulty speaking or chewing, loss of stability, face mask, leg stiffness, limb tremors, unusual body movements; signs of restless legs (akathisia): non-stop walking, feeling of arousal; signs of akinesia: weakness, muscle fatigue, indifference.Although akinesia is often confused with true depression, it is part of the most common group of negative effects called extrapyramidal disorders.

Call your doctor right away if you experience: change or blurred vision, difficulty urinating, fever and sore throat, yellowing of the eyes or skin, skin rash, fainting, itching, hallucinations, anxiety, need for constant movement, decreased thirst, unusual bleeding and hematomas, hot dry skin and lack of perspiration, blinking or cramping of the eyelids.

Call your doctor if you have consistently, for a long time, the following symptoms: menstrual irregularities, constipation, dry mouth, swelling or pain in the chest, abnormal milk flow, decreased sexual function, decreased sweating, weight gain, increased sensitivity of the skin to the sun (photosensitivity), nausea or vomiting.

Ask your doctor which of the following tests you should periodically do while taking this drug: liver function tests, tracking early signs of tardive dyskinesia, re-evaluating the need for the drug, CBC.

During pregnancy, the drug should be used only if absolutely necessary. If you are pregnant or if you suspect that you are pregnant, you should inform your doctor before taking this drug.

Haloperidol may cause a decrease in sweating, which leads to an increase in your body temperature. Be careful not to overheat during exercise and in warm weather if you are taking any of these medications, as overheating can lead to heatstroke.In addition, hot baths and saunas while taking this drug may cause dizziness and fainting.

Desmethylimipramine. Desipramine.

Desmethylimipramine is used to treat severe depression that is not caused by other drugs, alcohol, or extreme stress (such as the death of loved ones). It has mild sedative effects and mild negative anticholinergic effects compared to other antidepressants, and some medical practitioners suggest using it as the drug of choice.This drug should not be used to treat mild depression or anxiety, or as a sleep aid.

If you are over 60 years old, you usually need to take 1/3 to 1/2 of the usual therapeutic dose for younger people. If the starting dose is insufficient and needs to be increased, do so very slowly under the supervision of your doctor.

Your doctor should monitor the level of the drug in the blood, because there is a certain concentration level at which the risk of side effects outweighs the therapeutic value of the drug.

The amount of time it takes to develop the full effect of a drug may overlap the spontaneous recovery time, especially if the depression is situational – caused by the death of loved ones or other external circumstances. Most people get out of depression with the help of friends or physical exercise, work, reading, games, art, travel, spiritual practices. If depression is not overcome by these measures, see a psychotherapist or psychiatrist. Antidepressants should only be used for severe depression that cannot be cured by psychotherapy alone.

The elderly are particularly sensitive to the dangerous effects of desmethylimipramine. These medications should not be taken unless absolutely necessary. Mental effects: disorientation in time and space, delirium, impairment of short-term memory, weakening of attention. Physical effects: dry mouth, constipation, difficulty urinating (especially in men with an enlarged prostate gland), blurred vision, decreased sweating combined with fever, sexual dysfunction, worsening glaucoma.

Inform your doctor if you have or have experienced: allergy to drugs, alcohol dependence, asthma, blood disorders, diseases of the cardiovascular system, epilepsy, gastrointestinal diseases, glaucoma, kidney, liver and thyroid diseases, manic depressive psychosis, schizophrenia or paranoia, urinary retention or an enlarged prostate.

Tell your healthcare provider about any medications you are taking, including aspirin, herbs, vitamins, and other medications.

Ask your doctor to measure your blood pressure while lying down and two minutes after you get up, and take an electrocardiogram.

Do not stop taking the drug abruptly. Your doctor should schedule a gradual dose reduction for you to prevent the development of unwanted symptoms such as headaches, sudden mood swings, nausea, vomiting, diarrhea or insomnia, and dreams that are too vivid.

Until you find out how you react to this drug, do not drive or engage in other activities that require increased attention.

These drugs may cause blurred vision and drowsiness.

It may take several weeks before you feel the effect of the drug. If you feel this effect, discuss with your doctor the possibility of a gradual dose reduction.

Do not smoke. Smoking can increase the cardiotoxic effect of the drug.

Do not drink alcohol or take other medications that may cause drowsiness.

This drug may cause dizziness when lifting from a sitting or lying position.When getting out of bed, you should first dangle your legs and stay in this position for a few minutes, and then gently rise. When rising from a chair, you should get up slowly and stand next to the chair for a while until you are sure that you are not dizzy.

Check with your doctor before taking any other medications.

The effect of these drugs can be observed within a week after stopping the intake. Avoid alcohol intake and take all precautions during this period.

If you have surgery, including dental treatment, inform your doctor that you are taking this drug.

To reduce stomach irritation, take this drug with food.

If you are taking any other drug, take it 1 to 2 hours before taking your antidepressant.

Capsules can be opened and mixed with food or drink.

Do not store the drug in the bathroom.Do not expose it to high temperatures, moisture, or direct sunlight.

If you have missed a dose, follow this rule: If you are prescribed more than one dose per day, take the missed dose as soon as you remember, but skip it if it is almost time for the next dose.

If you only take your drug once a day before bed and if you forget to take it, do not take it in the morning. Call your healthcare professional.

Do not double dose.

Epinephrine, cimetidine, guantidine, isosorbide dinitrate, liothyronine, nitroglycenin (sublingual forms), propranolol, thioridazine cause “clinically highly significant” or “clinically significant” interactions when used together with this drug. Some other drugs, especially those belonging to the same groups as those listed below, can cause serious side effects when interacting with the described drug. As the number of new drugs recommended for sale increases, so does the risk of adverse interactions when used together, which are often identified with older drugs.Be carefull. Be sure to tell your doctor about all the drugs you are taking, and pay special attention to the doctor if you are taking any of the drugs that interact with the drug in question.

Call your doctor immediately if you have any signs of an overdose: confusion, extreme drowsiness, fever, hallucinations, restlessness and agitation, seizures, shortness of breath, difficulty breathing, tachycardia, bradycardia or arrhythmia, unusual tiredness, weakness, nausea, increased pupils; signs of parkinsonism: difficulty speaking or swallowing, loss of balance, face mask, leg stiffness, limb tremor, unusual body movements.

Call your healthcare professional immediately if you experience: unstable blood pressure, loss of bladder control, muscle stiffness, pale skin, blurred vision, constipation, confusion, delirium, hallucinations, decreased sexual function, difficulty speaking or swallowing, eye pain, fainting, loss of balance, waxy face, difficulty urinating, tremors of the limbs, unsteady gait, slow movements, stiff legs or arms, restlessness, breast enlargement in men and women, hair loss, abnormal milk production, increased sensitivity to sunlight (photosensitivity), irritability, red or brownish patches on the skin, ringing or tinnitus, skin rash, itching, sore throat, fever, swelling of the face and tongue, swollen testicles, dental and gum disease, yellowing of the skin or eyes.

Call your doctor if you have the following symptoms consistently for a long time: diarrhea, dizziness, dry mouth, headache, heartburn, insomnia, nausea or vomiting, increased sugar cravings, unpleasant taste in the mouth, weight gain , sleep disturbance.

Tell your doctor if the following symptoms persist after stopping the drug: headache, irritability, nausea or vomiting, diarrhea, restlessness or unusual agitation, insomnia.

Ask your doctor which of the following tests you should periodically do while taking this drug: CBC, pulse, blood pressure, glaucoma tests, desmethylimipramine blood test, liver function test, function test kidney, heart function tests such as electrocardiogram (ECG), dental examinations (at least twice a year).

Doxepin Imipramine Melipramine

These medicines are used to treat serious depression that is not caused by other drugs, alcohol, or emotional losses (such as the death of loved ones).They should not be taken for the treatment of chronic anxiety or mild depression, or as a sleeping pill. Since these drugs have significant negative effects compared to desapramine, we do not recommend using them.

If you are over 60 years old, as a rule, you need to take from 1/3 to 1/2 of the usual therapeutic dose. If the starting dose is insufficient and needs to be increased, do so very slowly.

Doxepin causes severe drowsiness.

The amount of time it takes for an antidepressant to take effect may exceed the spontaneous recovery time, especially if the depression is situational – caused by the death of loved ones or other external circumstances.Most people come out of depression with the help of friends or activities such as exercise, work, reading, play, art, travel, spiritual practice. If depression is not controlled by these measures, see a mental health professional, therapist, or psychiatrist. Antidepressants should only be used for severe depression that does not respond to psychotherapy.

The elderly are especially sensitive to the dangerous effects of these drugs.

Mental effects: disorientation in time and space, delirium, impairment of short-term memory, weakening of attention. Physical effects: dry mouth, constipation, difficulty urinating (especially in men with an enlarged prostate gland), blurred vision, decreased sweating combined with fever, sexual dysfunction, worsening glaucoma.

Before taking this drug, tell your doctor if you have or have had: drug allergy, alcohol dependence, asthma, multiple personality disorder (manic-depressive illness) or schizophrenia, blood system disorder, epilepsy, difficulty urinating or increased prostate, glaucoma, diseases of the cardiovascular system, high blood pressure, kidney or liver disease, overactive thyroid gland, diseases of the gastrointestinal tract.

Tell your healthcare provider about any medications you are taking, including aspirin, herbs, vitamins, and other medications.

Ask your doctor to measure your blood pressure while lying down and at least two minutes after standing up and take an electrocardiogram.

Do not stop taking the drug abruptly. Your doctor should schedule a gradual dose reduction for you to prevent the development of unwanted symptoms such as headaches, sudden mood swings, nausea, vomiting, diarrhea or insomnia, and dreams that are too vivid.

Until you find out how you react to this drug, do not drive or engage in other activities that require increased attention.

These drugs may cause blurred vision and drowsiness.

It may take several weeks before you feel the effect of the drug. If you feel this effect, discuss with your doctor the possibility of a gradual dose reduction.

Do not smoke. Smoking can increase the cardiotoxic effect of the drug.

Do not drink alcohol or take other medications that may cause drowsiness.

This drug may cause dizziness when lifting from a sitting or lying position. When getting out of bed, you should first dangle your legs and stay in this position for a few minutes, and then gently rise. When rising from a chair, you should get up slowly and stand next to the chair for a while until you are sure that you are not dizzy.

Check with your doctor before taking any other medications.

The effect of these drugs can be observed within a week after stopping the intake. Avoid alcohol intake and take all precautions during this period.

If you have surgery, including dental treatment, inform your doctor that you are taking this drug.

To reduce stomach irritation, take this drug with food.

If you are taking any other drug, take it 1 to 2 hours before taking your antidepressant.

Capsules can be opened and mixed with food or drink.

Do not store the drug in the bathroom. Do not expose it to high temperatures, moisture, or direct sunlight.

If you have missed a dose, follow this rule: If you are prescribed more than one dose per day, take the missed dose as soon as you remember, but skip it if it is almost time for the next dose.

If you only take your drug once a day before bed and if you forget to take it, do not take it in the morning.Call your healthcare professional.

Epinephrine, alcohol, cimetidine, guantidine, isosorbide dinitrate, liothyronine, nitroglycenin (sublingual forms), tramadol, thioridazine cause “clinically highly significant” or “clinically significant” interactions when used together with this drug. Some other drugs, especially those belonging to the same groups as those listed below, can cause serious side effects when interacting with the described drug. As the number of new drugs recommended for sale increases, so does the risk of adverse interactions when used together, which are often identified with older drugs.Be carefull. Be sure to tell your doctor about all the drugs you are taking, and pay special attention to the doctor if you are taking any of the drugs that interact with the drug in question.

Call your doctor immediately if you have any signs of an overdose: confusion, extreme drowsiness, fever, hallucinations, restlessness and agitation, difficulty breathing, irregular heart rhythms, unusual tiredness, weakness, nausea, dilated pupils, and if you have: increased or decreased blood pressure, loss of bladder control, muscle stiffness, pale skin, blurred vision, constipation, confusion, delirium or hallucinations, decreased sexual function, difficulty speaking or swallowing, eye pain, loss of consciousness loss of balance, waxy face, difficulty urinating, tremors in the limbs, unsteady gait, slow movements, stiff arms or legs, insomnia, breast enlargement in both men and women, hair loss, abnormal milk production, increased sensitivity to sunlight, irritability, muscle twitching, red or brownish e skin blemishes, ringing or tinnitus, skin rashes and itching, sore throat and fever, swelling of the face and tongue, swelling of the testicles, pain in the teeth or gums, yellowing of the eyes or skin.

Call your doctor if you have consistently, for a long time, the following symptoms: diarrhea, dizziness, dry mouth, headache, heartburn, insomnia, nausea or vomiting, cravings for sweets, unpleasant taste in the mouth, sudden weight gain , difficulty falling asleep.

Tell your doctor if you have any of the following symptoms after stopping the drug: headache, irritability, nausea or vomiting, diarrhea, anxiety or unusual agitation, insomnia.

Ask your healthcare professional which of the following tests you should periodically do while taking this drug: CBC, Blood pressure measurement, Pulse measurement, Glaucoma tests, Liver function tests, Kidney function tests, Heart function tests, such as electrocardiogram (ECG), assessment of the condition of the teeth (at least twice a year), measurement of the concentration of the drug in the blood.

During pregnancy, the drug should be used only if absolutely necessary.If you are pregnant or if you suspect that you are pregnant, you should inform your doctor before taking this drug.

Doxepin (Systemic) | Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ^® , contains all the necessary information about the drug, including the indications, route of administration, side effects, and when you should contact your healthcare provider.

Trade names: USA

Silenor

Trade names: Canada

NOVO-Doxepin; Silenor; SINEquan

Warning

• Drugs like this have increased the likelihood of suicidal thoughts or actions in children and young people.This risk may be higher in people who have attempted suicide or have had suicidal thoughts in the past. All people taking this drug must be closely monitored. Call your doctor right away if you have signs such as depressed mood (depression), nervousness, anxiety, grumpiness, or anxiety attacks, or if other mood or behavior changes occur or worsen. Call your doctor immediately if you have suicidal thoughts or attempted suicides.
• This drug is not approved for use in children. Consult your doctor.

What is this drug used for?

• The drug is used to treat depression.
• Used to treat anxiety.
• It is used to treat sleep disorders.
• This medicinal product can be used for other indications. Consult your doctor.

What should I tell my doctor BEFORE taking this drug?

For all purposes of this product:

• If you are allergic to this drug, any of its ingredients, other drugs, foods or substances.Tell your doctor about your allergy and how it manifested itself.
• In the following conditions: difficulty urinating or glaucoma.
• If you are taking any of the following drugs: linezolid or methylene blue.
• If you have taken a drug for depression or Parkinson’s disease in the past 14 days. These include isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline. An episode of very high blood pressure may occur.
• If you are taking other drugs that make you drowsy. There are many drugs that can have this effect. If you are unsure, check with your doctor or pharmacist.
• If you are breastfeeding. Do not breast-feed while taking this drug.

Drugs for the treatment of sleep disorders.

• For attacks of sleep apnea.

This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

Tell your doctor and pharmacist about all medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems. You need to make sure that this drug is safe for your medical conditions and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor’s approval.

What do I need to know or do while taking this drug?

For all purposes of this product:

• Tell all healthcare providers that you are taking this drug. These are doctors, nurses, pharmacists and dentists.
• Avoid drinking alcohol while taking this drug.
• Consult your doctor before using marijuana, other forms of cannabis, prescription or over-the-counter drugs that may slow you down.
• The risk of eye problems may be increased in some patients with this drug. Your doctor may order you to see an ophthalmologist to see if you are at increased risk of developing these eye problems. Call your doctor right away if you have eye pain, change in vision, swelling, or redness around the eye.
• You can easily get sunburn with this drug. Be careful if you are in the sun.If you get sunburn easily while taking this drug, talk to your doctor.
• If you have high blood sugar (diabetes), your blood sugar should be checked regularly.
• Consult your doctor if you have signs of high or low blood sugar, such as fruity breath, dizziness, rapid breathing, tachycardia, confusion, drowsiness, feeling weak, flushing, headache, increased thirst or hunger , frequent urination, shivering, or sweating.
• If you are 65 years of age or older, use this drug with caution. You may have more side effects.
• This drug may affect fertility. This can lead to infertility in both men and women. Data on the possibility of restoration of reproductive function have not been obtained.
• Tell your doctor if you are pregnant or planning to become pregnant. The benefits and risks of taking this drug during pregnancy will need to be discussed.
• Taking this drug during the third trimester of pregnancy may cause some health problems in the newborn. Consult your doctor.

Sleep:

• After taking this drug, avoid driving or other activities or activities that require extra attention. You may feel drowsy the day after taking this drug. Avoid these activities or types of work until you are completely awake.
• Use this drug for short periods of time. If symptoms recur, consult your doctor.
• If you have been taking this drug for several weeks, consult your doctor before stopping it. It may be best to gradually stop taking this medication.
• Some people, while still not fully awake, engaged in certain activities and performed various kinds of tasks, such as driving a car, cooking, eating, and having sex.In most cases, people do not remember that they performed these actions. If this happens to you, consult your doctor.

For other reasons:

• Avoid driving or other activities that require increased attention until you see how this drug affects you.
• It may take several weeks to achieve full effect.
• Do not stop taking this drug abruptly without talking to your doctor.This can increase the risk of side effects. If necessary, this drug should be stopped gradually as directed by your doctor.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, some people with this drug can have serious and sometimes deadly side effects. Call your doctor or get medical help right away if you have any of the following signs or symptoms, which may be associated with serious side effects:

• Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
• Signs of high or low blood pressure, such as very severe headache or dizziness, fainting, or vision changes.
• Rapid heartbeat.
• Obstruction of the urinary tract.
• Nervousness or excitability.
• Fever, chills, sore throat; the appearance of bruising and bleeding for unexplained reasons; a pronounced feeling of tiredness or weakness.
• Yellowness of the skin or eyes.
• Ringing in the ears.
• Change in sex drive.
• Enlargement of the mammary glands or the appearance of discharge from the nipples.
• Testicular edema.
• If you have asthma, use this drug with caution. Asthma has worsened in patients taking this drug. Call your doctor right away if your asthma worsens with this drug.

What are some other side effects of this drug?

Any medicine can have side effects.However, many people have little or no side effects. Call your doctor or get medical help if these or any other side effects bother you or do not go away:

• Feeling dizzy, sleepy, tired or weak.
• Constipation, diarrhea, abdominal pain, nausea, vomiting, or decreased appetite.
• Dry mouth.
• Changes in the ability to perceive taste.
• Irritation or pain in the mouth.
• Weight gain.
• Excessive sweating.
• Hyperemia (blush).
• Hair loss.
• Headache.

This list of potential side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Office.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your healthcare practitioner. Read all the information provided to you. Follow all instructions strictly.

Sleep:

• Take the drug within 30 minutes before bedtime.
• Do not take within 3 hours before or after meals.
• Do not use this drug if you cannot get enough sleep at night (for at least 7-8 hours) before you need to be active again.

For other reasons:

• Take at bedtime if you are taking the drug once a day.
• Continue taking this drug as directed by your doctor or other healthcare professional, even if you feel well.

Liquid:

• Measure liquid doses carefully. Use the measuring container that came with the medicine.
• Mix a dose of medication with 0.5 cup (4 oz / 120 ml) water, milk, or fruit juice and drink immediately.
• Take the dose immediately after mixing. Do not store for future use.
• Do not mix with carbonated drinks or grape juice.

What should I do if a dose of a drug is missed?

Sleep:

• If you are taking this medicine regularly, take the missed dose as soon as you can.
• If after taking the missed dose you are unable to get enough sleep (for at least 7 hours), skip the missed dose and then return to your usual dosing schedule.
• Do not take 2 doses at the same time or an additional dose.
• In most cases, this drug is used as needed. Do not take this medicine more often than prescribed by your doctor.

For other reasons:

• Take the missed dose as soon as you can.
• If it is time for your next dose, do not take the missed dose and then return to your normal dose.
• Do not take 2 doses at the same time or an additional dose.

How do I store and / or discard this drug?

• Store at room temperature, protected from light. Store in a dry place. Do not store in the bathroom.
• Store all medicines in a safe place.Keep all medicines out of the reach of children and pets.
• Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

General information on medicinal products

• If your health does not improve or even worsens, see your doctor.
• You should not give your medicine to anyone and take other people’s medicines.
• Some medicines may have other patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
• A separate patient instruction sheet is attached to the preparation. Please read this information carefully. Reread it every time you replenish your supply.If you have questions about this drug, talk with your doctor, pharmacist, or other healthcare professional.
• If you think an overdose has occurred, call a Poison Control Center immediately or seek medical attention. Be prepared to tell or show which drug you took, how much and when it happened.

Use of information by the consumer and limitation of liability

This information should not be used to make decisions about taking this or any other drug.Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are suitable for a particular patient. This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient. Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug.This information should not be construed as a treatment guide and does not replace information provided to you by your healthcare professional. Check with your doctor for complete information on the possible risks and benefits of taking this drug. Use of this information is governed by the Lexicomp End User License Agreement available at https://www.