Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Doxepin discontinued

Doxepin (Sinequan)® capsules are being discontinued in all strengths according to the National Electronic Library for Medicines.

Doxepin is a tricyclic antidepressant with sedative properties. It is expected that supplies will be exhausted by October 2006 although some strengths may disappear sooner.

Doxepin is not widely used but is not available generically and therefore alternative products will need to be used if treatment needs to continue. Amitryptiline, Dosulepin or Clomipramine may be suitable choices.

Action: Clinicians should be aware of this products discontinuation and may wish to identify individuals currently taking this drug. Alternative treatments will need to be investigated if treatment will continue beyond October 2006.

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24 Comments to “Doxepin discontinued”

  1. I have been on doxepin for 30 years. I had bad reaction to amitriptyline. It brings on anxiety and a bad ringing in my brain. I then have to taken lorezepam and a sleeping tablet while going through struggles with sleep.
    I have just started to switch to a different brand of doxepin from ratiopharm. First night I took 3 of my normal anten doxepin 25mg and 1/4 tablet of the new doxepin.
    I was told it was the same. Within 30 minutes I had developed a bad ringing in my brain and had to taken lorazepam and sleeping tablet to sleep while feeling crazy! So many people are suffering. Can we lobby to bring back anten doxepin.
    Or how do you wean off that stuff? I'm in New Zealand.

    Comment by Nicki Bell — January 8, 2021 #
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    1. @Nicki,

      It seems that the manufacturer of Anten (Mylan) notified the New Zealand authorities in early 2019 that it was being discontinued. If you have generic dose-in it contains the same active ingredient but other ingredients may vary. It's strange that you have such a pronounced reaction but worth bringing it to the attention of your doctor to see if they can think of an alternative for you to try.

      Comment by Matthew Robinson — January 11, 2021 #
      Reply

      1. My doctor wants me to try citalopram SSRI. Have people had success switching from an ssri from doxepin? I'm still not sleeping at night and have been off doxepin for 3 weeks now. I'm taking zopicone to sleep which is not ideal.

        Comment by Nicki Bell — March 7, 2021 #
        Reply

        1. @Nicki Bell,

          There are certainly people who have switch from drug like doxepin to SSRIs, there are recommendations on how to do this here in Britain based on past experience in places like mental health hospitals and trusts. How successful it is will probably depend on why you are not sleeping at night, but sleep hygiene measures (so a good mental approach to sleep) will also be of help over time.

          Comment by Matthew Robinson — March 7, 2021 #
          Reply

  2. I posted in July - still on a roller coaster to find an alternative in NZ - so far nortriptyline, mirtazapine, buspirone, clonazepam and then diazepam taken with the mirtazapine. Just recovering after beginning quetiapine and sertraline - massive fail. Am going back to low doses of clonazepam and mirtazapine - less than ideal but the best of the fails. Doctorr also said I could take phenergan for sleep - not sure if that should be with or instead of the other sedative meds? He suggested phenergan instead of quetiapine but I have lost faith and will not take the sertraline either. Life is not good right now. Strangely I had taken diazepam on its own for many years when younger - perhaps it doesn't like being combined with mirtazapine?

    Comment by Sheryl Day — December 21, 2020 #
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    1. @Sheryl,

      It seems that here in the UK since I posted this original artifice that several other manufacturers have stepped in and started producing doxepin - that said they seem to be taking financial advantage of the situation by currently pricing 28 packs of the 25mg at £97 and 28 of the 50mg at £154 (Prices from Drug Tariff for Dec 2020).

      One option that you seem not to have tried, a drug that is quite similar to doxepin is dosulepin (or dothiepin). You may want to ask your doctor about it and check if it is possible for you.

      Comment by Matthew Robinson — December 21, 2020 #
      Reply

  3. I have been on doxepin 30 years, prior to that diazepam, stopped suddenly, no weaning as suddenly doxepin unavailable after years of threatening to become so. Nortriptyline caused side effects partly I feel as I came off Doxepin cold turkey while beginning the nortriptyline. Next was mirtazapine, went deaf and massive sinus headache, Doctor gave meds for sinus which I didn't take but stopped the new pill and hearing came back slowly. Weaned myself off that and now on nothing but clonazepam as needed while await specialist pyschiatrist appointment. (just for someone with knowledge of meds - I hope!!) Not doing so well. Have some buspirone that I was prescribed but didn't ever use - am thinking will self medicate with this - can't be any worse surely that the meds I have not adjusted to? Wondering why amitriptyline has not been prescribed - other family members seem to tolerate that. Am fed up and life looking very dismal.

    Comment by Sheryl Day — July 4, 2020 #
    Reply

    1. @Sheryl Day,

      Amitriptyline may be an option worth trying for you but then again it is very similar to nortriptyline in terms of side effect profile. I hope you manage to find something that suits you are works well for you.

      Comment by Matthew Robinson — July 4, 2020 #
      Reply

      1. Still looking - not doing so well - desperate and began the buspirone. Very small dose but after 4 days suddenly pulse rate down to 52 and thumping - scary so stopped this drug too! Still waiting for mental health evaluation / advice. Light headed nauseous, tired, waking early, sometimes not getting to sleep and weight loss. Anyone had a successful alternative to doxepin - I stopped it in May and am still withdrawing??

        Comment by Sheryl Day — July 23, 2020 #
        Reply

        1. Like you, I was on Deptran for about 30 years at 25mg. I went to the pharmacy to get a refill the other night and was told it was discontinued. Back to my doctor next day, and I was told to take nothing for 2 days then go onto Endep 10 (Amitriptyline). It's only been 2 nights, but I'm sleeping well and feel happy, and my chronic pain is already zapped by about 50%. Maybe it's all in my mind, as it seems so fast, or perhaps I didn't completely withdraw from Doxepin. Try it.

          Comment by Kezza — September 12, 2020 #
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        2. Where do you live? I am in California. Doxepin is not being discontinued here. I have been using it since the 1970s.

          Comment by Patrice Nagel — December 18, 2020 #
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    2. This medicine is being carried by KnippeRx Pharmacy in America
      855 647 7379
      1‑85‑KnippeRx

      Comment by Felice Evans — November 1, 2020 #
      Reply

    3. Amitriptyline (Elavil®) will take all of your withdrawal symptoms away and work better than Sinequan. You'll need the same milligram dose.

      Comment by Larry Kirkman — December 3, 2020 #
      Reply

  4. I just went yesterday to get my monthly script filled out and was shocked to find it is no longer funded. My doctor here in NZ never mentioned anything too me, so unprofessional, and I have been on a sickness benefit because I'm bipolar so I didn't have the money to pay for the medication. Because I can't not take it I had to go borrow the money just so I could have the months worth of medication, I am so angry and now really panicked and upset. I have been on every antidepressant you can think of, 6 years ago I was put on doxepin and because I suffer from insomnia too and it helped me sleep. Finally, I found a medication that worked for me, my depression has been a lot better since I have been on doxepin, but every time I have had to change antidepressant medication I have been at my most vulnerable mentally. On some medications my depression has been so bad I have self harmed and had extreme suicide tendencies, so to be told without any notice that this medication is no longer funded and I can't afford to take it and I have to find something else is a huge thing. I'm terrified of the repercussion of coming off this medication, one that finally works for me and to have to change onto something that could have the worst effects on me. I sent a letter to pharmac telling them these decisions to stop funding a antidepressant like this is not only reckless but dangerous to those on it. My anxiety is through the roof and I'm so disappointed and upset that a decision to stop funding this medication has such a negative affect on someones life. By what Warren Higham said I'm sick with worry and concern I won't find a good alternative either.

    Comment by Danny Smitten — June 13, 2020 #
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  5. The NHS stopped prescribing Trimipramine and Doxepin amongst others because two brothers got around a generic drug loophole. Drugs like trimipramine for 28x50mg tablets used to cost £7.80 they now cost £200.50. Doxepin for 28x50mg £154.00. NHS wants patients off these drugs because there are cheaper alternatives. But having tried numerous tricyclics I can vouch that they are not that similar to each other.
    https://economictimes.indiatimes.com/news/international/world-news/indian-origin-brothers-caught-up-in-uk-pharma-scandal-report/articleshow/52574272.cms

    Comment by Stephen Mathieson — May 6, 2020 #
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  6. If this medication is being discontinued and expected to run out by 2006 how come I've been on it for 4 years?

    Comment by Gordon Stuart Montgomery — November 7, 2019 #
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    1. @Gordon Stuart Montgomery,

      At the time of the original post there were no generic options available. It seems that some stepped in and started making doxepin when the branded version (Sinequan®) was discontinued.

      Comment by Matthew Robinson — November 7, 2019 #
      Reply

    2. I was thinking the same thing. I've been on Doxepin 75mg×2 since the 1970s. This is the only Antidepressent that works for me. I have a hard time sleeping and the Doxipen helps. Are you in the US? I'm asking because it looks like it's being taken off the shelf in NZ. If it's going to be discontinued I need to find an Online Pharmacy so I can stock up.

      Comment by Patrice Nagel — December 18, 2020 #
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  7. Why has doxepin recently been discontinued in New Zealand? No reason has been given on the internet.

    Comment by Colin Rammell — October 15, 2019 #
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    1. @Colin Rammell,

      We don't use dose-in very much here in the UK, but an internet search I did found this:

      http://www.medicinesinformation.co.nz/2019/07/18/withdrawal-of-dosulepin-dothiepin-and-doxepin-from-new-zealand/

      Following some of the links suggests it was discontinued due to main ingredient shortages.

      Comment by Matthew Robinson — October 16, 2019 #
      Reply

  8. I have been taking doxepin for almost 26 years, I am worried about switching to another medication besides doxepin because this is good medicine to control my anxiety and panic attacks. My question is which medication you would recommend to take instead doxepin when I finish my last month supply..thanks

    Comment by Jesus Salabarrieta — August 7, 2019 #
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    1. @Jesus Salabarrieta,

      There are a few options but your own doctor is best placed to advice as they have access to your medical history and can ensure the alternative is suitable for you.

      Comment by Matthew Robinson — August 7, 2019 #
      Reply

    2. I've also been on Doxepin for 26 years and have come off it slowly. I'm now on to my second lot of replacement antidepressants and have gone through hell so far. Not suitable and a lot of GI side effects. My doctor says that my body will get used to it. Sorry, not going to happen as I've been on my current one for 2 months and there is no let up with the GI side effects and I feel very flat in mood, I've lost my spark that I had on Doxepin. There must be a closer alternative surely.

      Comment by Warren Higham — January 15, 2020 #
      Reply

      1. @Warren Higham,

        Doxepin is classified as a tricyclic antidepressant, there are several alternatives available in the UK. Amitriptyline, nortriptyline, imipramine and clomipramine are some examples you could perhaps ask your doctor about.

        Comment by Matthew Robinson — January 15, 2020 #
        Reply

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