Antidepressants and Pain Control: Doxepin

By | May 8, 2012

Doxepin is sold as a racemic mixture of dextrorotatory and levorotatory stereoisomers.

Doxepin is a tricyclic antidepressant with significant anxiolytic properties. Its side effect profile is significantly better than the other commonly used tricyclic compounds, but its efficacy in treating severe cases of neuropathic pain also appears to be less. At Schlesinger Pain Centers it is used mainly for mild to moderate chronic pain in sensitive individuals and in the elderly. It is sold under the trade name of Sinequan in normal antidepressant doses. It has recently been approved by the FDA in low doses as a sleep aid, (an action which I have not found to be particularly useful). It is sold under the trade name of Silenor in 3 and 6 mg strengths for this usage. While I rarely use it as a sleep aid, I have found these strengths to be effective in some cases of chronic pain in the elderly. Doxepin has traditionally been dosed twice a day, but given its 17-hour half-life and the 51-hour half-life of its major metabolite desmethyldoxepin, once a day dosing is often adequate in the elderly.

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