Type 1A and 1C antiarrhythmics are generally contraindicated (e.g., quinidine, disopyramide, and procainamide).In rare instances, hemoperfusion may be beneficial in acute refractory cardiovascular instability in patients with acute toxicity.

This dose may be given at bedtime. The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Emesis is contraindicated.Cardiovascular: A maximal limb-lead QRS duration of ≥0.10 seconds may be the best indication of the severity of the overdose. It is desirable to monitor TCA plasma 6 levels whenever a TCA is going to be co-administered with another drug known to be an inhibitor of P450 2D6.Doxepin is primarily metabolized by CYP2D6 (with CYP1A2 & CYP3A4 as minor pathways). Optimal antidepressant effect may not be evident for two to three weeks.Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with Sinequan and should counsel them in its appropriate use. Of particular importance, sufficient time must elapse before initiating TCA treatment in a patient being withdrawn from fluoxetine, given the long half-life of the parent and active metabolite (at least 5 weeks may be necessary).Concomitant use of tricyclic antidepressants with drugs that can inhibit cytochrome P450 2D6 may require lower doses than usually prescribed for either the tricyclic antidepressant or the other drug. Doxepin is prescribed for depression, anxiety, bipolar disorder, or depression due to alcoholism or brain damage. The complete text of the Medication Guide is reprinted at the end of this document.Patients should be advised of the following issues and asked to alert their prescriber if these occur while taking Sinequan.Anyone considering the use of SINEQUAN in a child or adolescent must balance the potential risks with the clinical need.Sedating drugs may cause confusion and oversedation in the elderly; elderly patients generally should be started on low doses of SINEQUAN and observed closely. )In addition, certain drugs inhibit the activity of this isozyme and make normal metabolizers resemble poor metabolizers. Multiple drug ingestion (including alcohol) is common in deliberate tricyclic antidepressant overdose. If the pH response is inadequate, hyperventilation may also be used. Inhibitors or substrates of CYP2D6 (i.e., quinidine, selective serotonin reuptake inhibitors [SSRIs]) may increase the plasma concentration of doxepin when administered concomitantly. Use Older adults may be more sensitive to the side effects of this drug, especially Some products that may interact with this drug include: arbutamine, Tell your doctor or pharmacist if you are taking other products that cause drowsiness such as If someone has overdosed and has serious symptoms such as passing out or If you miss a dose, take it as soon as you remember.

(See PRECAUTIONS−Geriatric Use. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selections.Sedating drugs may cause confusion and oversedation in the elderly; elderly patients generally should be started on low doses of SINEQUAN and observed closely. (See WARNINGS. The extent of interaction depends on the variability of effect on CYP2D6. Dosage may subsequently be increased or decreased at appropriate intervals and according to individual response.

This is especially important in patients who may use alcohol excessively.Tolazamide: A case of severe hypoglycemia has been reported in a type II diabetic patient maintained on tolazamide (1 gm/day) 11 days after the addition of doxepin (75 mg/day).Deaths may occur from overdosage with this class of drugs. To reduce your risk of side effects (such as drowsiness, Use the dropper that comes with the medication to measure out the prescribed amount.

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