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Doxepin (SILENOR, SINEQUAN)
Visualize Pharmacology
Doxepin is a tricyclic antidepressant with very strong histamine H1 receptor affinity. Low-dose Silenor is used for sleep-maintenance insomnia; higher doses have antidepressant effects.
Doxepin mechanism and mnemonic
The mascot mnemonic is “Box with pins.” The ballicule shows doxepin’s receptor and transporter profile.
At low doses used for insomnia, H1 antagonism predominates. At antidepressant doses, its broader tricyclic effects include greater anticholinergic burden.
Metabolism and cautions
Doxepin is a substrate of CYP2C19 and CYP2D6. The interaction avatar provides a visual cue for metabolism.
Sedation, anticholinergic effects, and overdose toxicity are important concerns, particularly at antidepressant doses. Dose and formulation matter when comparing doxepin’s effects.
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