Doxepin (topical)

Doxepin topical cream is intended for short-term use in patients experiencing itchiness due to eczema.

Overview

Doxepin topical cream is prescribed for itchiness caused by eczema.

How it Works

Currently, medical researchers do not fully understand the mechanisms of action for Doxepin topical cream.

It is believed that Doxepin inhibits the side effects of histamine, a naturally occurring substance in the body which generally causes patients to itch. Other researchers contend that since Doxepin induces drowsiness, this consequently causes the symptoms of itching to go unnoticed by users.

The medicine is predominantly prescribed for:

  • Eczema Or Atopic Dermatitis
  • Thickening Skin: Otherwise known as Lichen Simplex Chronicus, it's when a patient develops thickening skin due to excessive itching or skin irritation.
  • Pruritus: A term medical specialists use to refer to itchiness due to eczema.

In the United States, pharmacists dispense this medicine under the brand names Prudoxin and Zonalon. Doxepin is only available with a written prescription from a medical provider. Additionally, it is only intended for certain types of eczema.

Conditions Treated?

  • Pruritus, Lichen Simplex Chronicus, Atopic Dermatitis

Type Of Medicine?

  • Tricyclic Antidepressant

Side Effects

As with all medicines, Doxepin could cause adverse reactions in some patients. To minimize the risks, follow the warnings below and always use the medicine as prescribed.

Common Side Effects of Doxepin Topical Cream

Some of the most commonly reported adverse effects of using Doxepin topical cream include:

  • Burning Sensation
  • Distorted Sense of Taste
  • Extreme Itchiness
  • Extreme Thirst
  • Feeling Anxious
  • Feeling Weak or Sleepy
  • Headaches
  • Mood Swings
  • More Eczema Breakouts
  • Skin that Scales or Feels Dry
  • Tingling at the Application Site

Many of these symptoms subside with time. Medical studies suggest that patients are more prone to side effects when the cream is applied to more than 10% of the skin surface area. It should therefore only be used on the affected site.

Rare Side Effects of Doxepin Topical Cream

In rare cases, using Doxepin topical cream could cause patients to experience a fever.

When to Call a Doctor

Even though Doxepin is a topical medicine, there is still a possibility of overdosing on the drug. Some of the warning signs of an overdose include:

  • A High Fever
  • Abnormal Heartbeat
  • Chills
  • Extreme Lethargy
  • Feeling Constipated
  • Feeling Faint or Dizzy
  • Feeling Jittery
  • Feeling Unalert
  • Involuntary Muscle Twitching or Jerking
  • Nausea
  • Pain or Swelling in the Abdomen
  • Persistent and Chronic Dry Mouth
  • Pupils That Look Dilated or Enlarged
  • Seizures
  • Slow or Weakening Pulse
  • Trouble Breathing
  • Unconsciousness
  • Urination Difficulty
  • Vision Changes or Blurred Vision

Note: If any of these signs occur, stop use and call 911 immediately.

Dosage

Doxepin topical cream doses vary from one patient to another. In large part, the prescribed amount is generally dependent on the patient's age. Other factors that play a role in how much of the medicine is prescribed include:

  • Underlying Conditions
  • The Patient's Weight
  • The Medication Strength
  • The Number of Times per Day Needed
  • The Length of Treatment

Recommended Doxepin Doses for Itching:

  • Eczema

The following dosage table provides a general overview of recommended dosage amounts. However, this guide should not replace instructions provided by a pharmacist or medical provider:

  • Children: Varies by Patient
  • Adults: 1 Thin Layer | 4x Daily

How to Use

To avoid complications and for best results, follow the below steps while taking Doxepin topical cream:

1. Clean the Application Site: For best results and to minimize the risk of infection, the application site or the area/s of itchiness should be cleaned and dried thoroughly before applying the cream.

Pharmacists typically recommend using a fragrance-free soap or cleanser to clean the skin area. Studies suggest that eczema is sometimes triggered by perfumes, dyes, and other additives. Today, there are many eczema-friendly cosmetics on the market for children and adults. Ask your doctor for the best product suggestions.

2. Gently Rub in a Thin Layer: To apply, squeeze a small drop of the cream in the affected area only and spread evenly into a thin layer. Rub in gently to avoid aggravation.

3. Wash Hands: To avoid cross-contamination or getting the medicine into the eyes, wash your hands thoroughly after each use. In the event the medicine gets into the eye, wash it under a tap with cold water.

Use for the Length Prescribed

In most cases, topical applications of Doxepin creams should not exceed eight days unless advised by a medical provider. Pharmacists also recommend using this treatment in the daytime and scheduling the doses around three to four hours apart for best results.

Follow All Prescription Orders

On the other hand, it is also important that patients do not underuse the medicine. This means that all doses should be taken for optimal results. In the event of a missed dose, take it as soon as you remember but do not double the dose. Doing so could increase the risk of negative side effects as the medicine is absorbed systematically.

Do Not Wrap the Treatment Area

Sometimes patients make the mistake of wrapping the treatment area with a bandage following application to ensure the cream stays put. Nevertheless, Doxepin topical cream is a prescription drug which enters the bloodstream. When the surface area is wrapped, this ultimately increases the risk of developing negative side effects.

Interactions

Generally, it is not recommended that Doxepin be prescribed concurrently with specific medicines. These include but aren't limited to:

  • Moclobemide
  • Propyphenazone
  • Granisetron
  • Linezolid
  • Leuprolide
  • Vortioxetine
  • Buserelin
  • Etofenamate
  • Proquazone
  • Eslicarbazepine Acetate
  • Bromfenac
  • Flufenamic Acid
  • Selegiline
  • Desvenlafaxine
  • Escitalopram
  • Procainamide
  • Vandetanib
  • Niflumic Acid
  • Levomethadyl
  • Thioridazine
  • Oxyphenbutazone
  • Hydroxytryptophan
  • S-Adenosylmethionine
  • Crizotinib
  • Vilazodone
  • Droperidol
  • Sulfamethoxazole
  • Moxifloxacin
  • Sertraline
  • Tiotropium
  • Chloroquine
  • Ketoconazole
  • Levalbuterol
  • Celecoxib
  • Iproniazid
  • Tenoxicam
  • Aripiprazole
  • Darunavir
  • Nefopam
  • Tiaprofenic Acid
  • Aspirin
  • Norepinephrine
  • Epinephrine
  • Amitriptyline
  • Fepradinol
  • Sematilide
  • Bepridil
  • Piperaquine
  • Tacrolimus
  • Droxicam
  • Vinflunine
  • Quetiapine
  • Phenylbutazone
  • Valdecoxib
  • Levofloxacin
  • Phenprocoumon
  • Piketoprofen
  • Ivabradine
  • Meperidine
  • Procarbazine
  • Sertindole
  • Fluoxetine
  • Pimozide
  • Cannabis
  • Vilanterol
  • Amisulpride
  • Rofecoxib
  • Oxaprozin
  • Ibutilide
  • Carbamazepine
  • Zuclopenthixol
  • Naproxen
  • Ketoprofen
  • Tedisamil
  • Propoxyphene
  • Nafarelin
  • Morniflumate
  • Oxycodone
  • Oxilofrine
  • Ibuprofen
  • Choline Salicylate
  • Sevoflurane
  • Amtolmetin Guacil
  • Erythromycin
  • Telithromycin
  • Buprenorphine
  • Ranolazine
  • Phenelzine
  • Nimesulide Beta Cyclodextrin
  • Astemizole
  • Paroxetine
  • Goserelin
  • Grepafloxacin
  • Haloperidol
  • Warfarin
  • Pranoprofen
  • Vemurafenib
  • Fluconazole
  • Deslorelin
  • Tolmetin
  • Saquinavir
  • Gatifloxacin
  • Pentamidine
  • Arbutamine
  • Metoclopramide
  • Pasireotide
  • Delamanid
  • Sultopride
  • Histrelin
  • Arsenic Trioxide
  • Venlafaxine
  • Sulindac
  • Tranylcypromine
  • Lorcaserin
  • Salsalate
  • Amifampridine
  • Iobenguane I 123
  • Efavirenz
  • Dicumarol
  • Phenylephrine
  • Piroxicam
  • Dofetilide
  • Etoricoxib
  • Oxymetazoline
  • Sulpiride
  • Gonadorelin
  • Vasopressin
  • Hydroxyzine
  • Isoflurane
  • Felbinac
  • Meclofenamate
  • Salicylic Acid
  • Methoxamine
  • Feprazone
  • Pimavanserin
  • Rasagiline
  • Donepezil
  • Trazodone
  • Nabumetone
  • Phenytoin
  • Zotepine
  • Ziprasidone
  • Acenocoumarol
  • Trimethoprim
  • Aceclofenac
  • Palonosetron
  • Foscarnet
  • Bromopride
  • Tapentadol
  • Sparfloxacin
  • Flurbiprofen
  • Anagrelide
  • Clorgyline
  • Safinamide
  • Methylene Blue
  • Cyclobenzaprine
  • Acemetacin
  • Dexketoprofen
  • Tramadol
  • Ketorolac
  • Enflurane
  • Pargyline
  • Moricizine
  • Lumiracoxib
  • Disopyramide
  • Ramelteon
  • Levothyroxine
  • Isocarboxazid
  • Amiodarone
  • Levomilnacipran
  • Almotriptan
  • Tolfenamic Acid
  • Nebivolol
  • Ondansetron
  • Midodrine
  • Diflunisal
  • Diclofenac
  • Bretylium
  • Frovatriptan
  • Cisapride
  • Gemifloxacin
  • Parecoxib
  • Mefenamic Acid
  • Indomethacin
  • Nimesulide
  • Prochlorperazine
  • Hydroxychloroquine
  • Meloxicam
  • Oxymorphone
  • Cimetidine
  • Bupropion
  • Floctafenine
  • Mesoridazine
  • Acecainide
  • Sumatriptan
  • Fenoprofen
  • Loxoprofen
  • Clarithromycin
  • Clonidine
  • Naratriptan
  • Guanethidine
  • Degarelix
  • Pitolisant
  • Proglumetacin
  • Spiramycin
  • Panobinostat
  • Dexibuprofen
  • Zolmitriptan
  • Metronidazole
  • Nepafenac
  • Fentanyl
  • Amoxapine
  • Dipyrone
  • Domperidone
  • Terfenadine
  • Etodolac
  • Mirtazapine
  • Trifluoperazine
  • Clonixin
  • Octreotide
  • Bethanidine
  • Isradipine
  • Peginterferon Alfa-2b
  • Lornoxicam
  • Sodium Salicylate
  • Pazopanib
  • Bufexamac
  • Dextromethorphan
  • Dronedarone
  • Fosphenytoin
  • Albuterol
  • Halofantrine
  • Quinidine
  • Halothane
  • Azimilide
  • Sotalol
  • Dolasetron
  • Triptorelin
  • Risperidone
  • Etilefrine
  • Dabrafenib

Note: In specific patient cases, concurrent use may be necessary, and in these cases, the doctor may decide on altering the dose of one or more medicines.

Interactions with Underlying Medical Conditions

Using topical Doxepin cream could cause certain conditions to become worse. These include but aren't limited to patients who have been diagnosed with:

Due to the risks of negative side effects associated with taking Doxepin topical cream with certain groups of medicines or when patients have an underlying ailment, it is best to disclose your full medical history before commencing treatment with this medicine.

Warnings

To reduce the possible side effects when taking Doxepin topical cream, read all instructions included in the insert label. Some of the top warnings when taking Doxepin topical cream include:

Reoccurring Symptoms

Doxepin use should not exceed eight days. If you have followed all directives and kept all scheduled doses but your symptoms do not improve after this period, consult your medical provider.

CNS Depressants

Patients who are using this medicine are generally advised against using alcohol, CNS depressants, or over-the-counter medicines containing alcohol. Concurrent use of these drugs or substances has been proven to affect the nervous system it could cause delayed reactions in patients and extreme feelings of drowsiness. Some cases in point include:

  • Anesthetics
  • Antihistamines
  • Barbiturates
  • Hay Fever, Allergy, Or Cold Medicines
  • Medications for Pain
  • Muscle Relaxants
  • Seizures Drugs
  • Tranquilizers or Sedatives

Inform your doctor if you are using these or any other medicines before commencing treatment with Doxepin.

Driving or Operating Heavy Machinery

As this medicine could trigger extreme drowsiness, patients who are taking Doxepin topical cream should use caution when driving or operating heavy machinery.

For External Use Only

Doxepin topical cream should only be used topically on skin surfaces. It should never be taken orally or applied to the eyes or genital area. In the event of an overdose, contact 911 or the American Association of Poison Control Centers at 1(800) 222-1222.

Eye Sensitives

If small amounts of Doxepin topical cream get into the eye, wash your hands and rinse the eyes under cold running water. If eye irritation persists, seek medical help right away.

Dry Mouth

Doxepin topical cream is proven to cause dry mouth in some patients. If you experience this symptom, chew on small bits of ice chips or gum, preferably sugarless to help alleviate the effects temporarily. This can be done throughout the day during the treatment schedule of eight days or less.

If the side effects persist for more than 14 days, be sure to consult with a medical provider. This is an important step to take as persistent dry mouth subsequently increases patients' risk of:

Additional medicines may be required to alleviate dry mouth.

Fainting Spells

As this medicine may cause patients to feel dizzy, lightheaded, and possibly cause fainting spells to occur, pharmacists generally advise users to get up and sit down slowly. This is particularly recommended for senior patients who may be more at risk of fainting.

Preexisting Conditions

Earlier in the guide, the effects of Doxepin on preexisting conditions were briefly discussed. As a precaution, patients should also inform medical providers if:

1. You Have Bipolar Disorder Or Schizophrenia: Doxepin may worsen the symptoms of bipolar disorder and cause mood swings to occur.

2. You're Breastfeeding: Doxepin topical cream seeps into human mothers' milk and could negatively affect newborns. Additionally, if you are pregnant or plan to be, inform your medical provider before commencing treatment with Doxepin.

3. You Have Trouble Urinating or Have Glaucoma: Using Doxepin cream could cause these conditions to worsen.

4. You Have Hypersensitivities: Serious allergic reactions could occur with the use of Doxepin. Inform your doctor, therefore, if you have a history of hypersensitivities to medicines, foods, dyes, or animal products.

5. You Have Other Underlying Conditions: More specifically, tell your doctor if you have liver, heart, or lung disease.

Storage

Doxepin topical medicine is a prescription-only medicine that should be kept out of the reach of children and pets at all times. Be sure to store in a high or hard-to-reach area.

To preserve the quality of the medicine, reseal the cap tightly after each dosage and place the tube in a cool and dry area at a room temperature of 27 degrees C (80 degrees F).

Any unused portions of Doxepin topical cream should be disposed of properly. The general recommendation is to take it back to a pharmacist where it can be discarded of in a safe manner.

Summary

Doxepin topical cream is a potent prescription-only medicine that is predominantly used for alleviating itching caused by eczema. It is intended for dermatologic and short-term use only.

In addition to treating itchiness, Doxepin is sometimes prescribed for Lichen Simplex Chronicus, which refers to thickening skin due to incessant itching and irritation due to eczema.

Doxepin topical cream can be absorbed systematically into the bloodstream and cause negative side effects to occur, particularly in patients with certain underlying conditions, such as glaucoma or urinary retention. As a result, patients should never take more of the medicine than prescribed.

As a rule of thumb for adult patients, only a small layer should be applied four times daily every 3-4 hours for a maximum of eight days. In children, the dosage varies based on a doctor's discretion.

If the itching does not resolve after the eight-day timeframe, alternative treatments may be required, and your medical provider should be contacted.

Doxepin topical cream should never be used in conjunction with alcohol or CNS depressants such as over the counter cold and allergy medicines due to its sedative effects. Moreover, care should be taken when driving or operating heavy machinery during use.

Some of the other common side effects include burning or stinging at the application site, as well as dry mouth, dizziness, or mood changes. Most of these symptoms subside with time. However, it is important to call a medical provider if troublesome symptoms, such as a weak pulse, abnormal heartbeat, or difficulty breathing occur. These could be signs of a serious negative reaction.

In general, Doxepin topical cream is well-tolerated in most patients and works fast to relieve itching in individuals with eczema.