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Doxepin is a mixture of and stereoisomers with an approximate ratio of 85:15. [5] When doxepin was developed, no effort was made to separate or balance the mixture following its synthesis, resulting in the asymmetric ratio. [5] (Z)-Doxepin is more active as an inhibitor of serotonin and norepinephrine reuptake than (E)-doxepin. [5]
The antidepressant drug doxepin has been associated with a number of different adverse effects, including the following. [1] [2] [3] The incidence of these adverse effects is not totally known as the scarcity of well-designed clinical trials involving doxepin prohibits it.
The first-generation sedating antihistamines diphenhydramine, doxepin, doxylamine, and pyrilamine are the most widely used medications in the world for preventing and treating insomnia. [6] As of 2004, doxylamine and diphenhydramine, which are both over-the-counter medications, were the agents most commonly used to treat short-term insomnia. [ 11 ]
Depakote (valproic acid/sodium valproate) – an antiepileptic and mood stabilizer used to treat bipolar disorder, neuropathic pain and others; sometimes called an antimanic medication.
Total exposures to both doxepin and nordoxepin differ by almost 10-fold in CYP2D6 ultra-rapid versus poor metabolizers. [3] Both doxepin and nordoxepin are also transformed into glucuronide conjugates. [3] The elimination half-life of nordoxepin is approximately 31 hours, which is almost twice that of doxepin (mean 17 hours). [1]
Dasotraline (INN; [1] former developmental code name SEP-225,289) is a serotonin-norepinephrine-dopamine reuptake inhibitor (SNDRI) that was under development by Sunovion for the treatment of attention-deficit hyperactivity disorder (ADHD) and binge eating disorder (BED).
It is the parent structure of certain drugs such as the tricyclic antidepressant doxepin and the analgesic fluradoline. [ 1 ] [ 2 ] [ 3 ] The former is the only tricyclic antidepressant that is a dibenzoxepin.
Dosulepin, also known as dothiepin and sold under the brand name Prothiaden among others, is a tricyclic antidepressant (TCA) which is used in the treatment of depression. [4] [6] [7] Dosulepin was once the most frequently prescribed antidepressant in the United Kingdom, but it is no longer widely used due to its relatively high toxicity in overdose without therapeutic advantages over other TCAs.