Doxepin can be administered as tablets or dragees, in drop form or as an injection solution. The dosage should always be agreed with the physician and individually adapted to the reaction of the patient. For the treatment of depression, 50 mg doxepin (tablet) in the evening is usually started.
After a few days the dose can be increased to 75 mg if necessary and after a few more days up to 150 mg. A daily dose of 150 mg should not be exceeded in outpatient treatment. An increase in dose should only be made after consultation with the treating physician. If side effects occur, the doctor must be informed.
Treatment with Doxepin – as with other antidepressants – should be continued for at least 4-6 months after the symptoms have subsided. If Doxepin is to be discontinued, this should be done gradually (i.e. with a gradual, slow dose reduction). Dose adjustment in adolescents and older patients (lower dose necessary).
The active ingredient doxepin contained in Aponal® is initially prescribed in low doses for antidepressant treatment. This often starts with a dosage of 50 mg. In order to achieve a sleep-promoting effect at the same time, it is recommended to take it before bedtime.
If it is not effective, the dose can be increased after a few days. After three to four days the dose can be increased to 75 mg, after seven to eight days to 100 to 150 mg per day. Overall, however, a daily dose of 150 mg should not be exceeded in the outpatient treatment of a depressive disorder.
If necessary, the dose can be increased up to 300 mg in the case of inpatient drug treatment, taking precautions. For the treatment of withdrawal symptoms, as may occur in alcohol, drug or medicine addiction, 50 mg of doxepin is administered three times a day. This is continued for three days.
Afterwards the dose can be continuously reduced until the treatment is terminated. To end a therapy with Aponal® , the dose must be continuously reduced over a longer period of time to avoid specific withdrawal symptoms. The dose is reduced by about half a week.
The main indication (area of application) is endogenous depression, although doxepin is more of a second-choice remedy here. First choice for the treatment of depression are drugs from the group of serotonin reuptake inhibitors (SSRI), venlafaxine and mirtazapine, among others. Other areas of application are restlessness and sleep disorders, as Doxepin has a damping (sedating) effect. Doxepin can also be prescribed for anxiety disorders. It is also sometimes used to treat mild withdrawal symptoms of alcohol or drug addiction.
Aponal® is not only available in tablet form but also as drops available in pharmacies on prescription. One package contains 30 ml of the drops. With their active ingredient doxepin, they are also used to treat depressive disorders.
The effects, side effects and interactions are comparable to those of the tablet form. Aponal®-drops should be taken diluted with a glass of water, because undiluted intake may cause temporary numbness of the tongue and oral mucosa. They can be taken before or after meals and before going to bed. However, care should be taken to take the drops regularly in order to achieve a constant amount of the active substance in the blood. An antidepressant effect occurs at the earliest after 1 to 2 weeks, while the side effects can occur just a few days after the start of therapy.