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Tips for tapering doxepin (Sinequan, Zonalon)


Altostrata

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AKA Aponal, Adapine, Doxal, Deptran, Sinquan, Sinequan, Silenor

Doxepin is an older tricyclic antidepressant (TCA) sometimes prescribed for sleep issues.

From official FDA information at http://www.drugs.com/pro/doxepin.html


....It is desirable to monitor TCA plasma levels whenever a TCA is going to be coadministered with another drug known to be an inhibitor of P450 2D6 [a liver enzyme].

Doxepin is primarily metabolized by CYP2D6 (with CYP1A2 & CYP3A4 as minor pathways) inhibitors or substrates of CYP2D6 (i.e., quinidine, selective serotonin reuptake inhibitors [sSRIs]) may increase the plasma concentration of Doxepin when administered concomitantly.

....An individual who is stable on a given dose of TCA may become abruptly toxic when given one of these inhibiting drugs as concomitant therapy....


If you are taking multiple drugs of any type, you may wish to check interactions with doxepin here http://www.drugs.com/drug_interactions.html

Doxepin comes in 10 mg, 25 mg, 50 mg, 75 mg and 100 mg capsules. Under various brand names, such as Silenor, it also comes in 3 mg and 6 mg tablets. It is readily soluble in water. (http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=1bec1223-5239-4eb6-a9e8-62444106d2c0 )

From the US National Library of Medicine http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=0306cdb2-f143-4f55-9d63-f0508c842609

Withdrawal Symptoms

The possibility of development of withdrawal symptoms upon abrupt cessation of treatment after prolonged doxepin administration should be borne in mind. These are not indicative of addiction and gradual withdrawal of medication should not cause these symptoms.


Reduce by 10% per month to start
The 10% rule holds for doxepin, just like other psychiatric drugs: Reduce by 10% per month, calculated on the last dosage. (The amount of the reduction gets progressively smaller.)

See Why taper by 10% of my dosage?

Use a combination of doxepin dosages to taper
If you are taking, for example, 150mg doxepin, you may wish to get 50mg of your prescription in 10mg. This will enable you to decrease by 10mg at a time. When you are down to 100mg, if your doctor is very cooperative, you may wish to fill part of your prescription with 3 mg or 6 mg tablets to continue a 10% taper.

You will probably find using a liquid to be much more convenient when tapering by amounts smaller than 10mg.

Tapering by cutting up tablets
The 3 mg or 6 mg tablets can be cut up. For precise measurements of small amounts, you may wish to weigh the fragments see Use a digital scale to accurately measure doses cut from tablets.

Using a liquid is much more convenient when tapering by tiny amounts.

Use doxepin oral solution to taper
In the US, doxepin comes in an oral solution by prescription.

From official FDA information at http://www.drugs.com/pro/doxepin.html


Doxepin hydrochloride oral solution is available as a concentrate for oral administration containing Doxepin hydrochloride equivalent to 10 mg of Doxepin per mL.


Make a doxepin liquid yourself from tablets or capsules
Doxepin is soluble in water. See How to make a liquid from tablets or capsules

Doxepin may degrade when exposed to light. If you make your own liquid, do not store it -- discard after you take your dose.

 

Use an oral syringe to precisely measure out doses as small as .01mg.

Edited by Altostrata
updated

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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  • 2 years later...

I accidentally decreased doxepin at least two weeks ago. I have not had any WD symptoms from it. I actually feel less tired in the morning and my brain fog has been better...

I was on 75mg in evening, I am now on 50mg in evening...

 

Is it possible that some meds may cause less WD than others?

 

I have been on doxepin on and off and also on other tricyclic meds since 1983...

Is this possible that I am somehow more used to decreasing them? So I respond less intense?

- 30.09.2020- reduced doxepin to 125mg, 16.10.2020- 100mg, 6.11.2020- 75mg

- May 2020, omeprazole 40mg switched to esomeprazole 20mg

- 2012 re-started Doxepin 75mg, evening. Increased to 150mg

- 2012, Atenolol 25mg, twice a day

- 2016, Low dose of HRT in evening, Sandrena and Utrogestan 

- Long terms of Nasal spray Otrivine

- 2012, PPI Omeprazole 40mg-evening

24.10.2014- Started ESCITALOPRAM-first 5mg and then 10mg; due to the adverse symptoms reduced on 5.01.2015- Escitalopram- 2.5mg 22.07.2016- re-started reduction by 1% at a time. Completed tappering on  19.03.2020 😇

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Yes, it is possible that you will not get withdrawal symptoms from that decrease. This cannot be predicted, which is why we recommend a more cautious taper.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Yes, of course. Thank you for your answer. As it happened with no planning, I will stay now on 50mg. I am ok...

 

Unfortunately, I used to use doxepin as a way of damping my emotions. In times I would go as high as 250mg...I don't do it anymore, but still get tempted to abuse it...

- 30.09.2020- reduced doxepin to 125mg, 16.10.2020- 100mg, 6.11.2020- 75mg

- May 2020, omeprazole 40mg switched to esomeprazole 20mg

- 2012 re-started Doxepin 75mg, evening. Increased to 150mg

- 2012, Atenolol 25mg, twice a day

- 2016, Low dose of HRT in evening, Sandrena and Utrogestan 

- Long terms of Nasal spray Otrivine

- 2012, PPI Omeprazole 40mg-evening

24.10.2014- Started ESCITALOPRAM-first 5mg and then 10mg; due to the adverse symptoms reduced on 5.01.2015- Escitalopram- 2.5mg 22.07.2016- re-started reduction by 1% at a time. Completed tappering on  19.03.2020 😇

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  • 1 year later...

Hi

Anyone here ever taper off the Silenor (Doxipen) a low dose 6mg  sleep aid.  I need to start a taper off this med since it is causing bad side effects.  I know the 10% rule and I have used it for large doses of Valiu, m Wellbutrin, just wondering about such a low dose of this doxipen. 

 

Id appreciate getting some feedback and opinions on this.  Also anyone who has tapered off Doxipen in general.

 

Thanks

Edited by KarenB
merged matching topics

 polyharmacy cocktail  FEB 2012 after hospital release , Wellbutrin 300mg xl once day, Lamictal 200mg daily, Klonopin 2mg Doxepin 7mg

 

 Klonopin micro taper started Dec  2012, C/O to 20mg Valium 12/2013, down to 1.5mg as of 10/01/2014,  updose to 1.6mg valium Oct 10/2014, updosed 2mg valium December 18 2014

 

Wellbutrin taper from 300mg, started  Jan 2015,  Wellbutrin 275mg, Jan 24 2015,  wellbutrin 250 mg, Feb 25,2015   225mg wellbutrin June 5, 200mg,July 2015, updosed 225mg, September 2015, 206mg, October, 2015 187.5mg, November  updosed to 200mg  May 2015, wellbutri167mg

 

Currently     Wellbutrin 187mg,      Lamictal 200mg,   Valium 2mg,    Doxepin 5.4mg July 09/16

 

 

 

 

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Hi Vetdoc,

 

I moved your post to this thread of the same topic.  Hopefully the above will answer your questions.

 

Karen

2010  Fluoxetine 20mg.  2011  Escitalopram 20mg.  2013 Tapered badly and destabilised CNS.  Effexor 150mg. 

2015 Begin using info at SurvivingAntidepressants.  Cut 10% - bad w/d 2 months, held 1 month. 

Micro-tapering: four weekly 0.4% cuts, hold 4 weeks (struggling with symptoms).

8 month hold.

2017 Micro-tapering: four weekly 1% cuts, hold 4 weeks (symptoms almost non-existent).

2020 Still micro-tapering. Just over 2/3 of the way off effexor. Minimal symptoms, - and sleeping well.
Supplements: Fish oil, vitamin C, iron, oat-straw tea, nettle tea.

My story of healing:ContinuedHealing

***I am not a doctor; please do your own research and be able to take responsibility for decisions you make.*** 

           'The possibility of renewal exists so long as life exists.'  Dr Gabor Mate.

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  • 2 weeks later...

I was on doxpein for 30 years. I finished a long taper in March of this year. The taper went rather smoothly as I took my time but I continue to have sleep and fatigue issues. How long after getting completely off of doxepin after an uneventful taper can I expect to have such symptoms? My doc put me on 15mg of remeron to address sleep & fatigue issues but its wearing off. Getting off one and on another Rx probably does not make a whole lot of sense, but everything I can find is that remeron is a much safer drug than most and I have to function still. But the sleep and fatigue issues wont leave me alone for good it seems,  so am thinking they are more related to not being completely off of doxepin that long (3.5 months completely off) after using it 30 years, i.e. residual affects still??? Also,  I'm wondering if the doxepin and benzo didnt permanently change my brain and that I will never sleep and feel like a normal person ever again???

 

Pokey

Was on xanax and doxepin for 25years. Got off both without to much trouble after long slow tapers. Still have issues with cognition, insomnia and fatigue. Was on 30mg mirtazapine.  Have tapered down to 9.375. When I get to 7.5 will hold there for a while to get good and stable again, then start down from there with liquid. Also take prevacid for GERD and bystolic for a mitral valve issue plus probiotic. 

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Pokey, we will need to discuss your questions in your Intro topic, as the answer depends on many things about your particular situation and would take this topic off-topic.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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I recently had to have my Doxepin liquid doses made up 5 days in advance and I'm now having increases in my symptoms.  I've read conflicting thought on making up batches of liquid Doxepin --- some say ok but most say it needs to made the same day as it is taken.  Anyone have knowledge/experience with this?   Thanks!

1971-81  Valium 5mg c/t PAWS     1992- through now Zoloft 25mg    2003-05 Valium 12mg Slow Taper Off

2013 Afrin Exposure to CNS    2013 O/D Val 230mg    2013 Doxepin 50mg Clonidine 2mg Zoloft 25mg

3/15/16  Doxepin 49mg Micro Tapering  Zoloft 24.3mg Holding taper

3/15/16 Clonidine mg 0.1 1/2 -    Decreasing incrementally. 

10/9/16  Doxepin 48.9  Zoloft 24.3  Clonidine  01.10  Continuing micro taper on Doxepin.

11/16/16 Doxepin 48mg  Zoloft 24.3mg  Clonidine 1.30mg

5/4/17  Doxepin 45mg  Zoloft 24mg  Clonidine 1.20mg   Micro taper of Doxepin, Clonidine

01/13/19  Doxepin 45mg   Zoloft 21mg   Will start Micro taper of Doxepin 2/19

 

 

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Doxepin may degrade when exposed to light. If you make your own liquid, do not store it -- discard after you take your dose.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Thanks Alto.  My "liquid" is water and each dose is stored in its own glass bottle.   I am pulling 1.04ml from 75ml right now.  I shake the bottle and drink the reduced amount of water and powder and then fill the bottle up with water again, swish it around and drink that.  The bottle is then cleaned and set aside for another dosing.  I will say that I had previously left the prepared liquid out in the light for a number of hours before taking it.  I'm now putting the prepared bottles (2 days worth) in my pantry closet which is cool and totally dark. 

1971-81  Valium 5mg c/t PAWS     1992- through now Zoloft 25mg    2003-05 Valium 12mg Slow Taper Off

2013 Afrin Exposure to CNS    2013 O/D Val 230mg    2013 Doxepin 50mg Clonidine 2mg Zoloft 25mg

3/15/16  Doxepin 49mg Micro Tapering  Zoloft 24.3mg Holding taper

3/15/16 Clonidine mg 0.1 1/2 -    Decreasing incrementally. 

10/9/16  Doxepin 48.9  Zoloft 24.3  Clonidine  01.10  Continuing micro taper on Doxepin.

11/16/16 Doxepin 48mg  Zoloft 24.3mg  Clonidine 1.30mg

5/4/17  Doxepin 45mg  Zoloft 24mg  Clonidine 1.20mg   Micro taper of Doxepin, Clonidine

01/13/19  Doxepin 45mg   Zoloft 21mg   Will start Micro taper of Doxepin 2/19

 

 

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The refrigerator is a better place to store any DIY mixture.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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OK!  I'll start putting the doses in the fridge.   Thanks!

1971-81  Valium 5mg c/t PAWS     1992- through now Zoloft 25mg    2003-05 Valium 12mg Slow Taper Off

2013 Afrin Exposure to CNS    2013 O/D Val 230mg    2013 Doxepin 50mg Clonidine 2mg Zoloft 25mg

3/15/16  Doxepin 49mg Micro Tapering  Zoloft 24.3mg Holding taper

3/15/16 Clonidine mg 0.1 1/2 -    Decreasing incrementally. 

10/9/16  Doxepin 48.9  Zoloft 24.3  Clonidine  01.10  Continuing micro taper on Doxepin.

11/16/16 Doxepin 48mg  Zoloft 24.3mg  Clonidine 1.30mg

5/4/17  Doxepin 45mg  Zoloft 24mg  Clonidine 1.20mg   Micro taper of Doxepin, Clonidine

01/13/19  Doxepin 45mg   Zoloft 21mg   Will start Micro taper of Doxepin 2/19

 

 

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