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Delisting of doxepin and alternative treatment options


Doxepin was scheduled to be delisted from 1 January 2020. The schedule for delisting was 1 January for 10 mg, 1 April for 25 mg, and 1 May for 50 mg.

Currently, only the 75 mg is available. 

Dothiepin continues to remain available at this time and according to the Waikato DHB mental health pharmacist, should be used as the first line substitute for doxepin, although it only appears to be available as the 75 mg tablet.

Dosages are comparable with one study suggested that dothiepin 154.8 mg was equivalent to doxepin 140.1 mg/day. 

New Zealand Formulary recommendations

Doxepin

Adult initially 75 mg daily in divided doses or as a single dose at bedtime, adjusted according to response; usual maintenance 30-300 mg daily (doses above 100 mg given in 3 divided doses); elderly initially 10-50 mg daily adjusted according to response (usual maintenance 30-50 mg daily)"

Dothiepin

Adult initially 75 mg (elderly 50-75 mg) daily in divided doses or as a single dose at bedtime, increased gradually as necessary to 150 mg daily (elderly 75 mg may be sufficient); up to 225 mg daily in some circumstances (such as hospital use).

Dose equivalents of antidepressants: Evidence-based recommendations from randomized controlled trials

J Affect Disord. 2015 Jul 15;180:179-84. doi: 10.1016/j.jad.2015.03.021. Epub 2015 Mar 31. 


For more information

Contact Andrew Darby, consultant psychiatrist: andrew.darby@pinnacle.health.nz.

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