Doxepin Hydrochloride

A tricyclic antidepressant dibenzoxepine with actions and uses similar to amitriptyline with major antihistaminic, antimuscarinic and sedative properties. Indicated in the treatment of certain states of depression, anxiety and psychosis. Oral administration in one or two daily doses.

Although it is concentrated in breastmilk rather than in plasma ^{(Weissman 2004)}, the amount in breastmilk is very small ^{(Frey 1999, Matheson 1985, Kemp 1985)}, but in two recorded cases the infants, 9 days ^{(Frey 1999)} and 8 weeks of age ^{(Matheson 1985)}, presented hypotonia, vomiting and weight loss ^{(Frey 1999)} as well as pallor, drowsiness and respiratory depression ^{(Matheson 1985)}.

An infant whose mother started treatment with doxepin a month postpartum did not have any problems during the little more than three months she continued with breastfeeding. ^{(Kemp 1985)}

Plasma levels of doxepin in these three infants ranged from undetectable in the 9-day-old infant ^{(Frey 1999)}, undetectable to very low in the one-and-a-half-month-old infant ^{(Kemp 1985)} and high, similar to those of maternal plasma in the 8 week-old infant. ^{(Sachs 2013, Matheson 1985)}.

It is believed that the ability to metabolize and excrete doxepin is minimal before 15 days of age and improves after 2 - 3 months of age. ^{(Wisner 1996, Pons 1994)} 

Until there is more published data on this drug in relation to breastfeeding, safer known alternatives are preferable ^{(Uguz 2021, Gjerdingen 2003, Håberg 1997)}, especially during the neonatal period (first month) and in case of prematurity.

Women suffering from depression during pregnancy need more breastfeeding support due to their increased risk of breastfeeding problems and early weaning. ^{(Grzeskowiak 2018, Leggett 2017, Venkatesh 2017, Gorman 2012)}

See below the information of these related products:

• Doxepin (Topic Cream) (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
• Maternal Depression (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
• Maternal Psychotic Disorder. Maternal psychosis, schizophrenia, bipolar disorder (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)