The uncontrolled medications prescribed in this sample were amitriptyline,
doxepin, hydroxyzine, low-dose quetiapine, and trazodone.
Participants were assigned to a placebo group or to one of the following 9 treatment interventions: citalopram,
doxepin, duloxetine, fluoxetine, imipramine, nortriptyline, paroxetine, sertraline, and trazodone.
Anti-itch preparations, such as compounded 0.25% menthol with 0.25% camphor in a suitable vehicle or
doxepin 5% cream, have not been adequately studied in uremic pruritus, but may be of benefit with little risk of adverse effects.
Table 1 CPIC gene/drug combinations with guidelines for psychiatry (a) Gene Drug(s) CYP2D6 Amitriptyline, fluvoxamine, nortriptyline, paroxetine, clomipramine, desipramine,
doxepin, imipramine, trimipramine CYP2C19 Amitriptyline, citalopram, escitalopram, clomipramine,
doxepin, imipramine, trimipramine, sertraline HLA-B Carbamazepine (a) As of April 2017 CPIC: Clinical Pharmacogenomics Implementation Consortium; CYP: cytochrome P450; HLA-B: human leukocyte antigen complex B Source: Reference 5 Table 2 Ms.
Aripiprazole was associated with a 21% reduction in risk, quetiapine had a 12% risk reduction, amitriptyline had an 11% risk reduction, and
doxepin had a 12% risk reduction.
Options include topical measures such as emollients, menthol, bandages, and topical steroids; antihistamines; antidepressants, such as amitriptyline and
doxepin; anticonvulsants, such as gabapentin; and serotonin inhibitors, such as ondansetron.
The most commonly prescribed drugs in this category are trazodone, mirtazapine, and
doxepin. Side effects of trazodone may include morning sedation and a temporary lowering of blood pressure, and mirtazapine may cause weight gain.
Dose dependency of brain histamine H(1) receptor occupancy following oral administration of cetirizineirizine hydrochloride measured using PET with [11C]
doxepin. Hum Psychopharmacol.
US Food and Drug Administration (FDA)-approved hypnotic medications fall into 5 families (TABLE 2(40)): benzodiazepines (BDZs), benzodiazepine agonists (BDZAs, sometimes called "Z drugs"), melatonin agonists (eg, ramelteon), tricyclic antidepressants (eg, low-dose
doxepin), and orexin antagonists (eg, suvorexant).
Apart from gabapentin 600 mg TID, the patient's other discharge medications included
doxepin 10 mg at bedtime for sleep, hydroxyzine pamoate 25 mg BID as needed for anxiety, and sertraline 100 mg daily, all of which were discontinued due to side effects or ineffectiveness during subsequent outpatient follow-up.
Doxepin used as a hypnotic agent shares many advantages over other available therapies.
doxepin - a tricyclic antidepressant (trade names Adapin and Sinequan) with numerous side effects (dry mouth and sedation and gastrointestinal disturbances)