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Doxepin vs. Pamelor


Living with depression can be draining, and finding the right treatment for your symptoms often takes time

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Living with depression can be draining, and finding the right treatment for your symptoms often takes time. With so many options on the market, it’s difficult to know where to start. 

Whether your current medications no longer work for you or you’re just embarking on your journey toward living symptom-free, tricyclic antidepressants could be useful remedies to discuss with your care provider. In this article, we’ll compare Doxepin and Pamelor so that you have a better understanding of how they work, what they treat, and the possible side effects.

At Klarity, we believe in accessible mental health care for all. That means affordable mental health care, convenient scheduling, and prescription refills where you don’t have to jump through hoops. 

Take this brief self-evaluation, and we’ll connect you with a licensed care provider in your state who can help treat your depression symptoms. 

This article discusses suicide, suicidal ideation, and self-harm. If you or someone you know is experiencing suicidal thoughts or is in crisis, contact the Suicide Prevention Lifeline immediately at 800-273-8255.

Pamelor and Doxepin Are the Same Class of Drugs (Tricyclics)

Pamelor and Doxepin are tricyclic antidepressants, which are among the oldest medications developed to treat major depressive disorder (MDD). While tricyclics aren’t right for everyone, they can be useful alternatives when other forms of treatment no longer work or aren’t an option. 

What Are Tricyclics?

Tricyclics are medications that block the reuptake of the neurotransmitters norepinephrine and serotonin. With higher levels of these neurotransmitters in our brains, we experience a boost in energy and mood, making tricyclic antidepressants effective in treating depression symptoms.

Pamelor and Doxepin Are Both Used To Treat Major Depressive Disorder

While Pamelor and Doxepin are both used to treat major depressive disorder, they’re prescribed in different doses and can have unique side effects. Additionally, each medication can be used off-label to treat conditions outside of MDD. 

If a medication is used for something other than its FDA-approved use, it’s considered an off-label treatment. If, for example, a medication is FDA-approved to treat cardiovascular conditions but can help alleviate anxiety, healthcare providers may use it to treat anxiety symptoms in an off-label capacity.

What Else Does Pamelor Treat?

Pamelor (Nortriptyline) is primarily prescribed to treat MDD. That said, it can also be used off-label to treat several issues outside of depression. 

Off-label Uses for Pamelor

Pamelor can be prescribed off-label to treat various conditions. Those conditions range from chronic pain to diabetic neuropathy, myofascial pain, orofacial pain, postherpetic neuralgia, headaches, and migraines. 

What Else Does Doxepin Treat?

Doxepin (Silenor) is most commonly used to treat depression and anxiety. However, like Pamelor, it also has been prescribed off-label to treat other issues. 

Off-label Uses for Doxepin

If you experience chronic pain or trouble sleeping, Doxepin could be an effective medication for you. Off-label uses for Doxepin include managing neuropathic pain and insomnia.

Doses, Dosage Form, and Side Effects of Doxepin

Doxepin comes in different forms and doses, and how you’ll take it depends on your current symptoms, health history, and the advice of your mental healthcare provider. 

Common Doxepin Doses and Forms

Doxepin is typically prescribed as a tablet, capsule, or liquid. While everyone’s dosage varies, you can expect to start with 10 to 75 mg daily. Your healthcare provider may increase that dose to 150 mg daily, depending on your symptoms and how you respond to the initial dosing recommendation. 

Common Doxepin Side Effects

Doxepin has some possible side effects you should be aware of before taking this medication. 

Common side effects include:

  • Dizziness
  • Dry mouth
  • Sleepiness
  • Blurred vision
  • Trouble urinating
  • Nausea
  • Vomiting
  • Stomach ache
  • Weight gain
  • Changes in how food tastes

Some of these side effects may go away with time, but you should alert your healthcare provider if they do not. If you experience any of the following serious side effects, contact your provider immediately or seek emergency medical care. 

  • Suicidal ideation or thoughts of self-harm
  • Worsening anxiety
  • Agitation or restlessness
  • Panic attacks
  • Insomnia
  • New or worsened irritability
  • Aggression, anger, or violent behavior
  • Mania
  • Unusual changes in mood or behavior
  • Difficulty urinating or pain when urinating

Common Doxepin Drug Interactions

Doxepin interacts with 661 drugs and has major interactions with 134 medications, moderate interactions with 502 medications, and 25 minor interactions. When cross-referenced with frequently prescribed medications, Doxepin has major interactions with Cymbalta and Zoloft and moderate interactions with the following drugs.

  • Adderall
  • Ambien
  • Klonopin
  • Lyrica
  • Seroquel
  • Xanax
  • Zyrtec

You should always discuss any medications you’re taking with your care provider before starting a new medication.

How Much Does Doxepin Cost?

The price of Doxepin varies depending on the dose you’re prescribed and which pharmacy you use. You could pay anywhere from $16.99 to $49.47 a month. If you’re looking for a more affordable alternative, speak with your care provider about using the generic Doxepin, Silenor.

Doses, Dosage Form, and Side Effects of Pamelor

Pamelor doesn’t come in as many forms as Doxepin, and it has its own unique side effects. Your dosage depends on what your healthcare provider recommends, which will vary from person to person. 

Common Pamelor Doses and Forms

Pamelor is a capsule taken orally in doses ranging from 25 mg to 150 mg per day. Your healthcare provider will likely start you on a low dose to see how you respond to the medication, increasing it as needed to treat your depression symptoms.

Common Pamelor Side Effects

Common side effects of Pamelor may dissipate over time as your body gets used to the medication. Those side effects include the following. 

  • Increased heart rate
  • Blurred vision
  • Urinary retention
  • Dry mouth
  • Constipation
  • Weight gain or loss
  • Dizziness when you stand up
  • Tingly feeling
  • Weakness
  • Lack of coordination
  • Unpleasant taste
  • Nausea
  • Ringing in your ears
  • Breast swelling
  • Decreased sex drive
  • Impotence
  • Difficulty orgasming

If you experience persistent unwanted side effects, you must talk with your mental health provider about your options before abruptly stopping Pamelor.

Common Pamelor Drug Interactions

Pamelor has 647 known drug interactions, with 134 being major, 488 moderate, and 25 minor. Of the medications most frequently prescribed, Pamelor has major interactions with the following.

  • Cymbalta
  • Flexeril
  • Lexapro
  • Topamax
  • Tramadol
  • Trazodone
  • Zoloft

Pamelor has moderate interactions with:

  • Ambien
  • Gabapentin
  • Lisinopril
  • Lyrica
  • Neurontin
  • Synthroid
  • Xanax

How Much Does Pamelor Cost?

Pamelor can be quite costly if you’re paying without insurance, with prices starting at $1,251 for 30 capsules of 10 mg. However, the generic version is much more affordable at $21 for 30 capsules at 25 mg. Consult your healthcare provider about your options so that you can get the best available price.

Do I Need A Prescription for Pamelor or Doxepin?

Yes, both Pamelor and Doxepin are only available with a prescription. Selling tricyclic antidepressants without requiring a prescription is illegal and can put your health at risk, as there’s no way to know if the medication includes harmful substances. Using a trusted pharmacy to fill your prescriptions is your best bet.

Other Tricyclic Side Effects

Tricyclic antidepressants can result in some serious side effects like Serotonin Syndrome, pregnancy risks, and the possibility of increased bleeding. If you experience any of these side effects, contact emergency medical services and alert your care provider. 

What is Serotonin Syndrome?

Serotonin Syndrome is a serious drug reaction that results in too much serotonin in the system. This reaction usually occurs when you’re taking multiple medications with serotonin or begin taking a new one that impacts serotonin levels. Signs and symptoms of Serotonin Syndrome include:

  • Restlessness
  • Sleep issues
  • Confusion
  • Rapid heart rate 
  • High blood pressure
  • Dilated pupils
  • Loss of muscle coordination or twitching 
  • Muscle rigidity
  • Excessive sweating
  • Diarrhea
  • Headaches
  • Shivering or goosebumps

If you experience any of those symptoms, contact your care provider immediately, as Serotonin Syndrome can be fatal if left untreated.

Pregnancy and Breastfeeding on Tricyclics

While using tricyclic antidepressants during pregnancy isn’t necessarily unsafe, it can result in preterm delivery, low birth weight, respiratory distress, and neonatal convulsions. If you become pregnant, speak with your healthcare provider about your options for treating your depression symptoms. 

Increased Bleeding Risk With Tricyclics

Because tricyclic antidepressants influence serotonin levels, there’s an increased risk of bleeding when taking them. Platelets in your blood release serotonin to help heal wounds and form blood vessels. When taken with other medications that impact serotonin levels, you could have abnormal bleeding. Talk with your healthcare provider immediately if bleeding events occur. 

Doxepin and Pamelor Frequently Asked Questions

What is Doxepin?

Doxepin is a tricyclic antidepressant most often prescribed to treat major depressive disorder (MDD). It can also be used off-label to treat neuropathic pain, anxiety, and insomnia.

What is Pamelor?

Pamelor is a tricyclic antidepressant used for major depressive disorder. Its off-label uses include treating chronic pain to diabetic neuropathy, myofascial pain, orofacial pain, postherpetic neuralgia, headaches, and migraines.

Are Doxepin, Pamelor, and other Tricyclics the same drug?

While Doxepin and Pamelor are both tricyclic antidepressants, they are not the same drug. They each have their own side effects and are prescribed in different doses depending on your symptoms. 

What’s better for anxiety? Doxepin or Pamelor?

Doxepin is approved to treat anxiety, impacting your central nervous system to increase chemicals in the brain that help you relax. Pamelor helps you feel better, but it may not alleviate anxiety symptoms. Which medication is best for you and your symptoms will depend on your health history and the advice of your mental health provider.

What’s better for depression? Doxepin or Pamelor?

Both Doxepin and Pamelor can treat symptoms of depression. That said, both have different drug interactions and side effects. Doxepin has been used for over 40 years to treat depression, whereas Pamelor is a newer medication. Which one is best for you will depend on your current symptoms and the recommendation of your care provider.

Can I drive on antidepressants like Doxepin or Pamelor?

Both antidepressants can cause drowsiness, and your healthcare provider may recommend taking your initial doses before bed until you understand how your body reacts to the medication. Once you’ve established that it’s safe, your healthcare provider may give you the green light to take your dose at a different time during the day.

Can I drink alcohol on Doxepin or Pamelor?

Drinking alcohol on Doxepin or Pamelor can reduce the effects of the medications and increase possible negative side effects. Consult your care provider before mixing alcohol with tricyclic antidepressants. 

Does it matter what time of day I take Doxepin or Pamelor?

Because both medications can make you drowsy, you should not operate heavy machinery or drive until you know how these medications will affect you. You should always take your medications as directed by your care provider, who will likely recommend taking your first dose before bed.

How Klarity Helps You Access Online Depression Treatment

At Klarity, we know that trying to find a provider in your area, requesting time off from work, and commuting long distances for appointments can make accessing care much more difficult. 

That’s why we make treatment accessible through licensed mental health providers on our platform. You can see your care provider online from the comfort of your home at a time that works best for you. 

Take our survey today to match with the right provider in your state within 48 hours and get the depression treatment you need. 


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