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Doxepin vs. Trimipramine: Which Should I Take?

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With so many different treatment options available, it can be challenging to navigate through the different medications and understand which is best for you. Living with symptoms of anxiety and depression is difficult, but finding the right medication for you shouldn’t be. 

In this article, we will compare two popular medications used in the treatment of depression, Doxepin, and Trimipramine, so that you can be better informed when discussing treatment options with your healthcare provider. 

At Klarity, we believe mental health care should be accessible, affordable, and convenient for all. We take the hassles out of the traditional psych clinic visit by having convenient online scheduling, no long wait times, and easy prescription refills. 

Start by taking our free 2-minute survey, and we’ll connect you with a licensed healthcare provider in your state and be seen in as little as 48 hours. 

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

Trimipramine and Doxepin are two medications that belong to the same class of drugs called tricyclic antidepressants (TCAs). These medications are primarily used to treat depression but have different properties that make each drug unique. 

What Are Tricyclics?

Serotonin and norepinephrine are two important neurotransmitters, or chemical messengers, that are involved in several bodily functions, such as mood, appetite, sleep, and sex drive. 

TCAs work by blocking the reuptake of serotonin and norepinephrine in the brain, which results in increased levels of these neurotransmitters and improvement in depressive symptoms. 

Trimipramine  and Doxepin Are Both Used To Treat Major Depressive Disorder

Tricyclic antidepressants, including Trimipramine and Doxepin, are used to treat depressive disorders. Major depressive disorder (MDD) is the most common mood disorder and is characterized by:

  • Loss of interest in pleasurable activities 
  • Feelings of sadness, emptiness, or hopelessness
  • Irritability 
  • Sleep disturbances, including insomnia or increased need for sleep
  • Changes in appetite, resulting in weight loss or gain

What Else Does Trimipramine Treat?

Trimipramine is a unique tricyclic medication because of its weak antipsychotic properties, which can be useful in treating depression with delusions or psychotic features. 

Off-label Uses for Trimipramine 

The term off-label refers to any use of a medication that has not been FDA-approved, which requires a lengthy and extensive research process. Like most TCA medications, Trimipramine has sedative effects and is useful in treating insomnia. 

What Else Does Doxepin Treat?

Aside from the treatment of anxiety and depression, Doxepin is also available as a topical cream to treat itching associated with certain dermatological conditions, such as eczema.  

Off-label Uses for Doxepin  

As described above, off-label describes a condition that has not been FDA-approved and does not mean it is ineffective. Doxepin can be used off-label for treating neuropathic pain and insomnia. 

Doses, Dosage Form, and Side Effects of Doxepin  

Common Doxepin Doses and Forms

Silenor is the brand name of Doxepin and is available in capsules, tablets, an oral solution, and topical creams. Doxepin capsules are available in a large range from 10 mg to 150 mg, and tablets are only available in 3 mg and 6 mg.  

Doxepin is typically started at a low dose of 75 mg once daily and can then be titrated up weekly to a maximum dose of 150 mg per day. 

Common Doxepin Side Effects

There are several potential side effects associated with Doxepin, ranging in severity from mild to serious and can even be life-threatening. It is important to contact your healthcare provider or seek immediate medical attention if you begin to experience any of the serious side effects listed below. 

Common side effects associated with Doxepin include: 

  • Agitation or confusion 
  • Chills, increased sweating 
  • Headache 
  • A sensation of burning, itching, or “pins and needles” on the skin 
  • Dizziness upon standing 
  • Muscle spasms, stiffness, twitching 

Serious side effects of Doxepin include: 

  • Signs of easy bruising or bleeding
  • Chest pain or tightness
  • Fast or irregular heartbeat 
  • Blurred vision 
  • Hearing loss 
  • Seizures
  • Loss of consciousness

Common Doxepin Drug Interactions

The majority of TCAs interact with several other commonly prescribed medications. As always, it is important to discuss all medications, including over-the-counter medications and supplements, with your healthcare provider before starting a new medication.

Common drug interactions with Doxepin include: 

  • Anticholinergic drugs 
  • MAOI medications, including isocarboxazid, linezolid, or methylene blue 
  • SSRIs
  • Thyroid supplements 
  • Certain antihypertensive medications, such as clonidine 
  • Antifungal medications, like Terbinafine 
  • Antiarrhythmic medications or drugs that treat irregular heart rate
  • St. John’s Wort

How Much Does Doxepin Cost?

Doxepin is typically covered by most insurance plans and is a relatively affordable medication for those who are uninsured. The use of coupon codes that are found at large name-brand pharmacies can lower the cost of your 30-day supply from the average retail price of $50 to less than $10 per month. 

Doses, Dosage Form, and Side Effects of Trimipramine  

Common Trimipramine Doses and Forms

Surmontil is the brand name of Trimipramine and is available in 25 mg, 50 mg, and 100 mg capsules. The initial recommended dose is 25 mg at bedtime but can vary based on the severity of symptoms. For example, the starting dose in hospitalized patients can be as high as 100 mg but requires close monitoring. 

The daily dose of Trimipramine can be slowly increased weekly with a maximum dose of 200 mg per day. This medication can be prescribed as a single dose at bedtime or divided into multiple doses throughout the day. 

Common Trimipramine Side Effects

As with any medication, there are associated risks, such as side effects, that should be considered before starting a medication. The most common side effects associated with Trimipramine are mild, but there are a few serious adverse effects that require immediate medical attention. 

The most common side effects of Trimipramine include: 

  • Fatigue 
  • Drowsiness 
  • GI upset, including nausea, vomiting, abdominal pain, or constipation 
  • Changes in blood pressure 
  • Loss of appetite
  • Headache 
  • Dry mouth 
  • A sensation of “pins and needles” on the skin of your extremities
  • Rash 
  • Decreased libido or changes in sex drive 

Rare but serious side effects of Trimipramine that require immediate medical attention: 

  • New or worsening suicidal thoughts or self-harm behaviors 
  • Signs of a heart attack – chest pain, fast or irregular heartbeat, sweating, or dizziness
  • Signs of a stroke – weakness, difficulty speaking, headache, imbalance or loss of coordination, changes in mental status, or paralysis of one side of your body
  • Serotonin syndrome – fever, high blood pressure, fast heart rate, changes in mental status, irregular movements 

Common Trimipramine Drug Interactions

Like other TCA medications, there are several drug interactions with Trimipramine. As always, you must disclose all current medications you are currently taking with your healthcare provider, including all over-the-counter medications and supplements. 

The most common drug interactions with Trimipramine include: 

  • MAO inhibitors 
  • Anticholinergic medications
  • Certain antihypertensive medications: clonidine, guanethidine
  • Protease inhibitors 
  • Medicines that affect heart rhythm: flecainide, quinidine, propafenone
  • Thyroid supplements 
  • Haloperidol 
  • Motion sickness medications 
  • Other drugs that increase levels of serotonin: SSRIs, St. John’s Wort, MDMA, or ecstasy 

How Much Does Trimipramine Cost?

Trimipramine, or name-brand Surmontil, is covered by the majority of health insurance plans, and coupon codes significantly reduce the cost of the medication for those who are uninsured. Coupons can be found at large retail pharmacies and lower the cost of the prescription from its retail price of around $130 to $35 for a 30-day supply. 

Do I Need A Prescription for Trimipramine or Doxepin?

Yes, a prescription from a licensed healthcare provider is necessary for both Trimipramine and Doxepin. These medications are not available over the counter because, as described above, there are several drug interactions and side effects that need to be taken into account before starting a TCA medication. Your healthcare provider will determine if a TCA medication, such as Trimipramine or Doxepin, may be right for you. 

Other Tricyclic Side Effects

There are a couple of uncommon but serious side effects that are associated with the use of tricyclic medications. It is important to be closely monitored when starting a TCA medication, and if you begin to experience any of the following adverse effects, contact your healthcare provider or seek out immediate medical attention. 

What is Serotonin Syndrome?

Serotonin syndrome is a rare but serious and potentially life-threatening condition that occurs when there are high levels of serotonin in the body. This is most common in those who are taking multiple medications that increase serotonin levels. 

Several medications cause serotonin levels to increase in the body, including other antidepressant medications, ADHD medicines, opioids, and non-prescription drugs like St. John’s Wort or MDMA. 

The signs and symptoms of serotonin syndrome include: 

  • High fever
  • Rapid heart rate and high blood pressure 
  • Nausea, vomiting, or diarrhea 
  • Dilated pupils 
  • Insomnia 
  • Agitation or restlessness
  • Muscle twitching or rigidity 
  • Altered mental status or confusion 

Severe complications of serotonin syndrome: 

  • Seizures 
  • Arrhythmias or irregular heartbeat 
  • Unconsciousness 

It is important to seek immediate medical attention if you begin to experience these symptoms after starting a TCA medication, as this condition can be fatal if left untreated. 

Pregnancy and Breastfeeding on Tricyclics

Tricyclics are generally avoided in pregnancy because of the following complications: 

  • Spontaneous loss of pregnancy 
  • High blood pressure, preeclampsia, or eclampsia 
  • Preterm birth 
  • Postpartum hemorrhage 
  • Postnatal effects: withdrawal symptoms, hypoglycemia, jaundice, or lack of respiratory drive

Taking a TCA medication while breastfeeding is typically viewed to be safe for the infant because there are relatively low levels of the drug within breast milk. 

Black Box Warning With Antidepressants

As with most antidepressant medications, there is a risk of worsening depression and suicidal ideation or self-harm behavior. This is a rare occurrence but is most commonly seen in those who are under the age of 24.    

Doxepin and Trimipramine Frequently Asked Questions

When comparing two medications from the same class of drugs, things can get confusing. We went over a lot of information, and it is common to have additional questions. Below we have answered some of the most frequently asked questions about Doxepin and Trimipramine:

What is Doxepin?

Doxepin is a tricyclic medication that is commonly used in the treatment of anxiety and depression. 

What is Trimipramine?

Trimipramine is another tricyclic medication that is also commonly used to treat anxiety and depression. This medication is a unique TCA, as it has mild antipsychotic properties and can be used for the treatment of depression with psychotic features. 

Are Doxepin and Trimipramine the same drug?

No, although both Doxepin and Trimipramine belong to the same class of drugs called tricyclics, they are two separate medications, and each has unique properties. 

Why is Doxepin an off-label treatment for anxiety?

Doxepin is considered to be an off-label treatment for anxiety because there are newer medications that are more effective in treating anxiety and are associated with fewer side effects. 

There are several reasons one of these newer first-line drugs is contraindicated in some, including drug interactions, certain health conditions, and inability to tolerate the medication, to name a few. In these cases, TCA medications like Doxepin remain to be a good alternative when treating anxiety. Your healthcare provider will help determine which anti-anxiety medication is best for you. 

What’s better for anxiety? Doxepin or Trimipramine?

Doxepin appears to be a better choice for the treatment of anxiety over Trimipramine, but it is also important to note that this is still considered off-label use for the medication. 

What’s better for depression? Doxepin or Trimipramine?

Although both medications are used to treat depression, Trimipramine is slightly more effective than Doxepin and can be used for more serious forms of depression because of its mild antipsychotic effects. 

Can I drive on antidepressants like Doxepin or Trimipramine?

Driving or operating heavy machinery should generally be avoided when initially starting any TCA medication, because of the potential to cause sedative effects. 

Can I drink alcohol on Doxepin or Trimipramine?

You should avoid drinking alcohol while taking any TCA medication, including Doxepin or Trimipramine because of an increased risk of adverse effects. Drinking alcohol and TCA medications both cause sedation and can be dangerous when taken together. 

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

Due to the sedating effects of TCA medications, Doxepin and Trimipramine are typically prescribed to be taken at night before bedtime. Your healthcare provider will instruct you on how to take your medication, and it is important to follow these instructions. 

How Klarity Helps You Access Depression Treatment

With so many different treatment options available for depression, finding the medication that is best for you can seem like an overwhelming process. Let the providers on Klarity help. 

At Klarity, we believe that you deserve access to affordable mental health care online at your convenience. Klarity offers quality care with no insurance or subscriptions necessary and, most importantly, no hidden fees. 

Schedule an appointment today on Klarity, and we’ll connect you with a licensed healthcare professional in your state within 48 hours to get started on your personalized depression treatment plan. 

Start today, and discuss your symptoms with a specialist who can help.

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