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Norpramin vs. Doxepin: Which Should I Take?

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Everyone experiences anxiety and depression differently, and seeking treatment involves a thorough evaluation with a professional healthcare provider. That said, understanding your options for medication can empower you to ask informed questions and make knowledgeable decisions about your mental health. 

If you’ve tried various SSRIs, SNRIs, or other medications in the past that haven’t helped treat your depression symptoms, you may be looking at other options. Tricyclic antidepressants can be alternatives prescribed for treatment-resistant depression or if you experience depression along with other mood disorders. 

In this post, we’ll explore how the tricyclics Norpramin and Doxepin compare so that you’re prepared to talk with your medical provider about your options for treatment.

Klarity has helped over 30,000 people connect with depression-trained healthcare providers. Through our online platform, you can be seen from the comfort of your own home within 48 hours. 

Take our brief mental health assessment so we can match you with a board-certified provider who will review your symptoms and get you the treatment you need. 

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.

Doxepin and Norpramin Are the Same Class of Medication (Tricyclics)

Norpramin and Doxepin belong to the same class of medication: tricyclic antidepressants. Each is used to treat depression, but they have distinct side effects, warnings, and interactions. 

What are Tricyclics?

Tricyclic antidepressants (tricyclics) block the serotonin and norepinephrine reuptake in the brain. Serotonin and norepinephrine are neurotransmitters, or messengers, that communicate between brain cells to regulate mood and energy levels. 

Tricyclics stop the reabsorption of serotonin and norepinephrine so that there are more of these neurotransmitters in the brain to account for any chemical imbalances and relieve symptoms of depression.

Doxepin and Norpramin Are Both Use to Treat Major Depressive Disorder

While Doxepin and Norpramin are used to treat major depressive disorder (MDD), characterized by feelings of sadness and apathy, they are also prescribed to treat other issues. 

What Else Does Doxepin Treat?

While Doxepin isn’t the right medication for everyone, it is primarily used to treat depression and anxiety. That said, it’s also used to treat other issues in an off-label capacity, depending on the advice of your healthcare provider.

Off-Label Uses for Doxepin

Doxepin can be used off-label to treat sleep disorders like insomnia. Off-label use means that, while the medication may be an effective part of treatment, it is not currently approved by the FDA. Because Doxepin slows brain activity, it can help you fall asleep and stay asleep. 

What Else Does Norpramin Treat?

Like Doxepin, Norpramin is approved to treat MDD, but it does have off-label uses that can be effective for some people. Because this medication has many side effects, you should always consult a healthcare specialist before taking it. 

Off-Label Uses for Norpramin

Off-label uses for Norpramin include treating:

  • Bulimia nervosa
  • Irritable bowel syndrome (IBS)
  • Neuropathic pain
  • Overactive bladder
  • ADHD
  • Post-herpetic neuralgia 

Doses, Dosage Form and Side Effects of Norpramin

Understanding possible side effects and the dosing schedule can help you and your healthcare provider make the best decision about your health. 

Common Norpramin Doses and Forms

Norpramin comes as a tablet, and an adult dose is typically between 100-200 mg daily. The dosage may be lower for elderly or adolescent patients, and Norpramin isn’t recommended for children under 12. Depending on the severity of your symptoms, your care provider may recommend increasing your dosage slowly over time to a maximum of 300 mg per day. 

Common Norpramin Side Effects

The most common side effects of Norpramin include:

  • Elevated blood pressure
  • Weakness
  • Loss of appetite
  • Lack of coordination
  • Nausea
  • Weight gain or weight loss
  • Vomiting
  • Dry mouth
  • Tingly sensations

Contact your healthcare provider immediately if you experience more serious side effects like vision issues, changes in mood or behavior, fever, and chest pain. 

Common Norpramin Drug Interactions

Norpramin interacts with 619 medications, 21 diseases, and alcohol. Of the most frequently checked interactions, there are five major interactions with medications, including Celexa, Cymbalta, Lexapro, Prozac, and Wellbutrin.

Of the diseases, Norpramin has major interactions with:

  • Cardiovascular disease
  • Depression
  • Pheochromocytoma
  • Seizure disorders
  • Anticholinergic effects
  • Acute myocardial infarction recovery

You should always talk to your care provider about any other medications you’re taking to ensure that it’s safe to add Norpramin to your regimen. 

How Much Does Norpramin Cost?

Without insurance, 100 tablets of 100 mg of Norpramin cost around $618, depending on your pharmacy. With insurance, it could cost anywhere from $68 to $160 per 100 tablets of 100 mg. 

Doses, Dosage Form and Side Effects of Doxepin

Doxepin, while also used to treat symptoms of anxiety and depression, comes in different forms and is administered in different doses than Norpramin.

Common Doxepin Doses and Forms

Doxepin comes as a liquid, capsule, or tablet and is taken one to three times a day. If your symptoms are less severe, your healthcare provider may prescribe 25-50 mg once a day. For more intense symptoms, the typical adult dose is 75-150 mg daily. Your provider may recommend increasing the amount to 300 mg if necessary. 

While you may feel the anti-anxiety effects soon after taking Doxepin, the antidepressant can take two to three weeks before you notice a change in your symptoms. 

Common Doxepin Side Effects

Like Norpramin, side effects of Doxepin also include:

  • Nausea
  • Vomiting
  • Weakness
  • Weight gain or weight loss
  • Loss of appetite
  • Dry mouth

Beyond those, you may also experience the following on Doxepin:

  • Dizziness
  • Dilated pupils
  • Mouth sores
  • Sensitivity to sunlight on your skin
  • Flushing
  • Digestive problems
  • Difficulty urinating
  • Changes in sex drive
  • Excessive sweating
  • Chills
  • Headache
  • Hair loss
  • Increased breast size 
  • Swollen testes 
  • Milky discharge from the nipple (in females)

Contact your healthcare provider immediately if you experience more serious side effects like elevated heart rate, yellowing skin or eyes, abnormal bleeding or bruising, and skin irritation or swelling.

Common Doxepin Drug Interactions

Doxepin interacts with 661 medications, 27 diseases, and alcohol. Of the most frequently checked medications, Doxepin has major interactions with Cymbalta, Flexeril, Lexapro, Topamax, and Zoloft. 

Like Norpramin, Doxepin has major interactions with the following diseases:

  • Cardiovascular disease
  • Depression
  • Seizure disorders
  • Pheochromocytoma
  • Anticholinergic effects
  • Acute myocardial infarction recovery

You should not take Doxepin if you’ve taken a MAO Inhibitor like isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, and tranylcypromine within the past two weeks. 

How Much Does Doxepin Cost?

The cost of Doxepin varies depending on your prescribed dosage. You can expect to pay anywhere from $14.50 to $18.17 through GoodRx.com. However, if you’re paying cash without insurance, the price range can be $87 to $292. The generic form, Doxepin, is often more affordable than the brand name version: Silenor.

Do I Need a Prescription for Doxepin or Norpramin?

Yes, both Doxepin and Norpramin require prescriptions. While neither medication is a controlled substance, they are not fist-choices in treating anxiety and depression due to the number of possible side effects. If your healthcare provider does prescribe Doxepin or Norpramin, you should take it exactly as instructed. 

Other Tricyclic Side Effects

Norpramin and Doxepin are not right for everyone. They’re members of the tricyclic class and can have many side effects like serotonin syndrome, issues with pregnancy or breastfeeding, and an increased risk of bleeding.

What is Serotonin Syndrome?

While the body naturally produces serotonin, a chemical that impacts how our brain and nerves function, too much serotonin can have severe adverse effects. Serotonin syndrome occurs when your body produces too much serotonin due to a change in medication or combining certain medications. 

You can experience mild symptoms like diarrhea or shivering to more intense symptoms like stiffening muscles, seizures, and fever. If left untreated, serotonin syndrome can be fatal. 

Pregnancy and Breastfeeding on Tricyclics

If you are pregnant or breastfeeding, you should always consult your doctor before taking tricyclics. In some cases, the fetus may experience withdrawal symptoms if you’ve been taking a tricyclic antidepressant during your pregnancy. Additionally, your infant should be monitored for sleep apnea and excessive drowsiness if you’re breastfeeding. 

Increased Bleeding Risk with Tricyclics

While tricyclics alone don’t necessarily increase your risk of internal bleeding, there is an increased bleeding risk when combined with blood thinners like Warfarin. Because tricyclic antidepressants impact blood serotonin levels, they can contribute to abnormal bleeding.

Black Box Warning With Antidepressants

Antidepressants like Doxepin and Norpramin can cause changes in mood and behavior, like thoughts of self-harm and suicidal ideation. Contact your healthcare provider immediately if you experience a shift in how you’re feeling or what you’re thinking, panic attacks, or insomnia.

Norpramin and Doxepin Frequently Asked Questions

What is Norpramin?

Norpramin is a tricyclic antidepressant and nerve pain medication prescribed to treat depression. 

What is Doxepin?

Doxepin is also a tricyclic antidepressant and nerve pain medication. It’s prescribed to treat depression and anxiety.

Are Norpramin and Doxepin the same drug?

While Norpramin and Doxepin belong to the same drug class, they have different side effects, doses, and forms. 

Are Norpramin and Doxepin off-label treatments for anxiety?

Doxepin is approved to treat anxiety, whereas Norpramin can be prescribed to treat panic disorders and social anxiety on an off-label basis.

What’s better for anxiety? Norpramin or Doxepin?

Doxepin is approved to treat depression and anxiety. Norpramin is a mood stabilizer, but it is primarily approved to treat depression. You should always discuss the best medication for your particular needs with a healthcare professional.

What’s better for depression? Norpramin or Doxepin?

Norpramin and Doxepin both treat depression. However, neither are first-line medications. The best option for you will depend on your health history, current symptoms, and the recommendation of your healthcare provider.

If you have a history of heart disease, Norpramin may not be the right choice. Doxepin could be a helpful treatment, but it also has a wide variety of side effects. 

Can I drive on antidepressants like Norpramin and Doxepin?

Norpramin and Doxepin can make you drowsy. Do not drive or operate machinery while taking either medication. 

Can I drink alcohol on Norpramin or Doxepin?

Both Norpramin and Doxepin interact with alcohol. Norpramin can increase the effects of alcohol within your body, causing negative side effects like dizziness, vomiting, and fatigue. Mixing Doxepin and alcohol can have serious side effects like central nervous system depression and an increased risk of falling. Do not drink while on either medication.

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

Because Norpramin and Doxepin can make you drowsy, it’s often recommended that you take them before bed at night. Ideally, you take Norpramin or Doxepin at the same time every day to maintain consistency and to better understand how the medication will affect you. 

Klarity Helps You Find Depression Treatment Online

Finding out which depression treatment is right for you doesn’t have to mean long wait times or inconvenient commutes to the nearest clinic. 

The board-certified healthcare providers on Klarity can do a thorough online consultation and prescribe the medication to treat your symptoms from the comfort of your home. 

Take this brief 2-minute self-evaluation and Klarity will match you with the right provider within 48 hours. 

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