If you are exploring tricyclic antidepressants, chances are you have treatment-resistant depression, haven’t responded well to first-line depression treatments like SSRIs or SNRIs, or have comorbid mental illnesses that require treatment with tricyclics.
As you are probably aware, there are many tricyclic antidepressant medications. This is because tricyclics are one of the oldest pharmaceutical treatments for depression. Though these medications all have a similar mode of action—some differences could make one a more favorable treatment than another.
In this post, we’ll explore key differences between the tricyclics Norpramin and Doxepin so that you’re better prepared to talk with your medical provider about your options for treatment. We’ll discuss—
- What Tricyclics Are
- What These Drugs Treat
- How Much These Drugs Cost
- Potential Side Effects, Drug Warnings, and Interactions
- Plus, we’ll answer many frequently asked questions!
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|Drug Class||Tricyclic antidepressant||Tricyclic antidepressant
|Brand/Generic Status||Brand name for desipramine||Generic (Brand name: Silenor)
|Form(s) of the Drug||• Immediate-release tablets||• Immediate-release capsules
• Immediate-release tablets
• Clear, blueberry-mint flavored liquid suspension
• Topical cream (for itching)
|Standard Dosage||Tablets: |
• 10mg per dose
• 5% formula
|Conditions Treated||FDA-approved uses: |
• Major depressive disorder
• Various mood disorders
• Nerve pain
• Sleep disorders
• Overactive bladder
• Bulimia nervosa
• Irritable bowel syndrome (IBS)
• Major depressive disorder
• Anxiety disorder
• Itchiness due to atopic dermatitis, pruritus, or lichen simplex chronicus
• Topical neuropathic pain
|Cost||Generic form (desipramine): |
• $7.33 for a 30-day supply
• $52 to $61 for a 30-day supply
|Brand name (Silenor):
• $32 to $525 for a 30-day supply
Generic form (doxepin)
• $36 to $90 for a 30-day supply
• $8 for a 30-day supply with coupons/discounts
|Side-Effects||Common side effects: |
• Nausea and vomiting
• Loss of appetite
• Dry mouth
• Confusion, delusions, and hallucinations
• Restlessness, anxiety, and tremors
• Trouble sleeping (insomnia, nightmares)
• Sun sensitivity
• Weight changes
• Breast growth in men
Serious side effects:
• Chest pain
• Irregular heartbeat
• Weakness on one side of the body
• Eye pain, swelling, or redness
• Changes in vision
|Common side effects:
• Agitation, confusion
• Black, tarry stools, bleeding gums, blood in urine or stool
• Blurred vision
• A sensation of burning, itching, or “pins and needles” on the skin
• Chest pain or tightness, fast or irregular heartbeat
• Chills, cold sweats
• Urinary retention
• Dizziness upon standing, loss of consciousness
• Hearing loss
• Muscle spasms, stiffness, twitching
|Warnings For Use||Drug interactions: |
• Heart medications
• Blood pressure medications
• Thyroid supplements
• Seizure medications
• Blood thinners
• Thyroid supplements
• Anticholinergic drugs
• Some blood pressure medications: clonidine
• MAO inhibitors: isocarboxazid, linezolid, metaxalone, methylene blue
• St. John's Wort
• Drugs to treat irregular heart rate
Doxepin and Norpramin Are the Same Class of Medication (Tricyclics)
Norpramin and Doxepin belong to the same class of medication: tricyclic antidepressants. Each is primarily prescribed to treat depression, but they are also prescribed to treat other mental health conditions like anxiety disorders and chronic pain disorders like fibromyalgia.
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 more of these neurotransmitters are in the brain to account for any chemical imbalances and relieve symptoms of depression.
Unlike more recent antidepressants, like SSRIs or SNRIs, Doxepin, Norpramin, and other tricyclic antidepressants are nonselective. This means tricyclic antidepressants affect many different serotonin receptors all over the body. This differs from selective antidepressants—like SSRIs and SNRIs.
Because tricyclic antidepressants are nonselective, they can produce more side effects than SSRIs or SNRIs. Medical providers usually prescribe tricyclics when the first-line treatments do not improve depression symptoms or other mental health issues.
Doxepin and Norpramin Are Both Used to Treat Major Depressive Disorder
While Doxepin and Norpramin are used to treat major depressive disorder (MDD), characterized by 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
- 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 is a tablet; 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 to 300 mg per day.
Common Norpramin Side Effects
Common side effects of Norpramin include—
- Dry mouth
- Blurred vision
- Difficulty sleeping
- Weight changes
However, there are other side effects Norpramine users need to be aware of:
- Cardiovascular side effects: Norpramin can cause cardiovascular side effects such as rapid heart rate, high blood pressure, and irregular heartbeat. These side effects can be especially problematic for people with a history of heart disease.
- Anticholinergic side effects: Norpramin has anticholinergic properties, which can lead to side effects such as dry mouth, constipation, blurred vision, and urinary retention.
- Neurological side effects: Norpramin can cause neurological side effects such as confusion, agitation, tremors, and seizures. These side effects are more common in people who take high doses of the medication.
- Sexual side effects: Norpramin can cause sexual side effects such as decreased libido, erectile dysfunction, and difficulty achieving orgasm.
- Allergic reactions: In rare cases, Norpramin can cause allergic reactions such as hives, rash, itching, and swelling of the face, tongue, or throat. If you experience these symptoms, you should seek medical attention immediately.
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 Norpramin Drug Interactions
There is a risk of drug interactions when taking Norpramin, which can affect the medication’s effectiveness or increase the risk of side effects.
Here are some of the possible drug interactions with Norpramin:
- Monoamine oxidase inhibitors (MAOIs): Combining Norpramin with MAOIs can result in a potentially life-threatening condition called serotonin syndrome. This is because both medications affect the levels of the neurotransmitter serotonin in the brain, which can lead to an excessive buildup of serotonin.
- Other antidepressants: Norpramin can interact with other antidepressants, including selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. These interactions can increase the risk of side effects, such as dizziness, confusion, and sedation.
- Antipsychotics: Norpramin can interact with antipsychotic medications, increasing the risk of side effects such as sedation, confusion, and dizziness.
- Antihistamines: Norpramin can interact with antihistamines, increasing the risk of side effects such as dry mouth, constipation, and urinary retention.
- Alcohol: Drinking alcohol while taking Norpramin can increase the risk of side effects, such as dizziness, sedation, and impaired coordination.
- Blood thinners: Norpramin can interact with blood-thinning medications, such as warfarin, increasing the risk of bleeding.
- Stimulants: Norpramin can interact with stimulant medications, such as amphetamines, increasing the risk of side effects such as agitation, anxiety, and heart palpitations.
It is essential to tell your doctor about all medications you are taking, including prescription and over-the-counter medications, herbal supplements, and vitamins, to avoid potential drug interactions.
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, Doxepin has several common side effects, including:
- Dry mouth
- Blurred vision
- Difficulty sleeping
- Weight gain
But there are other side effects of Doxepin you need to be aware of:
- Cardiovascular side effects: There is a risk of cardiovascular side effects like rapid heart rate, high blood pressure, and irregular heartbeat when taking Doxepin.
- Neurological side effects: Neurological side effects like confusion, agitation, tremors, and seizures are possible while taking Doxepin. This is more common for people on high doses of the medication.
- Sexual side effects: Doxepin can cause sexual side effects such as decreased libido, erectile dysfunction, and difficulty achieving orgasm.
- Allergic reactions: Like Norpramin, taking Doxepin can cause allergic reactions, including hives, rash, itching, and swelling of the face, tongue, or throat. This is a serious medical reaction—seek emergency medical attention immediately.
- Other side effects: Taking Doxepin can lead to other side effects, such as sweating, headache, weakness, fatigue, and vomiting.
Common Doxepin Drug Interactions
Doxepin has many similar drug interactions to Norpramin, but there are key differences.
- Monoamine oxidase inhibitors (MAOIs): Like with Norpramin, taking doxepin with MAOIs can lead to a dangerous condition called serotonin syndrome. This can occur because both medications affect the levels of the neurotransmitter serotonin in the brain, which can result in an excessive buildup of serotonin.
- Other antidepressants: Doxepin interacts with the same antidepressant medications that Norpramin does, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).
- Antihistamines: Doxepin acts like an antihistamine. When you take it with other antihistamines, you increase the risk of experiencing drowsiness, dry mouth, and constipation.
- CNS depressants: Doxepin can interact with other medications that depress the central nervous system (CNS), such as benzodiazepines and opioids. This can increase the risk of side effects such as sedation, confusion, and respiratory depression.
- Alcohol: Drinking alcohol while taking doxepin can increase the risk of side effects, such as drowsiness, dizziness, and impaired coordination.
- Blood thinners: Doxepin interacts with blood-thinning medications like warfarin. This increases the risk of bleeding.
- Thyroid hormones: Doxepin can interact with thyroid hormones, potentially altering thyroid hormone levels.
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, which 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. Your infant should also be monitored for sleep apnea and excessive drowsiness if breastfeeding.
Increased Bleeding Risk with Tricyclics
While tricyclics alone don’t necessarily increase your risk of internal bleeding, when combined with blood thinners like Warfarin, there is an increased bleeding risk. 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, what you’re thinking, or if you experience 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 are 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?
You should always discuss the best medication with a healthcare professional. Doxepin is approved to treat depression and anxiety. Norpramin is a mood stabilizer, but it is primarily approved to treat depression.
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 has many 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, you should 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
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The board-certified healthcare providers on Klarity can do a thorough online consultation and prescribe the medication to treat your symptoms if needed from the comfort of your home.
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Mayo Clinic Staff. “Tricyclic antidepressants and tetracyclic antidepressants.” Mayo Clinic
“Compare doxepin vs. desipramine.” Iodine
Mayo Clinic Staff. “What is depression? A Mayo Clinic expert explains.” Mayo Clinic
IBM Micromedex. “Doxepin (Oral Route).” Mayo Clinic
David N. Neubauer. “Pharmacotherapeutic Approach to Insomnia in Adults.” ScienceDirect
“Doxepin (Insomnia)” MedlinePlus
Jasdave S. Maan; Alan Rosani; Abdolreza Saadabadi. “Desipramine.” National Library of Medicine
P L Hughes, L A Wells, C J Cunningham, D M Ilstrup. “Treating bulimia with desipramine. A double-blind, placebo-controlled study.” National Library of Medicine
John P. Cunha, DO, FACOEP. “Norpramin.” RxList
“Norpramin Interactions.” Drugs.com
“Norpramin Prices, Coupons and Patient Assistance Programs.” Drugs.com
“Doxepin Dosage.” Drugs.com
“Doxepin (Depression, Anxiety).” MedlinePlus
“Doxepin (Sinequan).” Everyday Health
“Doxepin Prices, Coupons and Patient Assistance Programs.” Drugs.com
Mayo Clinic Staff. “Serotonin Syndrome.” Mayo Clinic
Kelly A. Cochran, Larisa H. Cavallari, Nancy L. Shapiro, Jeffrey R. Bishop. “Bleeding Incidence with Concomitant Use of Antidepressants and Warfarin” National Library of Medicine
Femi Aremu. “Doxepin, Oral Capsule.” Healthline