Therapeutic rationale for low dose doxepin in insomnia patients

Katwala, Jigar; Kumar, Ananda K; Sejpal, Jaykumar J; Marcelle, Terrence; Mishra, Manish

doi:10.1016/s2222-1808(13)60080-8

Cited by 20 publications

(9 citation statements)

References 22 publications

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“…30 Low-dose doxepin is different from other tricyclic antidepressants in that it is not associated with increased risk of suicide or abuse potential and is not known to prolong QT interval. 31 In our study, only 2 patients had adverse effects of enuresis and aggressive behavior, making these and any other reported adverse effects very uncommon.…”

Section: Discussionmentioning

confidence: 50%

Doxepin in children and adolescents with symptoms of insomnia: a single-center experience

Shah

Stringel

Pavkovic

et al. 2020

Journal of Clinical Sleep Medicine

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Study Objectives: Pediatric insomnia is a widespread problem and especially difficult to manage in children with neurodevelopmental disorders. There are currently no US Food and Drug Administration-approved medications to use once first-line therapy fails. The objective of this study was to evaluate the efficacy and tolerability of doxepin in pediatric patients. Methods: This is a retrospective single-center chart review of children and adolescents (2-17 years of age) whose sleep failed to improve with behavioral intervention and melatonin who were then trialed on doxepin. Treatment was initiated at a median starting dose of 2 mg and slowly escalated to a median maintenance dose of 10 mg. Improvement in sleep was recorded using a 4-point Likert scale reported by parents on follow-up visits. Results: A total of 29 patients were included in the analysis. Mean follow-up duration was 6.5 ± 3.5 months. Of 29 patients, 4 (13.8%) patients discontinued doxepin because of lack of efficacy or side effects. Eight (27.6%) patients showed significant improvement of their insomnia, 8 (27.6%) showed moderate improvement, 10 (34.5%) showed mild improvement, and 3 (10.3%) showed minimal to no improvement on treatment with doxepin (P <.05) Only 2 patients (6.9%) experienced adverse effects in the form of behavioral side effects (aggression) and enuresis. Conclusions: Results of our studies suggest that low-dose doxepin is both effective and well tolerated in pediatric patients with insomnia.

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Section: Discussionmentioning

confidence: 50%

Doxepin in children and adolescents with symptoms of insomnia: a single-center experience

Shah

Stringel

Pavkovic

et al. 2020

Journal of Clinical Sleep Medicine

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“…These drugs decrease sleep latency, increase total sleep time (TST), and quality of sleep except for zaleplon which is effective for decreasing sleep latency. [ 41 42 ] According to a meta-analysis (13 studies, N = 4378), non-BZDs (Z-drugs) improved polysomnographic sleep onset (95% CI, −0.57, 0.16) and subjective sleep onset (−0.33, −0.62, 0.04). [ 43 ]…”

Section: Resultsmentioning

confidence: 99%

Role of optimum diagnosis and treatment of insomnia in patients with hypertension and diabetes: A review

Garg

2018

J Family Med Prim Care

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“… 39 In addition, doxepin, a selective blocker of H1R, is also used at low concentrations (1–6 mg) to treat insomnia. 40 …”

Section: Sleep and Wake Cyclementioning

confidence: 99%

Histaminergic neurotransmission in aging and Alzheimer's disease: A review of therapeutic opportunities and gaps

Satpati

Neylan

Grinberg

2023

A&D Transl Res & Clin Interv

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Introduction Alzheimer's disease (AD) is a progressive neurodegenerative disorderfeaturing a brain accumulation of extracellular β‐amyloidplaques (Aβ) and intracellular neurofibrillary tautangles (NFTs). Although cognitive decline is a disease‐defining symptom of AD, sleep dysfunction, a common symptom often preceding cognitive decline, hasrecently gained more attention as a core AD symptom. Polysomnography and othersleep measures show sleep fragmentation with shortening of N3 sleep togetherwith excessive daytime sleepiness (EDS) and sundowning as the main findings in AD patients. The latter reflects dysfunction of the wake‐promoting neurons (WPNs), including histaminergic neurons (HAN) located in thetuberomammillary nucleus (TMN) of the posterior hypothalamus, which projectunmyelinated axons to various parts of the brain. Histamine's role in cognitionand arousal is broadly recognized. Selective targeting of histaminergic subtype‐3 and 4 receptors show therapeutic potential in rodent models of AD andaging. Method Based on PubMed, Scopus, and google scholar databases search, this review summarizes the current knowledge on the histaminergic system in AD and aging, its therapeutic potential in AD, and highlight areas where moreresearch is needed. Results Animal studies have demonstrated that pharmacological manipulation of histaminergic receptors or histamine supplementation improves cognition in AD models. However, measurements of HA or HA metabolite levels in the human brainand CSF present contradictory reports due to either lack of power or controls for known confounders. Discussion Systemic studies including broad age, sex, neuropathological diagnosis, and disease stage are warranted to fill the gap in our current understanding of the histaminergic neurotransmitter/neuromodulator system in humans, especially age‐related changes, and therapeuticpotential of histamine in AD‐related dysfunction.

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Therapeutic rationale for low dose doxepin in insomnia patients

Cited by 20 publications

References 22 publications

Doxepin in children and adolescents with symptoms of insomnia: a single-center experience

Doxepin in children and adolescents with symptoms of insomnia: a single-center experience

Role of optimum diagnosis and treatment of insomnia in patients with hypertension and diabetes: A review

Histaminergic neurotransmission in aging and Alzheimer's disease: A review of therapeutic opportunities and gaps

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