Doxepin

INTRODUCTION

Indications

PO: Depression. Topical: Short-term control of pruritus associated with Eczematous dermatitis, Lichen simplex chronicus. Unlabeled Use: PO: Chronic pain syndromes: Pruritus, Dermatitis, Anxiety, Insomnia.

Action

PO: Prevents the reuptake of norepinephrine and serotonin by presynaptic neurons; resultant accumulation of neurotransmitters potentiates their activity. Also possesses significant anticholinergic properties. Topical: Antipruritic action due to antihistaminic properties. Therapeutic Effects: PO: Relief of depression. Decreased anxiety. Topical: Decreased pruritus.

Adverse Reactions/Side Effects

CNS: fatigue, sedation, agitation, confusion, hallucinations. EENT: blurred vision, increased intraocular pressure. CV: hypotension, arrhythmias, ECG abnormalities. GI: constipation, dry mouth, hepatitis, increased appetite, weight gain, nausea, paralytic ileus. GU: urinary retention, decreased libido. Derm: photosensitivity, rashes. Hemat: blood dyscrasias. Misc: hypersensitivity reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Measure blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

• Assess heart rate, ECG, and heart sounds, especially during exercise (see Appendixes G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

• Watch for signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia or other blood dyscrasias. Report these signs to the physician.

• Be alert for increased depression and suicidal thoughts and ideology, especially when initiating drug treatment or in children and teenagers. Notify physician or mental health professional immediately if patient exhibits worsening depression or other changes in mood and behavior.

• Monitor any confusion, agitation, hallucinations, or other alterations in cognitive function (See Appendix D). Notify physician promptly if these symptoms develop.

• If used to treat chronic pain, assess pain levels periodically to help document drug efficacy.

• If treating skin disorders, monitor skin lesions and related symptoms (redness, burning, itching) to help assess drug efficacy.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight gain or increased body fat.

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth), and implement fall-prevention strategies (See Appendix E).

• Because of the risk of cardiac arrhythmias and hypotension, use caution during aerobic exercise and endurance conditioning. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix ...