Sinequan

Before taking this medicine

Do not take Sinequan (doxepin) if you: • Are allergic to doxepin. Reactions have included tongue swelling and hives; cross-sensitivity with other dibenzoxepines is possible. • Have glaucoma. • Have, or have ever had, urinary retention (difficulty emptying your bladder). • Are taking a monoamine oxidase inhibitor (MAOI), or have stopped one within the past 14 days. This includes linezolid and intravenous methylene blue, because of the increased risk of serotonin syndrome. Doxepin should also be avoided in people with untreated narrow drainage angles in the eyes. It can cause sedation; do not drive or operate dangerous machinery while taking it. Patients should be monitored for worsening symptoms, suicidal thoughts or behaviour, and serotonin syndrome. The risk of serotonin syndrome increases when doxepin is taken with other medicines that affect serotonin. If serotonin syndrome occurs, doxepin and any other serotonergic medicines must be stopped immediately and supportive treatment started. Screening for bipolar disorder is needed before treatment because mania or hypomania may occur. Doxepin is not approved to treat bipolar depression. Use during late pregnancy can cause adaptation problems in newborns, including breathing or feeding difficulties, unstable temperature, low muscle tone and irritability. Babies exposed during the third trimester should be monitored. Breastfeeding is not recommended. Older adults may develop confusion or excessive sedation. People who metabolise medicines poorly through CYP2C19 or CYP2D6 have an increased risk of adverse reactions.