Dosing & Uses
Dosage Forms & Strengths
cream
- 5%
Pruritus
Apply to affected area q6hr
Administration
Allow at least 3-4 hour intervals
No more than 8 days chronic use
Not recommended
Interactions
Interaction Checker
No Results

Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor

Contraindicated (1)
- selegiline
selegiline increases levels of doxepin cream by pharmacodynamic synergism. Contraindicated. Avoid combination within 14 days of MAOI use.
Serious - Use Alternative (15)
- dacomitinib
dacomitinib will increase the level or effect of doxepin cream by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.
- fosphenytoin
fosphenytoin will decrease the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- isocarboxazid
isocarboxazid increases levels of doxepin cream by pharmacodynamic synergism. Contraindicated. D/C MAO inhibitor 2 weeks before.
- linezolid
linezolid increases levels of doxepin cream by pharmacodynamic synergism. Contraindicated. D/C MAO inhibitor 2 weeks before.
- lopinavir
lopinavir will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- mefloquine
mefloquine increases toxicity of doxepin cream by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.
- methylene blue
methylene blue and doxepin cream both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.
- nefazodone
nefazodone will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- phenelzine
phenelzine increases levels of doxepin cream by pharmacodynamic synergism. Contraindicated. D/C MAO inhibitor 2 weeks before.
- procarbazine
procarbazine increases levels of doxepin cream by pharmacodynamic synergism. Avoid or Use Alternate Drug. D/C MAO inhibitor 2 weeks before.
- rifapentine
rifapentine will decrease the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- selegiline transdermal
selegiline transdermal increases levels of doxepin cream by pharmacodynamic synergism. Contraindicated. D/C MAO inhibitor 2 weeks before.
- tipranavir
tipranavir will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- tranylcypromine
tranylcypromine increases levels of doxepin cream by pharmacodynamic synergism. Contraindicated. D/C MAO inhibitor 2 weeks before.
- voriconazole
voriconazole will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
Monitor Closely (32)
- abiraterone
abiraterone increases levels of doxepin cream by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.
- amobarbital
amobarbital will decrease the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- atazanavir
atazanavir will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cannabidiol
cannabidiol, doxepin cream. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Owing to the potential for both CYP1A2 induction and inhibition with the coadministration of CYP1A2 substrates and cannabidiol, consider reducing dosage adjustment of CYP1A2 substrates as clinically appropriate.
- carbamazepine
carbamazepine will decrease the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cenobamate
cenobamate will decrease the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
- ceritinib
ceritinib will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cimetidine
cimetidine increases levels of doxepin cream by decreasing metabolism. Use Caution/Monitor.
- clarithromycin
clarithromycin will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cobicistat
cobicistat will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- darunavir
darunavir will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- eliglustat
eliglustat increases levels of doxepin cream by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.
- fedratinib
fedratinib will increase the level or effect of doxepin cream by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.
- iloperidone
iloperidone increases levels of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.
- indinavir
indinavir will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- itraconazole
itraconazole will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- levothyroxine
levothyroxine increases effects of doxepin cream by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.
- liothyronine
liothyronine increases effects of doxepin cream by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.
- liotrix
liotrix increases effects of doxepin cream by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.
- lorcaserin
lorcaserin will increase the level or effect of doxepin cream by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- mifepristone
mifepristone will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- mirabegron
mirabegron will increase the level or effect of doxepin cream by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- nelfinavir
nelfinavir will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifampin
rifampin will decrease the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ritonavir
ritonavir will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rolapitant
rolapitant will increase the level or effect of doxepin cream by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.
- rucaparib
rucaparib will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- saquinavir
saquinavir will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- stiripentol
stiripentol will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tazemetostat
tazemetostat will decrease the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- terbinafine
terbinafine will increase the level or effect of doxepin cream by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.
- thyroid desiccated
thyroid desiccated increases effects of doxepin cream by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.
Minor (6)
- acetazolamide
acetazolamide will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- anastrozole
anastrozole will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- cyclophosphamide
cyclophosphamide will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ethanol
ethanol increases effects of doxepin cream by pharmacodynamic synergism. Minor/Significance Unknown.
- larotrectinib
larotrectinib will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ribociclib
ribociclib will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
Adverse Effects
>10%
Burning/stinging (23%)
Drowsiness (20%; esp if applied to >10% BSA)
1-10%
Dizziness (2%)
Dry mouth (10%)
Eczema exacerbated
Edema (1%)
Emotional changes (2%)
Warnings
Contraindications
Hypersensitivity
Narrow-angle glaucoma
Urinary retention
Side effects increased by MAO inhibitors; discontinue MAOIs 2 weeks before doxepin
During acute recovery phase of MI
Cautions
Risk of drowsiness
May cause anticholinergic effects (xerostomia, constipation, urinary retention)
Use caution in patients with decreased intestinal motility, paralytic ileus
Possibility of significant systemic absorption, resulting in anticholinergic effects
May cause orthostatic hypotension
May cause sedation
Use caution in patients with cardiovascular disease or hepatic or renal impairment
Allow at least 3-4 hr between applications
Use caution in patients with thyroid dysfunction or seizure disorder
Pregnancy & Lactation
Pregnancy Category: B
Lactation: May pass into breast milk; do not nurse
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Potent histamine H1- & H2-receptor antagonist activity
Pharmacokinetics
Absorption: Absorptioin possible
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