Aponal®

Active ingredient

Doxepin

introduction

Doxepin (trade name: Aponal®) is a drug from the group of tricyclic antidepressants.

It works in the central nervous system by inhibiting the re-uptake of the neurotransmitters (messenger substances) serotonin and noradrenaline. Doxepin has a mood-enhancing and sedating (dampening) effect.

Read more on this topic: The role of serotonin / neurotransmitters in depression

The main indication (area of ​​application) is depression. While the dampening effect sets in quickly after taking it, it takes about 2-3 weeks for the mood-enhancing effect to set in. This course is typical for antidepressants.

Side effects

Tricyclic antidepressants is a anticholinergic effect common. This means that they have certain receptors (cholinergic receptors) To block and thus certain Side effects cause.

Typical anticholinergic side effects include:

• Dry mouth
• Constipation (Constipation)
• Problems at the Urination (Micturition disorders)
• Racing heart (Tachycardia)
• Difficulty focusing with the eyes (Accommodation disorders)
• a Increase in intraocular pressure (to be considered especially in patients with glaucoma) and
• States of confusion With Clouding of consciousness (Delirium).

Other possible side effects of Doxepin include:

• Cardiac arrhythmias
• Drop in blood pressure (Hypotension)
• Gastrointestinal complaints how nausea and stomach pain
• skin rash (Exanthema) and itching
• appetite- and Weight gain
• increased sweating (Hyperhidrosis)
• fatigue
• Increase in liver values (Transaminases) in the blood and
• sexual dysfunction such as decreased sexual interest (decrease in libido) or Erectile dysfunction

Rare can it to Changes in blood count can come, and in the case of pre-stressed people risk For epileptic seizures increase (lowering of the seizure threshold). Occasionally, the syndrome of inadequate ADH secretion (SIADH or Schwartz-Bartter syndrome) can occur, among other things in a Changes the composition of the Blood salts (Electrolytes) with corresponding symptoms.

Interactions

A combination with other depressant (sedative) agents should be avoided or handled carefully, as this increases the depressant effect and possibly inhibits the respiratory drive (respiratory depressive effect).
These include alcohol, older drugs against hay fever and other allergies (antihistamines), sedatives such as benzodiazepines (e.g. Valium®), sleeping pills, certain pain relievers (opioids), drugs for the treatment of psychoses (neuroleptics) and drugs for the treatment of epilepsies (antiepileptics) ).

The combination with other drugs that also have an anticholinergic effect (i.e. have an inhibitory effect on the acetylcholine receptor) should be handled carefully because of the possible increase in side effects.
These include, for example, other drugs against depression from the group of tricyclic antidepressants, atropine (Dysurgal®) and certain Parkinson's medications (e.g. Biperiden = Akineton®).

A combination with MAOIs, which are also used to treat depression, should be avoided as there is a risk of serious side effects. Among other things, states of excitement and confusion with clouding of consciousness, seizures and fever.
A combination of these symptoms is known as serotonin syndrome or serotonergic syndrome. It is life-threatening and requires immediate discontinuation of the triggering drug as well as medical treatment and supervision.

Treatment with Aponal® can reduce the effects of certain antihypertensive drugs. E.g. Clonidine (e.g. Catapresan ®) and methyldopa (e.g. Presinol®), which is mainly used during pregnancy. However, an increased decrease in blood pressure can also occur with combination treatment with, for example, beta-blockers (e.g. Beloc Zok ® and nitrates (e.g. Nitrangin®).

Combination with drugs used to treat cardiac arrhythmias (antiarrhythmics) such as amiodarone and quinidine can increase the risk of cardiac arrhythmias.

dosage

Doxepin can as tablet or dragee, in Teardrop shape and as Solution for injection administered. The dosage should always take place after consultation with the doctor and be based on the patient's individual reaction. The treatment of depression is usually done with 50 mg doxepin (Tablet) on Eve began. After a few days, the dose can be increased if necessary 75 mg and after a few more days up to 150 mg can be increased. A daily dose of 150 mg should not be exceeded for outpatient treatment. A Dose increase should only according to the arrangement with the attending physician respectively. If side effects occur, the doctor should be informed.

Treatment with Doxepin - like that with other antidepressants - should be continued after the symptoms have subsided at least 4-6 months to be continued. If Doxepin is to be discontinued, it should creeping out (i.e. with gradual, slow dose reduction). Dose adjustment at Teenagers and elderly patients (lower dose required).

50-75-150 - when are which dosages used?

The active ingredient doxepin contained in Aponal® is initially prescribed in low doses for antidepressant treatment. There one often starts with a dosage of 50 mg. In order to achieve a sleep-promoting effect at the same time, it is recommended to take it before going to bed. If it is not effective, the dose can be increased after a few days. After three to four days the dose can be increased to 75 mg, after seven to eight days it can be increased to 100 to 150 mg per day.

Overall, however, a daily dose of 150 mg should not be exceeded in outpatient treatment of a depressive illness. If necessary, the dose can be increased to up to 300 mg in the case of inpatient drug treatment, taking precautionary measures into account.

To Treatment of withdrawal symptomsas they can occur with alcohol, drug or drug addiction 50 mg doxepin three times a day administered. This continues for three days. The dose can then be continuously reduced until treatment is stopped.

In order to end a therapy with Aponal®, the dose must be continuously reduced over a longer period in order to avoid specific withdrawal symptoms. The dose is reduced by about half a week.

application

The main indication (area of ​​application) is endogenous depression, with Doxepin being more of a second choice.

The first choice for treating depression include drugs from the group of serotonin reuptake inhibitors (SSRIs), venlafaxine and mirtazapine.

Other areas of application are restlessness and sleep disorders, as Doxepin has a dampening (sedating) effect. Doxepin can also be prescribed for anxiety disorders. It is also used in some cases to treat mild withdrawal symptoms caused by alcohol or drug addiction.

Aponal® drops

In addition to the dosage form in the form of tablets, Aponal® is also available in the form of drops in the pharmacy with a prescription. One pack contains 30 ml of the drops. They become doxepin with their active ingredient used to treat depressive disorders. The The effect, side effects and interactions are comparable to those of the tablet form.

Aponal® drops should be taken diluted with a glass of water, since if taken undiluted, the tongue and oral mucosa may temporarily become numb. It can be taken both before and after meals and before going to bed. However, you should ensure that the drops are taken regularly in order to achieve a constant amount of the active ingredient in the blood. An antidepressant effect occurs after 1 to 2 weeks at the earliest, while the side effects can occur a few days after the start of therapy.

Contraindication

When known Hypersensitivity against Doxepin may no use respectively. Other contraindications are:

• States of confusion with impaired consciousness (delirium)
• poisoning (Intoxication) with central depressant drugs (Sleeping pills, sedatives, pain relievers)
• Intestinal paralysis (paralytic ileus)
• acute urinary retention and
• an untreated one Angle-closure glaucoma (certain form of the green star).

Doxepin must also not be used during Lactation and at Children under 12 years. Very careful Application at Heart disease (coronary artery disease (CHD), heart failure, cardiac arrhythmias, long QT syndrome) epilepsy, glaucoma (Glaucoma), Enlargement of the prostate (Prostatic hyperplasia), severe liver problems and Blood disorders.
An application of Doxepin during the pregnancy should only be done if she unavoidable is.

costs

The Prices For Aponal® vary depending on the manufacturer. On Private prescription 100 tablets of 50 mg cost about 25 euros (Doxepin Holsten 21 euros), 100 tablets of 100 mg cost about 34 euros (Doxepin Holsten 29 euros) (Source: Red List). With Till prescription only falls Prescription fee from 5 euros on.