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Doxepin overdose

Doxepin hydrochloride overdose

Doxepin is a type of medicine called a tricyclic antidepressant (TCA). It is prescribed to treat depression and anxiety. Doxepin overdose occurs when someone takes more than the normal or recommended amount of this medicine, either by accident or on purpose. A toxic level of a TCA can build up in the body if the TCA and other medicines interact. This interaction can affect how well the body can break down the TCA.

This article is for information only. DO NOT use it to treat or manage an actual overdose. If you or someone you are with overdoses, call the local emergency number (such as 911), or the local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.

Poisonous Ingredient

Doxepin

Where Found

These medicines contain doxepin:

  • Silenor
  • Sinequan
  • Zonalon

Other medicines may also contain doxepin.

Symptoms

Below are symptoms of an overdose of doxepin in different parts of the body:

AIRWAYS AND LUNGS

  • Slow breathing
  • Difficulty breathing

BLADDER AND KIDNEYS

  • Hard to start urinating
  • Hard to empty bladder

EYES, EARS, NOSE, AND THROAT

  • Blurred vision
  • Ringing in the ears

HEART AND BLOOD

  • Irregular heartbeat (may be fatal)
  • Low blood pressure
  • Shock

MOUTH, STOMACH, AND INTESTINAL TRACT

  • Constipation
  • Dry mouth
  • Nausea and vomiting
  • Unpleasant taste in mouth

NERVOUS SYSTEM

  • Agitation, confusion
  • Drowsiness, decreased alertness, coma
  • Headache
  • Muscle rigidity, lack of coordination
  • Restlessness
  • Seizures

SKIN

  • Very sensitive to sunlight

Home Care

Get medical help right away. Do not make the person throw up unless poison control or a health care provider tells you to.

Before Calling Emergency

Have this information ready:

  • Person's age, weight, and condition
  • Name of the medicine and the strength of the medicine, if known
  • Time it was swallowed
  • Amount swallowed
  • If the medicine was prescribed for the person

Poison Control

The local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

You can also get online poison help now at Poisonhelp.org. Just enter the product, poison, or medicine to get expert help.

What to Expect at the Emergency Room

Take the container with you to the hospital, if possible.

Your provider will measure and monitor your vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated. You may receive:

  • Activated charcoal
  • Blood and urine tests
  • Breathing support, including oxygen, or a tube that goes through the mouth into the lungs, and attachment to a breathing machine (ventilator)
  • Chest x-ray
  • CT scan of the brain
  • Electrocardiogram (ECG)
  • Intravenous fluids (given through a vein)
  • Laxative
  • Medicine to treat symptoms
  • Sodium bicarbonate, to counteract the effects of TCA overdose
  • Catheter (thin, flexible tube) into the bladder if the person cannot urinate on their own

Outlook (Prognosis)

How well a person does depends on the amount of medicine they swallowed and how quickly the treatment is received. The faster a person gets medical help, the better the chance for recovery.

Tricyclic antidepressant overdoses are very toxic and difficult to treat. Many people have died from TCA overdose, even with aggressive medical treatment.

Open References

References

Aminoff MJ, So YT. Effects of toxins and physical agents on the nervous system. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 86.

Aronson JK. Doxepin. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:1084.

Levine MD, Ruha AM. Antidepressants. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 141.

 

Review Date: 4/8/2025

Reviewed By: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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