Anxiety
23 min read
Written by Klarity Editorial Team
Published: Nov 9, 2022
Medically Reviewed by Dr. Zoe Russell
If you are exploring tricyclic antidepressants, chances are you have treatment-resistant depression, haven’t responded well to first-line depression treatments like SSRIs or SNRIs, or have comorbid mental illnesses that require treatment with tricyclics.
As you are probably aware, there are many tricyclic antidepressant medications. This is because tricyclics are one of the oldest pharmaceutical treatments for depression. Though these medications all have a similar mode of action—some differences could make one a more favorable treatment than another.
In this post, we’ll explore key differences between the tricyclics Norpramin and Doxepin so that you’re better prepared to talk with your medical provider about your options for treatment. We’ll discuss—
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This article discusses suicide, suicidal ideation, and self-harm. If you or someone you know is experiencing suicidal thoughts or is in crisis, contact the Suicide Prevention Lifeline immediately at 800-273-8255.
Norpramin | Doxepin | |
Drug Class | Tricyclic antidepressant | Tricyclic antidepressant |
Brand / Generic Status | Brand name for desipramine | Generic (Brand name: Silenor) |
Form(s) of the Drug | • Immediate-release tablets | • Immediate-release capsules • Immediate-release tablets • Clear, blueberry-mint flavored liquid suspension • Topical cream (for itching) |
Standard Dosage | Tablets: • 10mg • 25mg • 50mg • 75mg • 100mg • 150mg | Immediate-release capsule: • 10mg • 25mg • 50mg • 75mg • 100mg • 150mg Immediate-release tablets: • 3mg • 6mg Liquid suspension: • 10mg per dose Topical cream: • 5% formula |
Conditions Treated | FDA-approved uses: • Major depressive disorder Off-label uses: • Anxiety • Various mood disorders • Nerve pain • Sleep disorders • Overactive bladder • Bulimia nervosa • ADHD • Irritable bowel syndrome (IBS) | FDA-approved uses: • Major depressive disorder • Anxiety disorder • OCD Off-label uses: • Itchiness due to atopic dermatitis, pruritus, or lichen simplex chronicus • Topical neuropathic pain |
Cost | Generic form (desipramine): • $7.33 for a 30-day supply Brand name: • $52 to $61 for a 30-day supply | Brand name (Silenor): • $32 to $525 for a 30-day supply Generic form (doxepin) • $36 to $90 for a 30-day supply • $8 for a 30-day supply with coupons/discounts |
Side-Effects | Common side effects: • Nausea and vomiting • Loss of appetite • Headache • Dry mouth • Confusion, delusions, and hallucinations • Restlessness, anxiety, and tremors • Trouble sleeping (insomnia, nightmares) • Sun sensitivity • Weight changes • Breast growth in men Serious side effects: • Chest pain • Irregular heartbeat • Seizures • Fainting • Weakness on one side of the body • Eye pain, swelling, or redness • Changes in vision | Common side effects: • Agitation, confusion • Black, tarry stools, bleeding gums, blood in urine or stool • Blurred vision • A sensation of burning, itching, or “pins and needles” on the skin • Chest pain or tightness, fast or irregular heartbeat • Chills, cold sweats • Urinary retention • Dizziness upon standing, loss of consciousness • Headache • Hearing loss • Muscle spasms, stiffness, twitching • Seizures |
Warnings For Use | Drug interactions: • Heart medications • Blood pressure medications • Thyroid supplements • Seizure medications • SSRIs • Blood thinners • MAOIs | Drug interactions: • Thyroid supplements • Anticholinergic drugs • Some blood pressure medications: clonidine • MAO inhibitors: isocarboxazid, linezolid, metaxalone, methylene blue • SSRIs • St. John's Wort • Cimetidine • Terbinafine • Drugs to treat irregular heart rate |
Norpramin and Doxepin belong to the same class of medication: tricyclic antidepressants. Each is primarily prescribed to treat depression, but they are also prescribed to treat other mental health conditions like anxiety disorders and chronic pain disorders like fibromyalgia.
Tricyclic antidepressants (tricyclics) block the serotonin and norepinephrine reuptake in the brain. Serotonin and norepinephrine are neurotransmitters, or messengers, that communicate between brain cells to regulate mood and energy levels.
Tricyclics stop the reabsorption of serotonin and norepinephrine so that more of these neurotransmitters are in the brain to account for any chemical imbalances and relieve symptoms of depression.
Unlike more recent antidepressants, like SSRIs or SNRIs, Doxepin, Norpramin, and other tricyclic antidepressants are nonselective. This means tricyclic antidepressants affect many different serotonin receptors all over the body. This differs from selective antidepressants—like SSRIs and SNRIs.
Because tricyclic antidepressants are nonselective, they can produce more side effects than SSRIs or SNRIs. Medical providers usually prescribe tricyclics when the first-line treatments do not improve depression symptoms or other mental health issues.
While Doxepin and Norpramin are used to treat major depressive disorder (MDD), characterized by sadness and apathy, they are also prescribed to treat other issues.
While Doxepin isn’t the right medication for everyone, it is primarily used to treat depression and anxiety. That said, it’s also used to treat other issues in an off-label capacity, depending on the advice of your healthcare provider.
Doxepin can be used off-label to treat sleep disorders like insomnia. Off-label use means that, while the medication may be an effective part of treatment, it is not currently approved by the FDA. Because Doxepin slows brain activity, it can help you fall asleep and stay asleep.
Like Doxepin, Norpramin is approved to treat MDD, but it does have off-label uses that can be effective for some people. Because this medication has many side effects, you should always consult a healthcare specialist before taking it.
Off-label uses for Norpramin include treating:
Understanding possible side effects and the dosing schedule can help you and your healthcare provider make the best decision about your health.
Norpramin is a tablet; an adult dose is typically between 100-200 mg daily. The dosage may be lower for elderly or adolescent patients, and Norpramin isn’t recommended for children under 12. Depending on the severity of your symptoms, your care provider may recommend increasing your dosage slowly to 300 mg per day.
Common side effects of Norpramin include—
However, there are other side effects Norpramine users need to be aware of:
Contact your healthcare provider immediately if you experience more serious side effects like elevated heart rate, yellowing skin or eyes, abnormal bleeding or bruising, and skin irritation or swelling.
There is a risk of drug interactions when taking Norpramin, which can affect the medication’s effectiveness or increase the risk of side effects.
Here are some of the possible drug interactions with Norpramin:
It is essential to tell your doctor about all medications you are taking, including prescription and over-the-counter medications, herbal supplements, and vitamins, to avoid potential drug interactions.
Without insurance, 100 tablets of 100 mg of Norpramin cost around $618, depending on your pharmacy. With insurance, it could cost anywhere from $68 to $160 per 100 tablets of 100 mg.
Doxepin, while also used to treat symptoms of anxiety and depression, comes in different forms and is administered in different doses than Norpramin.
Doxepin comes as a liquid, capsule, or tablet and is taken one to three times a day. If your symptoms are less severe, your healthcare provider may prescribe 25-50 mg once a day. For more severe symptoms, the typical adult dose is 75-150 mg daily. Your provider may recommend increasing the amount to 300 mg if necessary.
While you may feel the anti-anxiety effects soon after taking Doxepin, the antidepressant can take two to three weeks before you notice a change in your symptoms.
Like Norpramin, Doxepin has several common side effects, including:
But there are other side effects of Doxepin you need to be aware of:
Doxepin has many similar drug interactions to Norpramin, but there are key differences.
The cost of Doxepin varies depending on your prescribed dosage. You can expect to pay anywhere from $14.50 to $18.17 through GoodRx.com. However, if you’re paying cash without insurance, the price range can be $87 to $292. The generic form, Doxepin, is often more affordable than the brand name version: Silenor.
Yes, both Doxepin and Norpramin require prescriptions. While neither medication is a controlled substance, they are not fist-choices in treating anxiety and depression due to the number of possible side effects. If your healthcare provider does prescribe Doxepin or Norpramin, you should take it exactly as instructed.
Norpramin and Doxepin are not right for everyone. They’re members of the tricyclic class and can have many side effects like serotonin syndrome, issues with pregnancy or breastfeeding, and an increased risk of bleeding.
While the body naturally produces serotonin, which impacts how our brain and nerves function, too much serotonin can have severe adverse effects. Serotonin syndrome occurs when your body produces too much serotonin due to a change in medication or combining certain medications.
You can experience mild symptoms like diarrhea or shivering to more intense symptoms like stiffening muscles, seizures, and fever. If left untreated, serotonin syndrome can be fatal.
If you are pregnant or breastfeeding, you should always consult your doctor before taking tricyclics. In some cases, the fetus may experience withdrawal symptoms if you’ve been taking a tricyclic antidepressant during your pregnancy. Your infant should also be monitored for sleep apnea and excessive drowsiness if breastfeeding.
While tricyclics alone don’t necessarily increase your risk of internal bleeding, when combined with blood thinners like Warfarin, there is an increased bleeding risk. Because tricyclic antidepressants impact blood serotonin levels, they can contribute to abnormal bleeding.
Antidepressants like Doxepin and Norpramin can cause changes in mood and behavior, like thoughts of self-harm and suicidal ideation. Contact your healthcare provider immediately if you experience a shift in how you’re feeling, what you’re thinking, or if you experience panic attacks or insomnia.
Norpramin is a tricyclic antidepressant and nerve pain medication prescribed to treat depression.
Doxepin is also a tricyclic antidepressant and nerve pain medication. It’s prescribed to treat depression and anxiety.
While Norpramin and Doxepin are the same drug class, they have different side effects, doses, and forms.
Doxepin is approved to treat anxiety, whereas Norpramin can be prescribed to treat panic disorders and social anxiety on an off-label basis.
You should always discuss the best medication with a healthcare professional. Doxepin is approved to treat depression and anxiety. Norpramin is a mood stabilizer, but it is primarily approved to treat depression.
Norpramin and Doxepin both treat depression. However, neither are first-line medications. The best option for you will depend on your health history, current symptoms, and the recommendation of your healthcare provider.
If you have a history of heart disease, Norpramin may not be the right choice. Doxepin could be a helpful treatment but it has many side effects.
Norpramin and Doxepin can make you drowsy. Do not drive or operate machinery while taking either medication.
Both Norpramin and Doxepin interact with alcohol. Norpramin can increase the effects of alcohol within your body, causing negative side effects like dizziness, vomiting, and fatigue. Mixing Doxepin and alcohol can have serious side effects like central nervous system depression and an increased risk of falling. Do not drink while on either medication.
Because Norpramin and Doxepin can make you drowsy, you should take them before bed at night. Ideally, you take Norpramin or Doxepin at the same time every day to maintain consistency and to better understand how the medication will affect you.
When you have treatment-resistant depression, finding out which depression treatment is right for you doesn’t have to mean long wait times or inconvenient commutes to the nearest clinic.
The board-certified healthcare providers on Klarity can do a thorough online consultation and prescribe the medication to treat your symptoms if it’s a medically necessary part of your treatment plan and all from the comfort of your home.
Schedule an appointment, and Klarity will match you with the right provider within 24 hours.*
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