This sheet talks about exposure to doxepin during a pregnancy and while breastfeeding. This information should not take the place of medical care and advice from your healthcare provider.
What is doxepin?
Doxepin is a tricyclic antidepressant approved to treat alcoholism, anxiety, depression, and insomnia (difficulty sleeping). As a cream it is used for short term treatment of itchiness. Some brand names include Quitaxon®, Prudoxin®, Silenor®, Sinequan®, and Zonalon®. There are other brand names for this medication. It is also marketed as a combination drug with levomenthol under the brand name Doxure®.
I take doxepin. Can it make it harder for me to get pregnant?
Studies on women have not yet been done to see if taking doxepin could make it harder for a woman to get pregnant.
I just found out that I am pregnant. Should I stop taking doxepin?
You should discuss any changes in your dose, or stopping of this medication with your healthcare providers who can also discuss the risks of not taking this medication. If you plan to stop this medication, your healthcare provider might suggest that you gradually lower the dosage instead of stopping all at once. This is because some people can have withdrawal symptoms when they suddenly stop taking doxepin.
MotherToBaby has fact sheets on depression https://mothertobaby.org/fact-sheets/depression-pregnancy/pdf/, anxiety https://mothertobaby.org/fact-sheets/anxiety/pdf/ and alcohol https://mothertobaby.org/fact-sheets/alcohol-pregnancy/pdf/.
Does taking doxepin increase the chance for miscarriage?
Studies on pregnant women have not been done to see if there is any increase in miscarriage while taking doxepin in early pregnancy.
Does taking doxepin in the first trimester increase the chance of having a baby with a birth defect?
This is not clear. In every pregnancy, a woman starts out with a 3-5% chance of having a baby with a birth defect. This is called her background risk. Based on animal studies, doxepin is not likely to increase the chance for birth defects. However, this medication has not been well studied for use in pregnant women. In a series of 8 pregnancies, there were no birth defects; but this number is too small to know what the risks/safety for doxepin is during pregnancy.
Could doxepin cause other pregnancy complications?
There are no studies available to understand if doxepin might cause other pregnancy complications.
I need to take doxepin throughout my pregnancy. Will it cause withdrawal symptoms in my baby after birth?
Possibly. There are no studies available to understand if doxepin might cause other pregnancy complications. However, withdrawal symptoms have been noticed when a mother has used different tricyclic antidepressants. Symptoms reported with other medications in this class of drugs are usually mild an may include: jitteriness, vomiting, crying, fussiness, altered sleep patterns, tremors, and/or difficulty eating and regulating body temperature. In most cases these symptoms were mild and went away on their own within a week or two after birth.
Can I breastfeed my baby if I am taking doxepin?
Breastfeeding while using doxepin has not been studied. Doxepin passes into breast milk and may have undesirable effects on a nursing infant. Two case reports of respiratory depression (difficulty breathing) have been reported in nursing babies of mothers who used doxepin. If you are breastfeeding while taking doxepin, contact your healthcare provider right away if you are worried about any symptoms that the baby has. Be sure to talk to your healthcare provider about all of your breastfeeding questions.
What if the baby’s father takes doxepin?
There are no studies looking at risks to a pregnancy when the father takes doxepin. In general, exposures that fathers have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures and Pregnancy at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/pdf/.
Selected References
- Amstron C. 2008. ACOG Guidelines on Psychiatric Medication Use During Pregnancy and Lactation. Am Fam Physician; 78(6):772-778.
- Eberhard-Gran M, et al. 2006. Use of psychotropic medications in treating mood disorders during lactation: practical recommendations. CNS Drugs. 20(3):187-98.
- Frey OR, et al. 1999. Adverse effects in a newborn infant breast-fed by a mother treated with doxepin. Ann Pharmacother; 33(6):690-3.
- Iqbal MM. 1999. Effects of Antidepressants During Pregnancy and Lactation. Ann Clin Psychiatry. 11(4):237-56.
- Kirchheiner J, et al. 2005. Impact of the CYP2D6 ultra-rapid metabolizer genotype on doxepin pharmacokinetics and serotonin in platelets. Pharmacogenet. Genomics; 15(8):579–87.
- Steiner M. 2012. Prenatal exposure to antidepressants: how safe are they? Am J Psychiatry; 169(11): 1130–1132.
- Venkatesh KK, et al. 2017. Impact of antidepressant treatment during pregnancy on obstetric outcomes among women previously treated for depression: an observational cohort study. J Perinatol; 37(9):1003-1009.
National Pregnancy Registry for Psychiatric Medications: There is a pregnancy registry for women who take psychiatric medications, such as doxepin. For more information you can look at their website: https://womensmentalhealth.org/research/pregnancyregistry/.
