Is Doxepin Safe to Use During Pregnancy? Expert Insights and Recommendations

Is it safe to take Doxepin during pregnancy?

Hello, Doctor.
I am currently 16 weeks pregnant.
Before my pregnancy, I had been taking Doxepin 15 mg (one packet) and Escitalopram 5 mg (one tablet) for 2 to 3 years due to insomnia issues (difficulty falling asleep and light sleep).
However, I feel that Escitalopram has not been effective for me, so I have not taken it even though I have a prescription.
I have researched that Doxepin is a tricyclic antidepressant, and while I did have some psychological issues 2 to 3 years ago, I feel that I have adjusted over time and am no longer as fixated on them.
However, insomnia still follows me, so the doctor prescribed Doxepin, which I find effective.
Now that I am pregnant, I would like to ask:
1.
I took Doxepin for 3 to 5 days before I knew I was pregnant.
Does this have any implications?
2.
After I found out I was pregnant, I experienced significant drowsiness due to morning sickness and did not have sleep issues, so I did not take any medication.
However, starting around week 12, I began to have difficulty falling asleep and light sleep.
Initially, I could sleep well two or three days a week, but it has progressively worsened.
By week 15, I was hardly sleeping well at all, often taking breaks to nap during the day (sometimes for 30 minutes, sometimes for an hour).
A few days ago, I had to return to the mental health clinic for medication, and the doctor prescribed Doxepin 15 mg and Escitalopram 5 mg again.
I asked the doctor about the safety of these medications during pregnancy, and he assured me that it is safe, as he has other pregnant patients who have taken them and delivered healthy babies.
However, I am aware that there is still a risk of teratogenic effects associated with these medications, so I would like to hear your advice and opinion.
Thank you.

3.
Would gradually tapering the medication to the lowest effective dose minimize any potential impact on the baby?
4.
Additionally, is Doxepin completely contraindicated for breastfeeding mothers? Thank you, Doctor.

Doris, 40~49 year old female. Ask Date: 2022/10/04

Dr. Wu Enliang reply Psychiatry

1.
Is there any relation to taking Doxepin for 3 to 5 days when I was unaware of my pregnancy? A: There is no relation.

2.
After I found out I was pregnant, I experienced excessive sleepiness due to morning sickness and did not have any sleep issues, so I did not take any medication.
However, starting around week 12, I began to have difficulty falling asleep and experienced light sleep.
Initially, I could sleep well two to three days a week, but it has progressively worsened.
By week 15, I was hardly sleeping well and often took leave to rest during lunch (sometimes for 30 minutes, sometimes for an hour).
A few days ago, I had to return to the mental health clinic for medication, and the doctor prescribed Doxepin 15 mg and Escitalopram 5 mg.
I asked the doctor about the safety of these medications during pregnancy, and he assured me that it was safe, mentioning that he has had pregnant patients who took them and delivered healthy babies.
However, I am aware that there is still a risk of teratogenic effects associated with these medications, and I would like to hear your advice and opinions.
Thank you.
A: I recommend first enhancing "sleep hygiene" and exploring non-pharmacological methods such as increasing physical activity, relaxation training, and cranial microcurrent stimulation (out-of-pocket) to improve sleep, resorting to medication only when absolutely necessary.
The risk of teratogenic effects should be particularly noted during the first trimester (the first three months).

3.
Would gradually tapering the medication to the lowest dose minimize its impact on the baby? A: Yes.

4.
Is it true that breastfeeding mothers should completely avoid taking Doxepin? A: It is best to avoid medication if possible.
Dr.
Wu Enliang

Reply Date: 2022/10/04

More Info

Doxepin is a tricyclic antidepressant that is often prescribed for conditions such as depression and insomnia. When it comes to its use during pregnancy, the safety profile is a crucial consideration. Doxepin is classified as a Category C medication by the FDA, which means that while animal reproduction studies have shown an adverse effect on the fetus, there are no adequate and well-controlled studies in pregnant women. Therefore, the potential benefits must be weighed against the potential risks.

1. Use of Doxepin Before Knowing You Were Pregnant: Taking Doxepin for a few days before realizing you were pregnant is generally not a cause for alarm. Many women unknowingly take medications in the early weeks of pregnancy. While there is a theoretical risk associated with any medication during the first trimester, the actual risk of significant harm from a short course of Doxepin is considered low. However, it is always advisable to discuss any concerns with your healthcare provider.

2. Sleep Issues During Pregnancy: It is common for women to experience sleep disturbances during pregnancy due to hormonal changes, physical discomfort, and anxiety. If you are experiencing worsening insomnia, it is important to address this with your healthcare provider. Doxepin may help manage your sleep issues, but it is essential to monitor for any potential side effects or complications. Your doctor’s reassurance about the safety of Doxepin during pregnancy is based on clinical experience, but individual responses can vary.

3. Adjusting Medication Dosage: Gradually reducing the dosage of Doxepin may be a reasonable approach to minimize any potential risks to the fetus. Lowering the dose could help manage your insomnia while reducing the exposure of the fetus to the medication. However, any changes to your medication regimen should be done under the guidance of your healthcare provider to ensure that your mental health and sleep needs are adequately managed.

4. Doxepin and Breastfeeding: Regarding breastfeeding, Doxepin is excreted in breast milk. While it is generally considered safe for breastfeeding mothers, it is important to discuss this with your healthcare provider. They can help you weigh the benefits of continuing Doxepin against any potential risks to the breastfeeding infant. Monitoring the infant for any side effects is also advisable.

In conclusion, while Doxepin is classified as a Category C medication, many healthcare providers prescribe it during pregnancy when the benefits outweigh the risks. It is crucial to maintain open communication with your healthcare provider about your medication, sleep issues, and any concerns you may have. They can provide personalized recommendations based on your specific situation, ensuring both your health and the health of your baby are prioritized. Always consult your healthcare provider before making any changes to your medication or treatment plan.

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