Dothiepin
Mechanism :
Dothiepin hydrochloride is an antidepressant of the tricyclic family. The clinical effect is due to potentiation of adrenergic synapses by blocking uptake of norepinephrine at nerve endings. Also blocks uptake of serotonin.
Indication :
Contraindications :
Dothiepin is contraindicated in patients who have shown prior hypersensitivity to it and in acute porphyria, hepatic impairment and cardiovascular disease.
Dosing :
12-18 years:
50-75 mg at bedtime or in divided doses orally. Max dose: 150 mg/day.
Adverse Effect :
Mainly anticholinergic effects, sedation, postural hypotension, tremor, sweating, arrhythmia, increased appetite and weight gain, sexual dysfunction and lowered seizure threshold.
Interaction :
MAOIs: Hyperpyretic crises, severe convulsions, and deaths have occurred in patients receiving tricyclic antidepressant and monoamine oxidase inhibiting drugs simultaneously.
OCPs, Calcium Channel Blockers, Cimetidine, Phenothiazines, SSRIs: Plasma concentration of imipramine increased.
Rifampicin, Anti-Coagulants: Decreased plasma concentration of Imipramine.
Sedatives, Hypotensives, Drugs that Prolong QT Interval: Increased effects of these drugs.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Start with small dose, and titrate according to response |
| <10 | Start with small dose, and titrate according to response |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in GFR<10 mL/min |
| HD | Not dialysed. Dose as in GFR<10 mL/min |
| HDF/High flux | Unknown dialysability. Dose as in GFR<10 mL/min |
| CAV/VVHD | Unknown dialysability. Dose as in GFR=10–20 mL/min |
Hepatic Dose :
Use is not recommended in hepatic impairment. There is increased risk of toxicity due to impaired metabolism.