Suicidal Thoughts and Behavior
Sinequan may increase the risk of suicidal thoughts or behavior in some children, adolescents, and young adults, especially when treatment is first started or the dose is changed.
Patients should be monitored for:
- Worsening depression
- New or unusual changes in mood
- Agitation or restlessness
- Suicidal thoughts or behavior
Contact a healthcare provider right away if any of these symptoms occur.
Drowsiness and Reduced Alertness
Sinequan can cause drowsiness, dizziness, slowed thinking, or reduced coordination.
Until you know how the medication affects you, avoid driving, operating machinery, or doing other activities that require full alertness.
Alcohol and other medications that cause drowsiness can make these effects stronger.
Seizure Risk
Sinequan may lower the seizure threshold in some people.
Tell your healthcare provider if you have a history of seizures or take medications that may also increase seizure risk.
Urinary Retention
Sinequan can make it more difficult to urinate.
Tell your healthcare provider if you have a history of urinary retention, an enlarged prostate, or other urinary problems.
Contact your healthcare provider if you develop difficulty starting urination, weak urine flow, or an inability to empty your bladder.
Glaucoma
Sinequan can increase pressure inside the eye in people who are at risk for certain types of glaucoma.
Tell your healthcare provider if you have glaucoma, especially narrow-angle glaucoma.
Seek prompt medical attention if you develop severe eye pain, blurred vision, halos around lights, or sudden vision changes.
Anticholinergic Side Effects
Sinequan can cause anticholinergic side effects, including:
- Dry mouth
- Constipation
- Blurred vision
- Urinary retention
- Confusion
These effects may be more noticeable in older adults or people who are sensitive to anticholinergic medications.
Heart Problems
Sinequan should be used carefully in people with cardiovascular disease.
Tricyclic antidepressants can affect heart rhythm and electrical conduction.
Tell your healthcare provider if you have:
- An irregular heartbeat
- Heart block
- A history of heart attack
- Other significant heart disease
Sinequan is generally not recommended during the immediate recovery period after a heart attack.
Liver Problems
Tell your healthcare provider if you have liver disease.
Because doxepin is processed by the liver, liver impairment may increase the amount of medication in the body and raise the risk of side effects.
A lower dose or closer monitoring may be needed.
Kidney Problems
Tell your healthcare provider if you have kidney disease.
Kidney problems do not always require a specific dose adjustment, but your healthcare provider may still consider your kidney function, age, other medical conditions, and medications when choosing the dose.
Drug Interactions
Sinequan can interact with many medications and substances.
Important interactions may occur with:
- Other antidepressants
- Monoamine oxidase inhibitors (MAOIs)
- Sedatives
- Sleeping medications
- Opioids
- Antihistamines
- Anticholinergic medications
- Alcohol
Tell your healthcare provider about all prescription medications, over-the-counter products, vitamins, supplements, and herbal products you use.
Do not start or stop another medication without checking with your healthcare provider.
MAO Inhibitors
Sinequan should not be taken together with an MAOI.
Using these medications too close together can cause serious or potentially life-threatening reactions.
A waiting period is usually required when switching between Sinequan and an MAOI.
Do Not Stop Sinequan Suddenly
Do not stop taking Sinequan suddenly unless your healthcare provider tells you to.
Stopping too quickly may cause symptoms such as:
- Nausea
- Headache
- Dizziness
- Trouble sleeping
- Irritability
- Tiredness
Your original symptoms may also return or become worse.
Your healthcare provider may recommend gradually reducing the dose before treatment is stopped.
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