Is doxepin a safer tricyclic for the heart?
BACKGROUND
Many clinicians believe that doxepin is the safest tricyclic with respect to cardiovascular effects. This belief has persisted for two decades despite the absence of rigorous prospective evaluation.


METHODS
To address this issue, the authors studied the cardiovascular effects of doxepin in 32 depressed patients with preexisting left ventricular impairment, ventricular arrhythmias, and/or conduction disease.


RESULTS
Doxepin (1) did not have a robust effect on heart rate, (2) did not adversely affect left ventricular function, (3) did have a significant antiarrhythmic effect, (4) slowed cardiac conduction, and (5) caused a significant increase in orthostatic hypotension. Five (16%) of the 32 patients dropped out due to cardiovascular side effects. The overall dropout rate was 41%.


CONCLUSIONS
The cardiovascular effects of doxepin in depressed patients with heart disease are comparable to those documented for imipramine and nortriptyline. Doxepin afforded no greater margin of cardiovascular safety; in fact, the drug was poorly tolerated by this patient population.
Roose
S P
SP
New York State Psychiatric Institute, N.Y.
Dalack
G W
GW
Glassman
A H
AH
Woodring
S
S
Walsh
B T
BT
Giardina
E G
EG
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects; D003866:Depressive Disorder / Q000150:complications / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004316:Doxepin / Q000009:adverse effects / Q000627:therapeutic use / Q000633:toxicity*; D004334:Drug Administration Schedule; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006321:Heart / Q000187:drug effects*; D006329:Heart Conduction System / Q000187:drug effects; D006331:Heart Diseases / Q000150:complications* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007024:Hypotension, Orthostatic / Q000139:chemically induced; D008297:Male; D008875:Middle Aged
D004316:Doxepin