Drilldown: Medicines

Doxepin (hydrochloride) (1) · Estradiol (17β-estradiol) (1) · Mirtazapine (1) · Pramipexole (1) · Ropinirole (1)

Estrace, Vivelle-Dot, Climara, Divigel, Evamist, Estring, Estraderm, Premarin (CEE, not strictly estradiol) (1) · Mirapex (IR), Mirapex ER (1) · Remeron (US brand discontinued; generic widely available), Remeron SolTab (ODT) (1) · Requip (IR), Requip XL (extended-release) (1) · Sinequan (oral antidepressant, US brand discontinued), Silenor (low-dose for insomnia), Prudoxin / Zonalon (topical cream) (1)

[[:Category:Antidepressants|Antidepressant]] (2) · [[:Category:Antihistamines|Antihistamine (potent H1)]] (1) · [[:Category:Antiparkinsonians|Antiparkinsonian]] (2) · [[:Category:Dopamine agonists|Dopamine D2/D3 receptor agonist (non-ergot)]] (2) · [[:Category:Estrogens|Estrogen]] (1) · [[:Category:Hormone_replacement_therapy|Hormone replacement therapy]] (1) · [[:Category:Sex_hormones|Sex hormone]] (1) · [[:Category:Sleep aids|Sleep aid (off-label)]] (1) · [[:Category:Sleep aids|Sleep aid (Silenor low-dose)]] (1) · [[:Category:Tetracyclic antidepressants|Tetracyclic antidepressant]] (1) · [[:Category:Tricyclic antidepressants|Tricyclic antidepressant (TCA)]] (1)

None (5)

'"`UNIQ--vote-00000013-QINU`"', '"`UNIQ--vote-00000014-QINU`"' (1) · '"`UNIQ--vote-00000017-QINU`"', '"`UNIQ--vote-00000018-QINU`"', '"`UNIQ--vote-00000019-QINU`"', '"`UNIQ--vote-0000001A-QINU`"' (1) · '"`UNIQ--vote-0000001B-QINU`"', '"`UNIQ--vote-0000001C-QINU`"', '"`UNIQ--vote-0000001D-QINU`"', '"`UNIQ--vote-0000001E-QINU`"', '"`UNIQ--vote-0000001F-QINU`"' (1) · '"`UNIQ--vote-0000001D-QINU`"', '"`UNIQ--vote-0000001E-QINU`"', '"`UNIQ--vote-0000001F-QINU`"', '"`UNIQ--vote-00000020-QINU`"', '"`UNIQ--vote-00000021-QINU`"', '"`UNIQ--vote-00000022-QINU`"' (1) · '"`UNIQ--vote-000003B5-QINU`"', '"`UNIQ--vote-000003B6-QINU`"', '"`UNIQ--vote-000003B7-QINU`"', '"`UNIQ--vote-000003B8-QINU`"', '"`UNIQ--vote-000003B9-QINU`"' (1)

15 mg PO at bedtime, titrate to 30-45 mg/day after 1-2 weeks. '''Counterintuitive dose paradox''': lower doses (7.5-15 mg) are more sedating than higher doses because H1 antihistamine effect dominates at low dose (1) · Depression: 25-75 mg/day to start, titrate to 75-150 mg/day at bedtime. Insomnia (Silenor): 3 mg PO 30 minutes before bedtime, max 6 mg. Topical (Prudoxin): apply to affected area every 3-4 hours (1) · Oral 1-2 mg daily; transdermal patch 0.025-0.05 mg/d twice weekly; transdermal gel 0.5-1 g/d; vaginal 10 mcg tablet twice weekly for GSM. Always combine with a progestogen in patients with an intact uterus. (1) · Parkinson disease: 0.125 mg PO TID, titrate weekly to maintenance ~1.5 mg TID. Restless legs syndrome: 0.125 mg PO 2-3 hours before bedtime, titrate to 0.5 mg/day if needed (1) · Parkinson disease: 0.25 mg PO TID, titrate weekly. Restless legs syndrome: 0.25 mg PO 1-3 hours before bedtime, titrate to 4 mg/day if needed (1)

Capsules 10, 25, 50, 75, 100, 150 mg; oral concentrate 10 mg/mL; Silenor tablets 3, 6 mg; topical cream 5% (Prudoxin, Zonalon) (1) · IR tablets 0.125, 0.25, 0.5, 0.75, 1, 1.5 mg; ER tablets 0.375, 0.75, 1.5, 2.25, 3, 3.75, 4.5 mg (1) · IR tablets 0.25, 0.5, 1, 2, 3, 4, 5 mg; XL tablets 2, 4, 6, 8, 12 mg (1) · Oral 0.5, 1, 2 mg tablets; transdermal patches (twice-weekly and once-weekly); 0.06% gel; 1.53 mg/spray topical; vaginal ring (Estring); vaginal tablet (Vagifem/Yuvafem); vaginal cream (1) · Tablets 7.5, 15, 30, 45 mg; orally disintegrating tablets (SolTab) 15, 30, 45 mg (1)

24 mg/day (Parkinson disease); 4 mg/day (restless legs syndrome) (1) · 300 mg/day (depression, hospitalized); 150 mg/day outpatient; 6 mg/day for insomnia (1) · 4.5 mg/day (Parkinson disease); 0.5 mg/day (restless legs syndrome) (1) · 45 mg/day (1) · Indication-specific; lowest effective dose for shortest duration is the WHI-era standard (1)

cypionate) (1) · IM (estradiol valerate (1) · Oral (5) · topical (1) · transdermal (1) · vaginal (1)

None · Hours · 30-60 minutes · 1-2 hours · ~30 min · LDL lowering at 2 weeks, max by 4 weeks · ~1 hour · 15-30 minutes · 15–30 min · 1–2 h · 30–60 min · Antidepressant effect emerges over 1-2 weeks · BP and symptomatic LUTS improvement within 1-2 weeks · BP effect within 1-2 weeks · Clinical improvement within 24-72 hours · Days · Motor improvement over days at therapeutic dose · Over weeks · Postprandial glucose effect within days; HbA1c by 12 weeks · Sleep effect from first dose; antidepressant effect over 1-4 weeks

Other values:

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24 hours (HS dosing) (2) · Route- and formulation-dependent (1) · TID dosing (IR); once-daily (ER) (1) · TID dosing (IR); once-daily (XL) (1)

20-40 hours'"`UNIQ--ref-00000023-QINU`"' (1) · 8-12 hours (longer in elderly and renal impairment)'"`UNIQ--ref-0000001B-QINU`"' (1) · ~13-20 hours (oral); transdermal pharmacokinetics buffer the peaks/troughs of oral dosing'"`UNIQ--ref-000003BA-QINU`"' (1) · ~15 hours (parent); nordoxepin active metabolite ~30 hours'"`UNIQ--ref-00000020-QINU`"' (1) · ~6 hours'"`UNIQ--ref-00000015-QINU`"' (1)

>90% (oral)'"`UNIQ--ref-0000001C-QINU`"' (1) · Oral ~5% (extensive first-pass to estrone and conjugates); transdermal bypasses first-pass, giving more physiologic estradiol:estrone ratio'"`UNIQ--ref-000003BB-QINU`"' (1) · ~30% (oral)'"`UNIQ--ref-00000021-QINU`"' (1) · ~50% (oral; substantial first-pass)'"`UNIQ--ref-00000024-QINU`"' (1) · ~55% (oral)'"`UNIQ--ref-00000016-QINU`"' (1)

Contraindicated in pregnancy (use is not appropriate during gestation; class label X). Lactation considerations vary by indication.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited human data.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited human data; rarely indicated in pregnancy given the typical patient population.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited human data; some observational signals reassuring relative to other antidepressants.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · TCA class signal; limited human data specific to doxepin.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1)

[[USLegal:Prescription only|Rx-only]] in US (3) · [[USLegal:Prescription only|Rx-only]] in US. Carries the antidepressant '''Boxed Warning''' for suicidality in children, adolescents, and young adults'"`UNIQ--ref-00000022-QINU`"' (1) · [[USLegal:Prescription only|Rx-only]] in US. Carries the antidepressant '''Boxed Warning''' for suicidality in children, adolescents, and young adults'"`UNIQ--ref-00000025-QINU`"' (1)