Is doxepin a safer tricyclic for the heart?
Roose, S.P.; Dalack, G.W.; Glassman, A.H.; Woodring, S.; Walsh, B.T.; Giardina, E.G.
Journal of Clinical Psychiatry 52(8): 338-341
1991
ISSN/ISBN: 0160-6689 PMID: 1869496 Document Number: 368169
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. Method: 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) showed 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.