Does Doxepin Interact With Venlafaxine? (3+ Findings)

By Ivan Kahwa

Page last updated: 06/02/2024 | Next review date: 06/02/2026

Author bio

Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.

Mr Ivan Kahwa’s Highlights:

Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.

Professional Experience:

Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.

With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.

With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.

Education:

2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.

2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.

2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.

Publications:

▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7

▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60

▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.

https://ethnobotanyjournal.org/index.php/era/article/view/4683

▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.

https://doi.org/10.53388/TMRIM202307004

▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.

https://doi.org/10.1186/s43094-021-00296-2

▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.

https://doi.org/10.5799/jmid.951600

Published book Chapter

▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.

https://doi.org/10.1016/B978-0-323-91942-5.00012-4

Submitted manuscripts Under Review:

▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience

▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine

▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology

Submitted book chapters under review

1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.

2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press

You can view my works on the following professional sites:

Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa

Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en

ORCID: https://orcid.org/0000-0002-6440-3437

Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159

Ivan Kahwa

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In this article, we will discuss whether or not doxepin interacts with venlafaxine, research supporting this association, the benefits and risks of combining them together, and what precautions should be taken when combining doxepin and venlafaxine together.

Does doxepin interact with venlafaxine?

Yes, doxepin can interact with venlafaxine. These medications work by increasing the amounts of serotonin (5-HT) and norepinephrine (NE) neurotransmitters (natural substances) in the brain. (1)

Excessive amounts of 5-HT and NE neurotransmitters in the brain can increase the risk of a life-threatening condition called serotonin syndrome. This condition is characterized by increased hallucinations, seizures, high BP (blood pressure), blurred vision, high fever, sweating, and confusion.

It is vital to immediately contact your healthcare provider if you encounter any of these adverse effects.

What does research suggest?

There are limited research studies on the combination of both doxepin and venlafaxine. However, a study revealed that doxepin can inhibit venlafaxine metabolism if used in excess amounts. Therefore, if both medications are used concurrently, plasma concentrations have to be monitored. (2)

Another research was conducted on the combination of doxepin and venlafaxine for improving the symptoms of depression and anxiety. However, the results showed that taking these two medications concurrently can increase the risk of serotonin syndrome. (3)

What are the benefits of doxepin and venlafaxine combination?

There are several benefits of combining doxepin and venlafaxine such as:

Efficacy. When doxepin and venlafaxine are taken together, the symptoms of MDD (major depressive disorder) and their effectiveness in treating depression can be improved.

Sleep quality. Combining doxepin and venlafaxine can improve your sleep quality, as doxepin is used mainly in treating insomnia (inability to sleep). Therefore, helping patients with depression to get better sleep. (4)

Improving withdrawal symptoms. Certain patients may develop withdrawal symptoms such as anxiety, mood fluctuations, and sleeplessness when they discontinue taking antidepressants. Venlafaxine and doxepin combination can reduce these withdrawal symptoms.

What are the side effects of doxepin and venlafaxine combination?

The combination of doxepin and venlafaxine can result in several side effects, some of which include: (4), (5), (6), (7)

Dizziness.
Sleepiness.
Constipation.
Blurred vision.
Headaches.
Body weight changes (weight gain or loss).
Sweating.

If doxepin and venlafaxine are taken in excess amounts, you should be aware of the serious and life-threatening side effects such as:

Serotonin Syndrome condition. It is characterized by agitation, confusion, tremors, high BP (Blood Pressure), and seizures.
If venlafaxine is used in excess doses with doxepin, it can result in QT prolongation which is a serious side effect that can result in several heart diseases.
Excess doses of doxepin and venlafaxine can result in severe psychological side effects such as hallucinations, anxiety, agitation, confusion, and mania.

It is noteworthy that certain people may not encounter these adverse effects, and that every individual differs from one another. If you experience any of these adverse effects, contact your healthcare so that they can properly assess your situation and take the proper action accordingly.

What precautions should be taken when using doxepin and venlafaxine together?

There are several precautions that should be taken when using doxepin and venlafaxine together, some of which include: (8), (9)

Avoid drinking alcoholic beverages, as alcohol can increase the adverse effects of both doxepin and venlafaxine.
Avoid driving or performing activities that require alertness while taking this combination, as they can increase sleepiness.
Inform your healthcare provider of any concurrent medications that you are using to avoid drug interactions.
Monitor your BP and HR regularly as venlafaxine and doxepin can decrease sodium levels and can hyponatremia, especially in the elderly.
If you experience any of the serotonin syndrome symptoms, seek medical attention immediately.
Do not discontinue the medications abruptly without consulting your healthcare provider.

Conclusion

Based on my knowledge and research, doxepin can interact with venlafaxine. Combining these medications can help improve the symptoms of depression and anxiety in certain individuals.

However, if you take doxepin and venlafaxine combination, you should be aware of the potentially fatal disorder serotonin syndrome. Any arising side effects should be reported to your healthcare professional so that they can take the appropriate action accordingly.

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References

1.-

Doxepin (Oral Route) Before Using – Mayo Clinic [Internet]. www.mayoclinic.org. Available from: https://www.mayoclinic.org/drugs-supplements/doxepin-oral-route/before-using/drg-20072083

2.-

Paulzen M, Haen E, Hiemke C, Fay B, Unholzer S, Gründer G, et al. Antidepressant polypharmacy and the potential of pharmacokinetic interactions: Doxepin but not mirtazapine causes clinically relevant changes in venlafaxine metabolism. Journal of Affective Disorders. 2018 Feb;227:506–11. Available from: https://pubmed.ncbi.nlm.nih.gov/29156365/#:~:text=Conclusions%3A%20Higher%20concentrations%20for%20VEN,to%20be%20taken%20into%20account.

3.-

Moret C. Combination/augmentation strategies for improving the treatment of depression. Neuropsychiatric Disease and Treatment [Internet]. 2005 Dec 1;1(4):301–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2424118/

4.-

Doxepin Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing – WebMD [Internet]. www.webmd.com. Available from: https://www.webmd.com/drugs/2/drug-8647-610/doxepin-oral/doxepin-capsule-oral/details

5.-

6.-

NHS. Side effects of venlafaxine [Internet]. nhs.uk. 2022. Available from: https://www.nhs.uk/medicines/venlafaxine/side-effects-of-venlafaxine/

7.-

Bavle A. Venlafaxine induced QTc interval prolongation in a therapeutic dose. Asian Journal of Psychiatry. 2015 Aug;16:63–4. Available from: https://pubmed.ncbi.nlm.nih.gov/26187237/

8.-

Venlafaxine (Oral Route) Precautions – Mayo Clinic [Internet]. www.mayoclinic.org. [cited 2023 Nov 6]. Available from: https://www.mayoclinic.org/drugs-supplements/venlafaxine-oral-route/precautions/drg-20067379#:~:text=Venlafaxine%20may%20cause%20some%20people

9.-

Doxepin (Oral Route) Precautions – Mayo Clinic [Internet]. www.mayoclinic.org. [cited 2023 Nov 6]. Available from: https://www.mayoclinic.org/drugs-supplements/doxepin-oral-route/precautions/drg-20072083?p=1#:~:text=Make%20sure%20you%20know%20how

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Does doxepin interact with venlafaxine? (3+ findings)