How does it work? This drug is mainly working on the nerve cells of the brain by blocking the absorption of neurotransmitters (serotonin and Nor epinephrine), which is mainly depleted in depressed patients. It takes two to four weeks to show the effect of this drug

When to use it (Indications)? This medicine is mainly used for depression as well as decreasing the anxiety in depressed patients by increasing sleep, low level of anxiety, chronic pain and appetite disorders. This medicine is not for emergency or swift effect for depression due to its delayed efficacy (2-4 weeks) and thus is not used for someone with bizarre thoughts and ideations. This drug also causes decrease sodium, postural hypertension and drowsiness that makes it difficult to operate machinery, as well as dry mouth and dry eyes.

What are the side effects? Dry mouth, dry eyes and blurred vision, drowsiness, Gastroenterologic symptoms (nausea, constipation), difficulty with urination, postural hypotension, sweating, tremors and muscle twitching, rashes, confusion, headache, sexual problems, mood change, increase weight, decrease in WBC count and susceptibility to infection, tachycardia.

When to use it with caution? Decreased liver function, heart disease, urinary retention, prostates hypertrophy, glaucoma, seizure due to other medicine or brain damage, hyperthyroidism/hypothyroidism, schizophrenia, candidates for electroconvulsive therapy, manic depression and porphyries.

When not to use it (contra indication)? Patient with sever liver disease, recent heart attack, heart block and arrhythmias, closed angle glaucoma, manic, and people who show sign and symptoms of allergy to this medication as well as pregnant and nursing women.

Drug interaction with other medicine: This medicine should not be taken with Mono Amine Oxidase inhibitors (MAOI) such as phenelzine, tranylcypromine, isocarboxazid, or moclobemide. And Dosulpin (dothiepine hydrochloride) should be started two weeks after cessation of MAOIs Drugs that increases level of serotonine in the brain such as lithium, selegiline, SSRI (fluoxetine, paroxetine), SNRI (venlafaxine) and other trycyclics may cause agitation, tremor, shivering, increased heart rate and diarrhea, known collectively as the 'serotonin syndrome'. This drug should not be used with antihistaminics, benzpdiazipines, and opioids due to increase drowsiness.

As well as other medication that increases the side effect of this drug like anticholinergics (oxybutynin, trihexyphenidyl), antihistamines (promethazine etc), antipsychotics (clozapin and others), antiarrhythmics (propafenone), Muscle relaxants (baclofen, atropine)

Dosulepin may alter the anti-blood-clotting effect of anticoagulant medicines such as warfarin. Your blood clotting time (INR) should be carefully monitored if you are taking these two medicines together.

Dosulepin may oppose the blood pressure lowering effects of clonidine and guanethidine. There may be a sudden and marked increase in blood pressure and heart rate if adrenaline, noradrenaline or phenylephrine are given by injection to people taking dosulepin. These medicines should be avoided in people taking dosulepin.

The following medicines may increase the blood level of dosulepin and could increase the risk of its side effects: calcium channel blockers (verapamil, dilriazem), cimitidine, methylphenidate, estrogen Oral contraceptives, rinonavir.

The level of dosulepin in the blood may be decreased by the following medicines, and these could make it less effective: barbiturate and rifampin

If you experience a dry mouth as a side effect of this medicine you may find that medicines that are designed to dissolve and be absorbed from under the tongue, eg sublingual glyceryl trinitrate (GTN) tablets for angina, become less effective. This is because the tablets do not dissolve properly in a dry mouth. To resolve this, drink a mouthful of water before taking sublingual tablets.

How to stop Dothiepin hydrochloride (Dosulpin)? You should not suddenly stop taking this medicine, as this can cause withdrawal symptoms such as nausea, vomiting, loss of appetite, headache, giddiness, chills, insomnia, restlessness or anxiety. Withdrawal symptoms are temporary and are not due to addiction or dependence on the medicine. They can usually be avoided by stopping the medicine gradually, usually over a period of weeks or months, depending on your individual situation. Follow the instructions given by your doctor when it is time to stop treatment with this medicine.

Dosage

Adults: Initially 75 mg/day in divided doses or as a single dose at night, increasing to 150 mg/day. In certain circumstances, e.g. in hospital use or unresponsive patients, dosages up to 300 mg daily have been used.

Suggested regimens: 25 or 50 mg three times daily or, alternatively, 75 or 150 mg as a single dose at night. Should the regimen of 150 mg as a single night-time dose be adopted, it is better to give a smaller dose for the first few days.

Elderly: 50 to 75 mg daily initially. As with any antidepressant, the initial dose should be increased with caution under close supervision. Half the normal adult dose may be sufficient to produce a satisfactory clinical response.

Children: Not recommended.