Drug General Information (ID: DDI0O43NJZ)
Drug Name			Doxepin (topical)		Drug Info		Dextroamphetamine		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antidepressants				Cns Stimulants
Structure

Mechanism of Doxepin (topical)-Dextroamphetamine Interaction (Severity Level: Moderate)
Additive hypertensive effects Click to Show/Hide Mechanism Graph
Drug Name		Doxepin (topical)				Dextroamphetamine
Mechanism 1		Hypertensive effects				Hypertensive effects
Key Mechanism Factor 1
		Factor Name		Hypertensive effects
		Factor Description		Hypertension is defined as a blood pressure reading above a prescribed limit (130/90 mmHg). Most people with hypertension have no signs or symptoms; others may experience: severe headache, shortness of breath, nosebleeds, severe anxiety, and feeling a tingling sensation in the neck or head.
Mechanism Description		Additive hypertensive effects by the combination of Doxepin (topical) and Dextroamphetamine
Increased risk of ventricular arrhythmias Click to Show/Hide Mechanism Graph
Drug Name		Doxepin (topical)				Dextroamphetamine
Mechanism 2		Cardiac arrhythmias				Cardiac arrhythmias
Key Mechanism Factor 2
		Factor Name		Ventricular arrhythmias
		Factor Description		Ventricular arrhythmias are abnormal heart rhythms that cause your heart's lower chambers to pump blood instead of pumping it. This can limit or stop your heart from supplying blood to your body. While some of these arrhythmias are harmless and do not cause symptoms, others can have serious, even fatal, effects on your body.
Mechanism Description		Increased risk of ventricular arrhythmias by the combination of Doxepin (topical) and Dextroamphetamine

Recommended Action
Management		Close monitoring of cardiovascular status is recommended for patients receiving this combination. Patients should be advised to promptly report symptoms such as fever, headache, or fast or irregular heartbeats.

References
1	Hardman JG, Gilman AG, Limbird LE eds. "Goodman and Gilman's the Pharmacological Basis of Therapeutics. 9th ed." New York, NY: McGraw-Hill (1995):.
2	Haritos VS, Ghabrial H, Ahokas JT, Ching MS "Role of cytochrome P450 2D6 (CYP2D6) in the stereospecific metabolism of E- and Z-doxepin." Pharmacogenetics 10 (2000): 591-603. [PMID: 11037801]
3	Raisfeld IH "Cardiovascular complications of antidepressant therapy: interactions at the adrenergic neuron." Am Heart J 83 (1972): 129-33