dosulepin hydrochloride: clinical use

Prescribing considerations

• Reserve for depressive illness when alternatives are unsuitable, ineffective or not tolerated; new initiation is restricted to specialist care.
• Assess suicide and overdose risk, co-prescribed cardiotoxic medicines, and storage and supply safety.
• Older people are more susceptible to confusion, agitation, postural hypotension and cardiovascular toxicity.
• Avoid abrupt withdrawal where possible because discontinuation symptoms can occur.
• Inform anaesthetic and dental teams before procedures.

Contraindications and cautions

• Recent myocardial infarction
• Any degree of heart block or other cardiac arrhythmia
• Mania
• Severe liver disease
• Hypersensitivity to dosulepin or product excipients

Monitoring

• Monitor mood, suicidal thinking, behaviour and clinical response closely, particularly early in treatment and after treatment changes.
• Review cardiovascular history and promptly investigate palpitations, syncope or conduction symptoms.
• Monitor blood glucose as clinically appropriate in people with diabetes.
• Consider hyponatraemia with drowsiness, confusion or convulsions.
• Review for antimuscarinic effects, postural hypotension, liver injury, blood dyscrasias and withdrawal symptoms.

Clinical pharmacology

A non-selective monoamine reuptake inhibitor of the tricyclic class. It inhibits neuronal reuptake of noradrenaline, serotonin and dopamine and has antimuscarinic and antihistaminic activity. It is absorbed gastrointestinally, extensively metabolised in the liver and eliminated mainly as metabolites.

Formulation and product differences

• Selected products are oral hard gelatin capsules and film-coated tablets.
• The tablet contains Ponceau 4R (E124), which can cause allergic reactions in susceptible people.
• Excipients differ between products; check the specific product information when allergy or intolerance is relevant.

Capsule

Route: Oral

Strengths: 25 mg

Tablet

Route: Oral

Strengths: 75 mg