The Dangers of Mixing Silenor with Alcohol

Doxepin, which is also sold under the brand name Silenor, is a tricyclic antidepressant. Silenor is prescribed to treat major depressive disorder and anxiety, especially when they occur together and in conjunction with alcoholism. Doxepin is also used to treat insomnia and allergic reactions.

Doxepin should not be taken within 14 days of treatment with a monoamine oxidase inhibitor (MAOI) due to potential health complications. Mixing an MAOI with a tricyclic like Silenor can result in a dangerous condition known as serotonin syndrome, which can result in psychosis if left untreated.

Side effects of doxepin use can include anticholinergic effects such as dry mouth, difficulty urinating and constipation. Doxepin can also affect the central nervous system, triggering lightheadedness, fatigue, drowsiness, nightmares, dizziness, insomnia, anxiety, seizures, agitation and temporary confusion. Other potential side effects include hypotension, nausea, rapid heart rate and abnormal heart rhythms.

Doxepin is a relatively unique tricyclic in that it has a different therapeutic effect depending on dose. At low doses of 25 mg or less, Silenor can be an effective antihistamine. Doxepin can be made into a topical ointment to reduce skin inflammation triggered by an allergic reaction. At slightly higher doses doxepin can be used to treat mild insomnia and depression. The average dose prescribed to individuals being treated for depression is 75 mg.

Silenor achieves its effects by inhibiting the reuptake of the neurotransmitters serotonin and norepinephrine. Both serotonin and norepinephrine are closely linked to occurrences of anxiety, depression and insomnia. By inhibiting the reuptake of these critical neurotransmitters, their effects become extended symptoms are reduced. Doxepin also inhibits the reuptake of acetylcholine, the primary neurotransmitter involved in problem-solving and critical thinking.

Tricyclic antidepressants like Silenor may enhance the effects of alcohol, barbiturates and other substances that depress the central nervous system. Likewise, alcohol may strengthen the depressant effects that doxepin has on the central nervous system.

The metabolism of doxepin can vary dramatically depending on the individual. Genetic variations of the enzymes that metabolize doxepin can result in excessively high plasma levels of the drug at certain doses. Other enzymatic variations can yield Silenor ineffective by reducing the bioavailability of the drug.

Mixing Silenor with an MAOI antidepressant can result in a dangerous condition of serotonin overload called serotonin syndrome. The condition is the result of excessively high levels of serotonin in the brain and can lead to irreversible psychosis in severe cases.

Silenor does not trigger life-threatening side effects when mixed with alcohol. However, combining them can amplify the impact that both have on the central nervous system and lead to unmanageable drowsiness and fatigue.

Doxepin use can trigger a wide range of side effects, the number and severity of which are largely dependent on dose. Most side effects, such as drowsiness, are the result of doxepin’s depressive effect on the central nervous system. Other symptoms, such as constipation and dry mouth can also occur. Taking Silenor within 14 days of taking an MAOI may put the patient at risk for serotonin syndrome.


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