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Overview: Topical doxepin is used to treat certain types of itchy skin. Common side effects include drowsiness, burning or stinging in the skin where it is applied, and dry mouth. Do not drive or do other activities that require alertness or coordination until you know how topical doxepin affects you. Before using topical doxepin, make sure to tell your health care provider about any health conditions or medicines you are taking.

Uses

What is topical doxepin used for?

Topical doxepin is commonly used to treat itchy skin from atopic dermatitis or lichen simplex chronicus. 

Topical doxepin may also be used for other conditions as determined by your health care provider.

How does topical doxepin work (mechanism of action)?

Topical doxepin is a type of medicine called a tricyclic antidepressant. It is unknown how topical doxepin reduces itching. One way topical doxepin may work is by blocking a chemical in your body called histamine, which causes your skin to itch.

How is topical doxepin supplied (dosage forms)?

Brands and other names

  • Zonalon

Dosage forms and strengths

  • 5% topical cream

See Doxepin for information on other dosage forms.

How should I store topical doxepin?

Topical doxepin should be stored below 80 F (27 C). Store in a cool, dry place.

Side Effects

What are the most common side effects of topical doxepin?

The most common side effects of topical doxepin are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Drowsiness
  • Burning or stinging on the skin area where it is applied
  • Dry mouth

There may be other side effects of topical doxepin that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of topical doxepin?

While less common, the most serious side effects of topical doxepin are described below, along with what to do if they happen.

Severe Allergic Reactions. Topical doxepin may cause allergic reactions, which can be serious. Stop using topical doxepin and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Drowsiness. Topical doxepin can make you drowsy. Do not drive or do other activities that require alertness or coordination until you know how topical doxepin affects you.

Warnings & Precautions

Who should not use topical doxepin?

Allergies to Ingredients. People who are allergic to any of the following should not use topical doxepin.

  • Doxepin
  • Zonalon
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific topical doxepin products they stock.

Narrow-Angle Glaucoma. Do not use topical doxepin if you have a narrow-angle glaucoma or increased pressure inside your eye that is not being treated.

Inability to Empty Bladder (Urinary Retention). Do not use topical doxepin if you have or have had urinary retention or trouble emptying your bladder.

What should I know about topical doxepin before using it?

Do not use topical doxepin unless it has been prescribed to you by a health care provider. Use it as prescribed.

Do not share topical doxepin with other people, even if they have the same condition as you. It may harm them.

Keep topical doxepin out of the reach of children.

Do not get topical doxepin near your eyes.

Using topical doxepin on too much of your skin can cause you to absorb too much of your medicine and have side effects, such as drowsiness. Talk to your health care provider about how much topical doxepin you should use.

Do not put bandages or tight clothing on the area where you apply topical doxepin, as it may cause you to absorb too much of the medicine. Ask your health care provider if you have any questions. 

People who are 65 and older can be at greater risk of some side effects from topical doxepin. Talk to your health care provider about your risks if you are in this age group.

What should I tell my health care provider before using topical doxepin?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if topical doxepin is right for you.

In particular, make sure that you discuss any of the following.

Other Medicines and Supplements. Topical doxepin may interact with other medicines and supplements. Before using topical doxepin, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. It is not known if or how topical doxepin could affect pregnancy or harm an unborn baby. Tell your health care provider if you are pregnant or plan to become pregnant.

Breastfeeding. Topical doxepin may pass into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed. Your health care provider will let you know if you should stop breastfeeding or stop using topical doxepin.

 

Interactions

Does topical doxepin interact with foods or drinks?

There are no known interactions between topical doxepin and foods or drinks.

Alcohol, especially large amounts, can increase your risk of drowsiness while using topical doxepin. It is best to limit the amount of alcohol you drink.

Does topical doxepin interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using topical doxepin.

  • An antihistamine, such as chlorpheniramine or diphenhydramine (Benadryl), which is a medicine commonly used to treat allergy symptoms
  • Cimetidine (Tagamet HB), which is a medicine used for heartburn
  • Flecainide, propafenone, or quinidine, which are medicines used for irregular heart rhythm
  • A phenothiazine, such as chlorpromazine or prochlorperazine (Compro and others), which is a medicine that may be used to treat certain mental health conditions or severe nausea and vomiting
  • A selective serotonin reuptake inhibitor (SSRI), such as fluoxetine, paroxetine, or sertraline, which is a medicine commonly used for anxiety and depression
  • A tricyclic antidepressant, such as amitriptyline, nortriptyline, or protriptyline, even if it is not used for depression
  • A monoamine oxidase inhibitor (MAOI) within the past two weeks, which is a medicine usually used for depression or Parkinson’s disease
  • Any other medicine that causes dizziness and sleepiness, such as prescription pain medicines, sleep medicines, or medicines for anxiety

Many other medicines may alter the blood levels of topical doxepin. Tell your health care provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with topical doxepin. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much topical doxepin?

If you or someone else has used too much topical doxepin, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of topical doxepin?

If you miss a dose, use it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only use the next dose. Do not use double or extra doses.