Dosulepin hydrochloride

How it works

It inhibits the reuptake of noradrenaline and serotonin and has antimuscarinic and antihistaminic actions, contributing to both its antidepressant and sedative effects.

Prescribing in practice

• Dosulepin is particularly dangerous and frequently fatal in overdose, so initiation by non-specialists is discouraged and it should generally be avoided in favour of safer antidepressants.
• It carries pronounced antimuscarinic and cardiotoxic effects and should be avoided in cardiovascular disease, arrhythmias and significant cardiac risk.
• Caution is needed in the elderly, in prostatic hypertrophy, glaucoma and epilepsy because of antimuscarinic effects and a lowered seizure threshold.

Monitoring

Monitor mood, suicidal ideation and cardiac and antimuscarinic adverse effects, especially during initiation and dose change.

Counselling the patient

• Do not take more than prescribed as this drug is very dangerous in overdose.
• May cause drowsiness, dry mouth and blurred vision and can impair driving.
• Continue treatment as directed and do not stop abruptly.

Evidence & guidelines

NICE advises against routine use of dosulepin because of its disproportionate toxicity in overdose compared with other antidepressants.