Doxepin

Last Update: 01 Sep 2026

Table of content

1. What is it? 2. What are the risks according to research? 3. Breastfeeding/ chestfeeding 4. What about fathers and sperm donors? 5. Key points

Welcome to our fact sheet on doxepin during pregnancy and lactation. This information is based on available published literature. It should not take the place of medical care and advice from your healthcare provider.

The HEALTHY PREGNANCY HUB team is collaborating with MotherToBaby to share information on this topic. The original version is available here (April 2026).

Serene, our chatbot, can also answer your questions about medications during pregnancy.

Please note that this fact sheet is based on the one from MotherToBaby with United States information and has been reviewed by our Canadian experts. Minor differences may exist between the two countries. Always consult your healthcare professional for information tailored to your situation.

1. What is doxepin? 

Doxepin is a tricyclic antidepressant that has been used to treat anxiety, depression, and insomnia (trouble sleeping). In other countries like the United States, doxepin is also available as a cream used for short-term treatment of itchiness. Some brand names include Quitaxon®, Prudoxin®, Silenor®, Sinequan®, and Zonalon®. It is also sold as a combination drug with another medication called levomenthol under the brand name Doxure®.

Sometimes when people find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take this medication. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy.

Some people may have a return of their symptoms (relapse) if they stop this medication during pregnancy. If you plan to stop this medication, your healthcare provider may suggest that you slowly lower the dose instead of stopping all at once. Stopping this medication suddenly can cause some people to have withdrawal symptoms.

Pregnancy can also change how your body processes this medication. Because of this, some people might need to have their doses adjusted during pregnancy. If needed, your healthcare provider can talk with you about whether any changes to your dose are recommended.

2. What does research say about the safety during pregnancy?

I take doxepin. Can it make it harder for me to get pregnant? 

It is not known if doxepin can make it harder to get pregnant.

Does taking doxepin increase the chance for miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. It is not known if taking doxepin increases the chance for miscarriage. Among one series of 14 pregnancies exposed to doxepin, 1 miscarriage occurred. Because miscarriages can happen for many reasons, it can be hard to know if a medication, the condition being treated, or other factors (such as age, health, or other exposures) caused a miscarriage. 

Does taking doxepin increase the chance of birth defects?

Birth defects can happen in any pregnancy for different reasons. Out of all babies born each year, about 3 out of 100 (3%) will have a birth defect. We look at research studies to try to understand if an exposure, like doxepin, might increase the chance of birth defects in a pregnancy. 

Doxepin has not been well-studied with use in pregnancy. Research from animal studies does not suggest an increased chance for birth defects. In a case series looking at 8 human pregnancies exposed to doxepin, no birth defects were reported. Topical use of doxepin has not been studied, but when the cream is applied to the skin very little is expected to enter the pregnant person’s bloodstream and reach the fetus.

Does taking doxepin in pregnancy increase the chance of other pregnancy-related problems?

It is not known if doxepin can cause other pregnancy-related problems, such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth).

I need to take doxepin throughout my entire pregnancy. Will it cause withdrawal symptoms in my baby after birth?

The use of tricyclic antidepressants during pregnancy can cause temporary symptoms in some newborns soon after birth. These symptoms are sometimes referred to as withdrawal. Symptoms reported with other tricyclic antidepressant medication have included jitteriness, vomiting, crying, fussiness, changes in sleep patterns, tremors, trouble with eating and/or regulating body temperature. In most cases these symptoms were mild and went away on their own within 1 to 2 weeks after birth. Not all babies exposed to tricyclic antidepressants will have these symptoms.

It is not known if taking doxepin during pregnancy would cause similar symptoms in newborns. However, it is important that your healthcare providers know you are taking doxepin so that if symptoms occur your baby can get the care that is best for them.

Does taking doxepin in pregnancy affect future behavior or learning for the child?

It is not known if doxepin increases the chance for behavior or learning issues as this has not been well studied for doxepin. One study looked at 80 children who were exposed to a tricyclic antidepressant medication during pregnancy (only 1 had been exposed to doxepin). This study did not find differences in learning or behavior.

3. Lactating while taking doxepin

Information on the use of doxepin while breast/chestfeeding or pumping is limited. Three case reports suggest that only small amounts of doxepin pass into human milk. However, in 2 of these reports, babies exposed to doxepin in lactation had respiratory depression (trouble breathing) and drowsiness (sleepiness). Based on these reports, other treatment options may be considered in lactation, especially for infants younger than 10 weeks of age and those born preterm, who may be less able to break down the medication. If you suspect the baby has any symptoms (trouble breathing, not gaining weight, constipation, or is very sleepy), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all of your breast/chest feeding questions.

The product label for doxepin recommends people who are lactating to not use this medication due to a lack of information and because of the potential for serious side effects, including sedation (sleepiness) and respiratory depression (trouble breathing). However, the benefits of using doxepin and breast/chestfeeding might outweigh possible risks. Your healthcare providers can talk with you about using doxepin and what treatment is best for you. 

Use of topical doxepin cream is unlikely to pose a risk for a nursed infant as the amount that enters the milk is thought to be low. Avoid application to the breast to ensure the infant does not come into direct contact with the medication. 

4. What about fathers and sperm donors?

If a male takes doxepin, could it affect fertility or increase the chance of birth defects?

It is not known if doxepin could affect a male’s fertility (ability to make healthy sperm) or increase the chance of birth defects. In general, exposures that fathers and sperm donors have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures here.

Key points

Doxepin is an antidepressant used to treat anxiety, depression, and insomnia.
There are few studies on the use of doxepin during pregnancy. Its risks during pregnancy and its effects on a child’s development are not well understood.
The few cases available in the literature have not found an increased risk of birth defects with doxepin use during pregnancy.
Antidepressants in the same family as doxepin can cause temporary symptoms in some newborns after birth. If symptoms do occur, they are usually mild and go away within a few days.
Doxepin passes into milk in small amounts, but there is limited research on its effects on infants in lactation. Due to adverse events reported in lactation prescribers may consider other treatment options in lactation.
It is important to talk with your healthcare provider before starting, changing, or stopping any medication during pregnancy or lactation.

References

Please click here for references.

Disclaimer

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