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ORIGINAL CONTRIBUTIONS
Year : 1990  |  Volume : 56  |  Issue : 3  |  Page : 218-220

Therapeutic efifect of doxepin in chronic idiopathic urticaria




Correspondence Address:
S Ghose


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  Abstract 

Among 56 recalcitrant cases of chronic idiopathic urticaria 28 subjects (Group A) selected at random, were, treated with doxepin 10 mg thrice daily and the rest ( Group B ) with pheniramine maleate 22.5mgthrice daily.B 3 weeks of therapy group.A and group B respectively showed complete remission in 28.6% and 10.7% cases, partial remission in 64.3% and 39.3% cases and no improvement in 7.1% and 50% cases. The difference in clinical improvement between the two groups was statistii significant (p0.001). One week after stopping the treatment among totally syrnptom - free patients, 37.5% in group A and 100% in-group B developed recurrence. Drowsiness was more common in-group B (60.7%) than in group A (35.7%) whereas dryness of the mouth was more frequent in group A (64.3%) than in group B (46.4%).


Keywords: Urticaria, Doxepin, Pheniramine maleate, Comparison


How to cite this article:
Ghose S, Haldar S. Therapeutic efifect of doxepin in chronic idiopathic urticaria. Indian J Dermatol Venereol Leprol 1990;56:218-20

How to cite this URL:
Ghose S, Haldar S. Therapeutic efifect of doxepin in chronic idiopathic urticaria. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2019 Oct 22];56:218-20. Available from: http://www.ijdvl.com/text.asp?1990/56/3/218/3529


Doxepin is a tertiary amine type tricyclic agent and a potent inhibitor of the pre-synaptic uptake of norepinephrine and serotonin[1]. Doxepin hydrochloride is a mixture of the cis and trans isomers of 3 - (dibenz (b,e) oxepin-11 (6H)­ylidene)-NN-dimethyl-propylamine hydrochloride, C 19 H 21 NO, HCL. It is readily absorbed from the gastrointenstinal tract, metabolised in the liver and excreted in the urine, either free or in the conjugated form. Its main side effects are drowsiness, dry mouth, metallic taste, constipation, urinary retention, blurred vision, palpitation and tachycardia. The dose is 30-150 mg daily in divided doses[2].

The reasons for selecting doxepin for the treatment of chronic urticaria are : (i) tricyclic antidepressants frequently show antihistamine side effects[3] and (ii) there are biochemical, pharmacologial and behavioural similarities between tricyclic antidepressants and some antihistamins. These compounds were originally classified as antihistamines.[4]

Doxepin was shown to be effective for the treatment of acute and chronic urticaria,[5],[6] and Greene et al[7] showed its superiority over diphenhydramine. It was also effective in urticaria pigmentosa[8].

We have compared here the therapeutic response of chronic idiopathic urticaria to doxepin in comparison with pheniramine maleate.


  Materials and Methods Top


Fifty six patients of chronic idiopathic urticaria in whom a detailed history, clinical examination and relevant investigations revealed no aetiology and who were refractory to previous treatment were selected. Persons below 18 years of age and pregnant and lactating mothers were excluded.

Twenty eight subjects (9 males and 19 females) were given doxepin 10 mg thrice daily for 3 weeks (group A). Their ages varied between 18 to 59 years; while the duration of illness ranged from 7 weeks to 6 years. Another 28 subjects (11 males and 17 females), ranging in age from 21 to 64 years, were treated with pheniramine maleate 22.5 mg thrice daily for 3 weeks (group B). Their duration of illness varied from 8 weeks to 4 years. Each patient was seen every week for 4 weeks. No other systemic or topical treatment was given during this period.

Estimation of hemoglobin, total and differential leukocyte count, ESR, SGPT, SGOT, serum alkaline phosphatase, creatinine, blood urea, sugar and urinalysis were done at the start of treatment and at the end of 2 and 4 weeks.


  Results Top


After 3 weeks of therapy, 8 (28.6%) patients in group A and 3 (10.7%) in group B were totally free, 18 (64.3%) in group A and 11 (39.3%) in group B had partial remission, while 2 (7.1%) in group A and 14 (50%) in group B had no improvement. Thus 26 (92.9%) patients in group A and 14 (50%) in group B showed improvement. This difference is statistically significant (p < 0.001).

Within 7 days of stopping the treatment, among the totally symptom-free patients, 3 (37.5%) in group A and 3 (100%) in group B got recurrence.

10 (35.7%) patients in group A and 17 (60.7%) in group B complained of drowsiness and 18 (64.3%) in group A and 13 (46.4%) in group B had dryness of the mouth.

Laboratory investigations remained significantly normal except that serum creatinine was a bit higher (2.8 rng/100 ml) in one patient in arouo A.


  Comments Top


Richelson[9] showed that tricyclic antidepressants have a high affinity for H 1 receptors in the mouse neuroblastoma cells. Among the tricyclic antidepressants, doxepin has got the highest affinity; 800 fold than diphenhydramine. Doxepin has a higher affinity for H 2 receptors also in the guinea pig brain compared to cimetidine[10]. An intradermal injection of doxepin supresses histamine-induced wheals" and its topical application inhibits histamine-induced pruritus[12].

Some cases of urticaria may originate from psychological stress. Psychic stress causes an increase in plasmin activity which leads to the release of kinin, increased capillary permeability and oedema and thus causing urticaria. Doxepin may suppress this form of urticaria by a central effect[7].

 
  References Top

1.Morris JB and Beck AT : The efficacy of antidepressant drugs, Arch General Psychiatry, 1974; 30:667-674.  Back to cited text no. 1    
2.Reynolds JEF and Prasad AB : Martindale the Extra Pharmacopoeia, 28th ed, The Pharmaceutical Press, London, 1982; p 118-119.  Back to cited text no. 2    
3.Hollister LE : Tricyclic antidepressants, N Eng J Med. 1978; 299:1106-1109.  Back to cited text no. 3    
4.Kuhn R : The imipramine story, in : Discoveries in Biological Psychiatry, Editors, Ayd FJ Jr and Blackwell B : JB Lippincott Company, Philadelphia, 1970; p 205-217.  Back to cited text no. 4    
5.Bernstein JE : Effect of doxepin hydrochloride on acute and chronic urticaria, J Invest Dermatol, 1982; 78:353-354.  Back to cited text no. 5    
6.Harto A, Sendagorta E and Ledo A : Doxepin in the treatment of chronic urticaria, Dermatologica, 1985; 170:90-93.  Back to cited text no. 6    
7.Greene SL, Reed CE and Schroeter AL : Double-blind cross over study comparing doxepin with diphenhydramine for the treatment of chronic urticaria, J Amer Acad Dermatol, 1985; 12:669-675.  Back to cited text no. 7    
8.Ghosh S, Haldar B and Sengupta S : Therapeutic response of urticaria pigmentosa to doxepin, Ind J Dermatol Venereol Leprol, 1988; 54:211-213.  Back to cited text no. 8    
9.Richelson E : Histamine H, receptor-mediated guanosine 3', 5' - monophosphate formation by cultured mouse neuroblastoma cells, Science, 1978; 201:69-71.  Back to cited text no. 9    
10.Green JP and Maayani S : Tricyclic antidepressant drugs block histamine HZ receptors in brain, Nature, 1977;269:163-165.  Back to cited text no. 10    
11.Sullivan TJ : Pharmacologic modulation of the whealing response to histamine in human skin : Identification of doxepin as a potent in vivo inhibitor, J All Clin Immunol, 1982; 69:260-267.  Back to cited text no. 11    
12.Bernstein JE, Whitney DH and Soltani K :Inhibition of histamine-induced pruritus by topical tricyclic antidepressants, J Amer Acad Dermatol, 1981; 5:582-585.  Back to cited text no. 12    



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