Doxepin and Ramelteon: interaction and safety
This source-based reference is not a personal treatment recommendation. The relevance and management of an interaction depend on the exact products, route, dose and clinical situation.
Interaction mechanism
Doxepin may increase ramelteon exposure. Other CNS depressants may increase the sedation caused by low-dose doxepin. Other CNS depressants may increase impaired alertness and complex sleep behaviours.
Clinical significance and safety
Doxepin and Ramelteon: Doxepin may increase ramelteon exposure. Other CNS depressants may increase the sedation caused by low-dose doxepin. Other CNS depressants may increase impaired alertness and complex sleep behaviours. Drowsiness, dizziness, reduced coordination and falls can be more likely. Driving and other hazardous tasks require particular caution when affected. The class warning does not mean that every combination is contraindicated or that each pair has been tested in a separate clinical trial. Changes in exposure can affect tolerability or treatment response. The prescriber must check the exact inhibitor, formulation, dose and timing against the cited product information; doses should not be adjusted without that review. The cited doxepin evidence concerns 3 mg/6 mg insomnia tablets, not higher-dose antidepressant formulations. The ramelteon interaction information concerns doxepin at the dose studied; the measured exposure change must not be assumed to apply unchanged to 3 mg/6 mg insomnia tablets. Ask a pharmacist or prescriber to review the full medicine list before adding or changing treatment.
Using this information
This is a source-based reference record, not a recommendation to combine, stop or change medicines. A missing interaction record does not establish safe use. A qualified healthcare professional should consider the exact products, doses, other medicines and individual health circumstances.