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Doxylamine

Clinical data
Trade names	Unisom
AHFS/Drugs.com	Monograph
MedlinePlus	a682537
Routes of administration	Oral
ATC code	R06AA09 (WHO)
Legal status
Legal status	OTC
Pharmacokinetic data
Bioavailability	Oral: 24.7%, Intranasal: 70.8%
Metabolism	Hepatic
Elimination half-life	variable; 6–12 hours
Excretion	Urine (primarily as metabolites)
Identifiers
IUPAC name (RS)-N,N-dimethyl-2- (1-phenyl-1-pyridin-2-yl-ethoxy)- ethanamine
CAS Number	469-21-6
PubChem CID	3162
DrugBank	DB00366
ChemSpider	3050
UNII	95QB77JKPL
KEGG	D07878
ChEBI	CHEBI:51380
ChEMBL	ChEMBL1004
CompTox Dashboard (EPA)	DTXSID1022970
ECHA InfoCard	100.006.742
Chemical and physical data
Formula	C17H22N2O
Molar mass	270.369 g/mol g·mol
3D model (JSmol)	Interactive image
SMILES O(CCN(C)C)C(c1ncccc1)(c2ccccc2)C
InChI InChI=1S/C17H22N2O/c1-17(20-14-13-19(2)3,15-9-5-4-6-10-15)16-11-7-8-12-18-16/h4-12H,13-14H2,1-3H3 Key:HCFDWZZGGLSKEP-UHFFFAOYSA-N
(verify)

Doxylamine is one of the many sedating antihistamines used by itself as a short-term sedative, and in combination with other drugs as a night-time cold and allergy relief drug. It is also used in combination with the analgesics paracetamol (acetaminophen) and codeine as an analgesic/calmative preparation, and is prescribed in combination with vitamin B₆ (pyridoxine) to prevent morning sickness in pregnant women.

Indications

Doxylamine is a member of the ethanolamine class of antihistamines and has anti-allergy power superior to almost every other antihistamine on the market, with the exception of diphenhydramine (Benadryl). It is also the most effective over-the-counter sedative available in the United States and is more sedating than some prescription hypnotics. One study found that doxylamine succinate was more effective than the barbiturate phenobarbital for use as a sedative.

The dosage required to induce hypnosis (sleep) can be as low as 6.25 mg, but is usually effective in dosages of up to 25 mg. Higher doses are not recommended by the United States Food and Drug Administration, although single dosage recommendations of up to 50 mg are common in some countries, including Australia, where it is marketed under the names Restavit and Dozile. A recent placebo-controlled, double-blind randomized trial found the formulation of doxylamine and pyridoxine marketed as Diclectin to be effective in controlling nausea and vomiting due to pregnancy.

Metabolites

The two main metabolites are desmethyldoxylamine and didesmethyldoxylamine.

Side effects

Doxylamine succinate is a potent anticholinergic and has a side-effect profile common to such drugs, including dry mouth, ataxia, urinary retention, drowsiness, memory problems, inability to concentrate, hallucinations, psychosis, and a marked increased sensitivity to external stimuli. Like many hypnotics, it should not be combined with other antihistamines, such as Zyrtec (cetirizine) or diphenhydramine, as this combination can increase the risk of serious side effects. Using doxylamine over a long period of time is not recommended and can cause dependence. However, the drug is not addictive and withdrawal effects are unlikely to be experienced with prolonged use.

Toxicity

Doxylamine succinate is generally safe for administration to healthy adults. Typical preparations that contain doxylamine range from 6.25 mg to 50 mg. The LD₅₀ is estimated to be 50–500 mg/kg in humans. Symptoms of overdose may include dry mouth, dilated pupils, insomnia, night terrors, euphoria, hallucinations, seizures, rhabdomyolysis, and death. Fatalities have been reported from doxylamine overdose. These have been characterized by coma, tonic-clonic seizures and cardiorespiratory arrest. Children appear to be at a high risk for cardiorespiratory arrest. A toxic dose for children of more than 1.8 mg/kg has been reported. A 3 year old child died 18 hours after ingesting 1,000 mg doxylamine succinate. Rarely, an overdose results in rhabdomyolysis and acute renal failure.

Formulations

Doxylamine is primarily used as the succinic acid salt, doxylamine succinate.

• It is the sedating ingredient of NyQuil.
• In Commonwealth countries, such as Australia, South Africa and the United Kingdom, doxylamine is available prepared with paracetamol (acetaminophen) and codeine under the brand name Dolased, Propain Plus, Syndol, or Mersyndol, as treatment for tension headache and other types of pain.
• Doxylamine succinate is used in general over-the-counter sleep-aids branded as Somnil, Dozile, Donormyl, Dormidina, Restavit, Unisom-2 and Sleep Aid (generic - Australia),.
• In the United States doxylamine succinate is the active ingredient in the over-the-counter sleep-aid tablets branded as Unisom; however, the gel-cap form contains diphenhydramine hydrochloride instead.
• In Canada doxylamine succinate is the active ingredient in the over-the-counter sleep-aid tablets branded as Unisom 2; while Unisom contains diphenhydramine hydrochloride as the active ingredient.
• It is also available in combination with vitamin B₆ and folic acid under the brand name Evanorm (marketed by Ion Healthcare).
• In Canada, doxylamine succinate and pyridoxine (vitamin B₆) are the ingredients of Diclectin, which is used to prevent morning sickness.

References

1. http://www3.interscience.wiley.com/journal/98016819/abstract
2. ^ http://www.drugbank.ca/drugs/DB00366
3. Am J Obstet Gynecol. 2010 Sep 13.
4. http://hazard.com/msds/mf/baker/baker/files/d8882.htm
5. Syed, Husnain (17 March 2009). "Doxylamine toxicity: seizure, rhabdomyolysis and false positive urine drug screen for methadone". BMJ Case Reports. 2003 (90). BMJ Group: 845. doi:10.1136/bcr.09.2008.0879. Retrieved 29 November 2009. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
6. http://www.medsafe.govt.nz/profs/datasheet/d/Dozilecap.pdf
7. Leybishkis B, B (July 2001). "Doxylamine overdose as a potential cause of rhabdomyolysis". American journal of the medical sciences. 322 (1). Lippincott Williams & Wilkins: 48–9. doi:10.1097/00000441-200107000-00009. PMID 11465247. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
8. manufacturer's website

• Use dmy dates from August 2010
• Antiemetics
• Ethers
• Pyridines
• H1 receptor antagonists
• Anticholinergics
• Hypnotics