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Drug Safety-related Labeling Changes (SrLC)

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SILENOR (NDA-022036)

(DOXEPIN HYDROCHLORIDE)

Safety-related Labeling Changes Approved by FDA Center for Drug Evaluation and Research (CDER)

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10/29/2020 (SUPPL-6)

Approved Drug Label (PDF)

8 Use in Specific Populations

8.1.     Pregnancy

(Pregnancy and Lactation Labeling Rule (PLLR) conversion; extensive revisions please see labeling)

8.2.     Lactation

(Pregnancy and Lactation Labeling Rule (PLLR) conversion; additions and/or revisions underlined)

Risk Summary

Data from the published literature report the presence of doxepin and nordoxepin in human milk. There are reports of excess sedation, respiratory depression, poor sucking and swallowing, and hypotonia in breastfed infants exposed to doxepin. There are no data on the effects of doxepin on milk production. Because of the potential for serious adverse reactions, including excess sedation and respiratory depression in a breastfed infant, clinicians should advise patients that breastfeeding is not recommended during treatment with SILENOR.

Clinical Considerations

Infants exposed to SILENOR through breast milk should be monitored for excess sedation, respiratory depression and hypotonia.

8.3.     Females and Males of Reproductive Potential

(Newly added subsection)

Infertility 

Based on results from animal fertility studies conducted in rats, doxepin may reduce fertility in females and males of reproductive potential [see Nonclinical Toxicology (13.1)]. It is unknown if the effects are reversible.

17 PCI/PI/MG (Patient Counseling Information/Patient Information/Medication Guide)

17.   PATIENT COUNSELING INFORMATION

(Additions and/or revisions underlined)

Pregnancy

Advise patients that SILENOR use late in pregnancy may increase the risk for neonatal complications requiring prolonged hospitalization, respiratory support or tube feeding [see Use in Specific Populations (8.1)].

Lactation

Advise patients that breastfeeding is not recommended during treatment with SILENOR [see Use in Specific Populations (8.2)].

Infertility

Inform patients that SILENOR may cause reduced fertility. It is not known whether these effects on fertility are reversible.