UnifiedACB

Medication evidence profile

Doxepin

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Clinical overview

Antidepressant

Doxepin has public medication-list entries in GABS 2018 and CALS 2022 Table 4. These are 2 separate source versions, each with its own evidence and definitions.

Source-specific scores

SourceScore
JARSNot listed
Yamada-ABSNot listed
BAASNot listed
Swe-ABSNot listed
GABS3
KABSNot listed
CALS3

How to read this: 0 means the source explicitly assigned zero. “Not listed” means the source did not provide a score for this medication. Scores from different scales are not averaged.

How to interpret the evidence

2 of 7 public source versions contain an explicit medication-list entry for doxepin.

The available rows for doxepin display the same numeric value. Agreement of the displayed numbers does not establish identical methods, clinical meaning or patient-level risk.

None of the public rows in this profile is an explicit zero. An unlisted source still supplies no value.

Source-specific evidence notes

Doxepin is omitted from the 2020 open medication-list supplement even though the antidepressant category header states N=20. UnifiedACB does not infer a 2020 supplement score from the category count. Original source

Source labels and provenance · 2 observations
  1. German Anticholinergic Burden Score 2018

    Source label: Doxepin. Published value: 3.
    Source version: GABS-2018
    Source location: RC4 source recovery; recovery_scope=primary_nonzero_complete
    Observation: GABS_2018_R0133; rating state: published_rating.

  2. CALS 2022 - primary final Table 4

    Source label: Doxepin. Published value: 3.
    Source version: CALS-2022-primary-table4
    Source location: Table 4; literal capture row 181; displayed table row 26; displayed column 6
    Observation: CALS2022_T4_0181; rating state: published_final_table_rating.

Class context — antidepressants with strong anticholinergic activity

For the antidepressants identified by the 2023 AGS Beers Criteria as strongly anticholinergic, the older-adult concern is not limited to one symptom: the criterion also highlights sedation and orthostatic effects. Interpret the Beers criterion separately from each UnifiedACB source score.

AGS Beers 2023 Table 2; AGS Beers 2023 Table 7

Doxepin: medication-specific notes

Dose qualification

The general strong-anticholinergic antidepressant criterion is dose-qualified: the 2023 source specifies doxepin above 6 mg/day and distinguishes low-dose doxepin at or below that threshold. A tablet strength alone does not identify the total daily dose.

AGS Beers 2023 Table 2

Older-adult medication context

AGS Beers context: classification and criteria

AGS Beers 2023 · Strong anticholinergic · >6 mg/dayBeers: Avoid / generally avoid in older adults · >6 mg/day
  • Table 7: Strong-anticholinergic reference listing qualified by doxepin >6 mg/day.
  • Table 2: General older-adult medication criterion; qualification: >6 mg/day.

Source-scale observations and geriatric criteria answer different questions. The Beers material does not alter any score above.

Adults 65 years and older; intended for ambulatory, acute, and institutional care except hospice/end-of-life settings.

Condition-specific and medication-combination contexts

Table 3: clinical conditions

Condition-specific contexts: delirium or high delirium risk, dementia or cognitive impairment, and history of falls or fractures. Applicability depends on the condition and the relevant source criterion.

Table 5: cumulative anticholinergic exposure

Concurrent use of more than one anticholinergic medication should be minimized because cumulative exposure increases geriatric safety concerns.

American Geriatrics Society 2023 updated AGS Beers Criteria — Tables 2, 3, 5 and 7; selected criterion context.

Potentially inappropriate does not mean absolutely contraindicated. Apply the criterion in clinical context and use shared decision-making.

What this page does not establish

  • No medication-list entry is available here from JARS 2025, Yamada-ABS 2023, BAAS 2019, Swe-ABS 2023, and KABS 2020 open validation supplement. These gaps remain “Not listed”; no score is inferred from another source or from class membership.
  • No route inference unless present in the source label.
  • These source records do not estimate an individual’s probability of harm or establish whether to start, stop or change a medication. Ordinal source scores are not averaged into a UnifiedACB score.
Why is this medication clinically relevant to anticholinergic burden?Is this medication identified in the 2023 AGS Beers Criteria?What geriatric concerns are most relevant for this medication?
What is the dose qualification for doxepin in the 2023 AGS Beers Criteria?

References

  1. Kiesel EK, Hopf YM, Drey M. An anticholinergic burden score for German prescribers: score development. BMC Geriatr. 2018;18(1):239. doi:10.1186/s12877-018-0929-6. Open source
  2. Ramos H, Moreno L, Pérez-Tur J, Cháfer-Pericás C, García-Lluch G, Pardo J. CRIDECO Anticholinergic Load Scale: an updated anticholinergic burden scale. Comparison with the ACB Scale in Spanish individuals with subjective memory complaints. J Pers Med. 2022;12(2):207. doi:10.3390/jpm12020207. Open source

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Medication context: Doxepin

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