Two tricyclic antidepressants (TCAs), dosulepin (dothiepin) and doxepin will no longer be available in New Zealand.

When transitioning patients to alternatives, consider:

• Is a TCA still appropriate? TCAs are associated with a higher risk of adverse outcomes in people with cardiovascular disease and older adults.
• Individual psychiatric history. Switching therapy increases the risk of relapse of mental illness and psychosocial support and/or referral may be needed.
• Antidepressant discontinuation syndrome. TCAs are associated with discontinuation symptoms, particularly if stopped abruptly after more than 4 weeks of regular use.
• Individual TCAs are not dose equivalent. Dose titration may be needed when switching to another TCA.
• Dosulepin (dothiepin) and doxepin are sedating antidepressants, switching to a less-sedating antidepressant (e.g. SSRI, nortriptyline) may cause sleep problems.

For general information on switching antidepressants, discontinuation symptoms and their relative adverse effects see nzf.org.nz/nzf_2225. Health professionals are also welcome to contact our service for more specific or detailed advice on switching therapy.

Notifications from PHARMAC regarding the withdrawal of these medicines:

• dosulepin (dothiepin): pharmac.govt.nz/medicines/my-medicine-has-changed/dosulepin/
• doxepin: haurakipho.org.nz/media/2335/2019-02-15-notification-re-doxepin-discontinuation.pdf