A “Solution” for Fibromyalgia Patients Sensitive to Tricyclics

Consider a concentrated solution (10 mg/mL) of doxepin for patients with fibromyalgia who experience side effects with other tricyclics at even 10-mg doses. Start with 10 drops nightly and titrate up or down depending on their tolerance. Some patients continue to take 5 to 10 drops nightly with better sleep and minimal hangover effect; others become more tolerant and can then successfully switch to another tricyclic in pill form.
- Dallas A. Carter, MD
   Coos Bay, Ore