Loxapine

A to Z Drug Facts

 Actions Unknown. Changes level of excitability of subcortical inhibitory areas in some animals.

 Indications

Capsules: Schizophrenia. Oral concentrate: Management of manifestations of psychotic disorders.

 Contraindications Comatose or severe drug-induced depressed states (eg, barbiturates); hypersensitivity to dibenzoxazepines.

 Route/Dosage

ADULTS: PO Initial dose: 10 mg bid, up to 50 mg/day, titrated fairly rapidly over first 7 to 10 days until symptoms are controlled. Maintenance dose: Reduce dosage to lowest amount compatible with symptom control. Usual range is 60 to 100 mg/day; dosages higher than 250 mg/daly are not recommended.

 Interactions

Lorazepam: Respiratory depression, stupor, and hypertension may occur.

 Adverse Reactions

CARDIOVASCULAR: Tachycardia; hypotension; hypertension; orthostatic hypotension; lightheadedness; syncope. CNS: Extrapyramidal effects; transient drowsiness; sedation; dizziness; faintness; staggering gait; shuffling gait; muscle twitching; weakness; insomnia; agitation; tension; seizures; akinesia; slurred speech; numbness; mental confusion; neuroleptic malignant syndrome; dystonic (eg, muscle spasms of the neck and face) and dyskinetic reactions (eg, choreoathetoid movements); tardive dyskinesia; headache. DERMATOLOGIC: Edema; pruritus; rash; alopecia; seborrhea. EENT: Nasal congestion; blurred vision. GI: Dry mouth; constipation; paralytic ileus; nausea; vomiting. GU: Urinary retention; amenorrhea; gynecomastia; menstrual irregularity. HEMATOLOGIC: Agranulocytosis; thrombocytopenia; leukopenia. HEPATIC: Hepatocellular injury; jaundice; hepatitis. METABOLIC: Weight gain/ loss. RESPIRATORY: Dyspnea. OTHER: Hyperpyrexia; facial flushing; paresthesia; ptosis; polydipsia.

 Precautions

Pregnancy: Undetermined. Lactation: Undetermined. CHILDREN: Safety and efficacy not established. Neuroleptic malignant syndrome: This potentially fatal condition has been reported in association with antipsychotic agents. Signs and symptoms include hyperpyrexia, muscle rigidity, altered mental status, irregular pulse or BP, tachycardia, diaphoresis, cardiac arrhythmias. Ocular toxicity: Carefully observe patient for pigmentary retinopathy and lenticular pigmentation. Special risk patients: Use with extreme caution in patients with a history of convulsive disorders, cardiovascular disease, glaucoma or tendency to urinary retention. Tardive dyskinesia: This syndrome of potentially irreversible, involuntary dyskinetic movements has occurred with other antipsychotic agents. Incidence appears to be highest among the elderly.

 Administration/Storage

Capsules

• Administer prescribed dose bid to qid.

Injectable

• For IM administration only. Not for IV, SC, or intradermal administration.
• Administer prescribed dose q 4 to 6 hr or longer.
• Do not use if particulate matter or discoloration noted.
• Store capsules and injectable at controlled room temperature (59° to 86°F). Store oral concentrate at 68° to 77°F. Do not freeze injectable or oral concentrate. Protect injectable from light.

Oral concentrate

• Use calibrated dropper to measure prescribed dose.
• Mix with orange or grapefruit juice shortly before administration.
• Administer prescribed dose bid to qid.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note history of hypersensitivity to dibenzoxapines, cardiovascular disease, glaucoma, urinary retention, previous episodes of neuroleptic malignant syndrome, or seizures.
• Inform health care provider immediately if hyperpyrexia, muscle rigidity, altered mental status, irregular pulse and BP, tachycardia, or diaphoresis develop.
• Assess baseline neurologic status and during treatment observe for involuntary body and facial movements, excessive drowsiness, behavior changes, and seizure activity. Inform health care provider if noted.
• Monitor patient for GI, CV, CNS, and general body side effects. Inform health care provider if noted and significant.
• Assess and document effect of medication on psychotic symptoms.
• Assess medication compliance.

 Patient/Family Education

• Explain name, dose, action, and potential side effects of drug.
• Advise patient that dose may be slowly increased until maximum benefit is achieved and to not take more than prescribed or increase the dose more rapidly than advised.
• Instruct patient to not stop taking loxapine when symptoms have improved.
• Tell patient to immediately report high fever, muscle rigidity, involuntary body or facial movements, altered mental status, irregular pulse, sweating, or seizures to health care provider.
• Advise patient to avoid strenuous activity during periods of high temperature or humidity.
• Instruct patient to avoid alcoholic beverages and other CNS depressant medications.
• Advise patient to take sips of water, suck on ice chips or sugarless hard candy, or chew sugarless gum if dry mouth occurs.
• Advise patient that drug may cause impaired mental or physical abilities and to use caution while driving or performing other tasks requiring mental alertness.
• Instruct women to notify healthcare provider if tpregnant, planning to become pregnant, or breastfeeding.
• Instruct patient to not take any prescription or OTC medications or dietary supplements unless advised to do so by health care provider.
• Advise patient that follow-up visits will be required to monitor therapy and keep appointments.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts