Loxapine (Inhalation)

When patients suffering from bipolar disorder or schizophrenia experience severe bouts of agitation, loxapine can be inhaled to calm the patient down.

Overview

Loxapine belongs to the class of drugs known as anti-psychotics, as it works on chemicals in the brain to help a highly agitated person return to a more normal state. It is only used to treat cases of acute agitation which are due to either bipolar disorder or schizophrenia, but not for episodes of agitation due to dementia or other causes.

This medicine works by delivering increased amounts of dopamine and serotonin to the brain, and since these chemicals help to manage depression, schizophrenia, and extreme agitation, they can be very effective at helping to restore chemical balance in the brain. The medication is only available for medical use under the brand name of Adasuve, and as part of a distribution program known as the Adasuve REMS program.

Condition Treated

Agitation related to bipolar disorder or schizophrenia

Type Of Medicine

Anti-psychotic

Side Effects

In addition to the beneficial effects imparted by loxapine to a patient, with the controlling of agitation, there may also be some unwanted side effects imparted by this medicine as well. If you should experience any of the side effects listed below to a degree which is uncomfortable for you, you should contact your doctor at the earliest opportunity, and describe the side effects as well as their severity.

While many patients will experience no side effects at all, some may experience side effects that are relatively severe in nature. One of the first side effects to be aware of is that of an allergic reaction to loxapine. Because the symptoms which appear during an allergic reaction have the potential of becoming life-threatening, you should seek emergency medical attention as soon as possible if you suspect that you are having an allergic reaction to this medication.

The symptoms to look for in an allergic reaction are the following:

  • Itchiness at almost any location on the body
  • Hives and/or rashes appearing on skin surfaces
  • Tightness in the chest, often accompanied by extreme difficulty with your breathing
  • Swelling or puffiness around the eyelids, and possibly on the tongue, lips, or throat
  • Dizziness or lightheadedness, usually accompanied by the sensation that you are about to pass out.

Some other side effects which you may experience when taking this medication are those listed below:

  • Nausea and/or vomiting
  • Loss of bladder control
  • Problems maintaining your balance
  • Profuse sweating
  • Blurry vision or other vision problems
  • Confusion or disorientation
  • Dizziness or lightheadedness when rising quickly from a lying or sitting position
  • Seizures or convulsions
  • Unexplained weakness or fatigue
  • Pain around the eyes
  • Persistent headaches
  • Fast or irregular heartbeat
  • Decrease in the volume of your urine
  • Less frequent urination
  • Persistent coughing
  • Inability to move your eyes around
  • Rapid spasms or twitching of the eyelids
  • Nervousness and agitation
  • Persistent difficulty urinating, usually with dribbling
  • Inability to remain in one place for any length of time
  • Extreme restlessness
  • Noisy breathing
  • Pain when urinating
  • A pounding sensation in your ears
  • Uncharacteristically pale skin
  • Strange facial expressions
  • Eyes tearing up
  • Twitching movements of the face, mouth, neck, or head
  • Chest tightness
  • Unexplained tiredness or fatigue
  • An urgent need to stick out your tongue
  • Movements which are significantly slowed down
  • Severe stiffness in the muscles
  • A shuffling gait
  • Tremors or shaking in the hands or fingers
  • Difficulty with speaking, swallowing, or breathing
  • Unmanageable twisting movements associated with the arms, neck, legs, or trunk
  • Changes in taste or loss of taste
  • Extreme drowsiness
  • Persistent fatigue, even without any prior exertion.

Dosage

Due to the potential for triggering bronchospasm, loxapine inhalation medicine is only made available through the restricted program known as Risk Evaluation and Mitigation Strategy (REMS), which means it also can only be delivered in a clinical setting, at a healthcare facility which has previously enrolled in the program.

Before any patient can be treated with this medicine, he/she must be screened for medical history including COPD, asthma, any kind of pulmonary diseases, chest auscultation, and any indications of respiratory problems, such as wheezing.

The medicine comes in single-use inhalers with 10 mg of medication, which is the standardized dosage for adults. Only a single 10-mg inhaler should be used by any patient within a period of 24 hours, and it must be administered by a trained and certified medical professional. The procedure for administering this medication is as follows:

  • Open the pouch and extract the inhaler from its package' at this point, the indicator light on the inhaler should be off
  • Pull the plastic tab located on the rear side of the inhaler, and check to see that the green light comes on, which is an indication that the inhaler can then be used
  • Within 15 minutes of pulling the tab and seeing the green 'ready' light, the inhaler medicine should be delivered to the patient. If medication is not delivered within the 15-minute time frame, the green light will go off, and the inhaler will then become unusable
  • Be aware that there may be a clicking sound and a flash of light when the inhaler comes on, and it may also become warm as it is delivering medicine
  • The inhaler should be held away from the mouth, and the patient should fully exhale to push out all air in the lungs
  • The mouthpiece of the inhaler should be placed between the patient's lips, which should then be closed around it, and inhalation through the mouthpiece should begin, using a steady deep breath
  • Once all medication has been inhaled, the green light should turn off to indicate that all medicine has been extracted
  • The patient should remove the mouthpiece from his/her mouth, and hold their breath for the longest time period they are able, hopefully for at least 10 seconds
  • When the patient has completed an inhalation, and the green light is still on, that is an indication that the full dosage of medicine has not been delivered, and the inhalation process should be repeated as many as two more times if necessary
  • If the green light on the inhaler remains on after repeated inhalation attempts, discard the inhaler and use a new one
  • After using the inhaler one time, discard it, using appropriate disposal methods,

Interactions

Similar to with most medications, there is a possibility of drug interactions when using loxapine at the same time as other medicines. When this happens, there's a possibility that any side effects experienced by a patient could be worsened, and it's also possible that either or both of the drugs interacting may lose their effectiveness when being taken concurrently.

In order to prevent this from happening, you as a patient should prepare a comprehensive list of all other medicines which you are currently using, even if they don't seem like medications, but are more like vitamins and herbal supplements. You should also include over-the-counter drugs, as well as any other prescription medications which you are using, and write down the appropriate dosage level for each one of these.

Your doctor can then review this list of medicines and make a determination on whether or not any of them have the potential for interacting with loxapine, and causing any kind of adverse impact to you. You can use the same medication list if you have a need to go to any other healthcare clinic where your primary care doctor is not in residence, or if you should have a need to visit an emergency room to be treated for some medical condition. Any doctor at one of these two facilities will be able to evaluate your list of medications and ensure that any prescribed treatment for you will not conflict with any of the medicines on your list.

Some of the drugs which are most commonly checked for by doctors when making a determination on drug interactions, include all of the following:

  • Cholecalciferol
  • Topiramate
  • Alprazolam
  • Aripiprazole
  • Lorazepam
  • Clozapine
  • Lithium
  • Olanzapine
  • Fluoxetine
  • Albuterol
  • Quetiapine
  • Lisdexamfetamine
  • Lamotrigine
  • Clonazepam
  • Haloperidol
  • Paliperidone
  • Venlafaxine
  • Docusate
  • Benztropine
  • Omega-3 polyunsaturated fatty acids.

There are also a number of medical conditions which can be impacted by your usage of loxapine, and these are shown in the list below:

Warnings

As with most medicines, there are some precautions and warnings which should be observed by patients, so that existing medical conditions are not worsened, and so that no new medical conditions are triggered by the medication.

Loxapine may cause a narrowing of the airways known as bronchospasm, and this could lead to difficulty with breathing. If you already have any kind of trouble breathing or chest tightness, you should notify your doctor, as these symptoms may be exacerbated by taking loxapine.

Contact your doctor immediately if you experience convulsions, a fast or irregular heartbeat, severe muscle stiffness, uncharacteristic fatigue or tiredness, profuse sweating, complete loss of bladder control, high fevers, or high or low blood pressure. All of these symptoms have been associated with a serious condition called neuroleptic malignant syndrome, and it is best if your doctor has a chance to check this out if you should experience any of the above symptoms.

When you rise up quickly from a lying position or sitting position, you may experience lightheadedness or noticeable dizziness after having used loxapine. It may help for you to rise up more slowly, but if the condition persists, you should notify your doctor.

It's possible for you to develop blurry vision after having used loxapine, and you could also become dizzy or drowsy in the wake of using this medication. This could be a very dangerous situation for yourself and for others, if you happen to be driving a motor vehicle or operating any kind of machinery. Before you engage in any of these activities, make sure you know how your body will react to loxapine, so that you don't unwittingly cause accidents.

Any other medications you are taking which act as depressants, including alcohol, should be taken only under a doctor's supervision and recommendation, since they may have the effect of deepening drowsiness and cause you to lose concentration. Some of the depressants on this list include the following:

  • Allergy medications
  • Cold medications
  • Sedatives
  • Tranquilizers
  • Antihistamines
  • Hay fever medication
  • Sleeping pills
  • Prescription pain medicine
  • Narcotics
  • Muscle relaxants
  • Seizure medication
  • Barbiturates
  • Anesthetics
  • Dental anesthetics.

Do not start taking any new medications, or stop taking any of the medicines you are currently taking, unless advised to do so by your doctor. You should also not change any dosage levels of medicines you are currently taking, again unless advised to do so by your doctor.

Women who are of childbearing age should have a serious discussion with the family doctor regarding the advisability of becoming pregnant while also being treated with loxapine. Although there is no positive data indicating harm can come to unborn infants, there is at least a possibility that infants exposed during the third trimester of pregnancy could be susceptible to tremors, respiratory distress, feeding disorders, and unusually high agitation.

For this reason, breastfeeding is also not advised for a woman being treated with loxapine. You should discuss with your doctor whether to avoid breastfeeding altogether, or to temporarily stop taking loxapine.

Storage

Loxapine will be stored in a clinical setting, and will not be used at home by a patient, so no special storage instructions are needed for this medication. Medical professionals will follow the manufacturer's recommended guidelines for safe storage and disposal.

Summary

Loxapine is a medication which is used to treat severe acute agitation which is due to either schizophrenia or bipolar disorder. It is only made available to patients under a trial program known as Risk Evaluation and Mitigation Strategy (REMS), and is only delivered to those medical clinics which are enrolled in that program.

The medicine acts by delivering increased amounts of dopamine and serotonin to the brain, so it can restore chemical balance. Patients experiencing agitation for bipolar disorder or schizophrenia often have a deficiency of these two chemicals in the brain, and loxapine helps to overcome that.