Loxapine (Oral)

Overview

Characterized by reduced emotional expression and limited social engagement, schizophrenia is a mental disorder. Patients with schizophrenia often experience a number of symptoms, such as false beliefs, confused thoughts and hallucinations. In some cases, patients may be described as losing touch with reality.

Although the exact causes of schizophrenia are still unknown, it is believed that the condition is influenced by environmental and genetic factors. Whilst schizophrenia cannot be cured, patients can be successfully treated with a mixture of therapies. As well as using medication to relieve the patient's symptoms, counselling and social support is often beneficial for patients who may have been socially isolated due to their condition.

As an antipsychotic agent, Loxapine acts as a tranquilizer and can reduce or prevent periods of psychosis. The medication acts as an inhibitor of serotonin 5-HT2, as well as a dopamine antagonist, and has a calming effect on patients. By relieving the patient's symptoms and reducing psychosis, Loxapine can have a beneficial effect on patients. With successful treatment, patients with schizophrenia are able to function normally and to avoid episodes or psychosis or irrational thinking.

However, Loxapine must only be used in appropriate situations. Whilst the medication is successful in treating patients with schizophrenia and may be used to treat patients with bipolar disorder, it should not be prescribed to patients who are experiencing psychosis caused by dementia. As Loxapine can have harmful side-effects if used to treat patients with dementia, it's vital that an accurate diagnosis is made before Loxapine is prescribed.

Conditions Treated

  • Schizophrenia
  • Bipolar disorder

Type Of Medicine

  • Antipsychotic

Side Effects

It is not uncommon for patients to experience side-effects when they are taking antipsychotic medications, such as Loxapine. In many cases, these side-effects will be more apparent when patients first start using Loxapine but will decrease as the patient becomes accustomed to the medication.

For example, patients or their caregivers may notice the following side-effects when Loxapine is first used:

  • Blurred vision
  • Lightheadedness, fainting or dizziness
  • Confusion
  • Increased sensitivity of the skin to the sun
  • Drowsiness
  • Missing menstrual periods
  • Dryness of the mouth
  • Headache
  • Constipation (mild)
  • Nausea or vomiting
  • Decreased sexual ability
  • Trouble sleeping
  • Enlargement of breasts (in both male and female patients)
  • Weight gain
  • Unusual secretion of milk

If the above side-effects only occur for a short period of time and are not severe, additional medical treatment may not be required. However, if the adverse effects do not decrease or are particularly severe, patients or their caregivers should access medical help.

Furthermore, the patient's physician should be notified straight away if the patient exhibits the following side-effects when taking Loxapine:

  • Difficulty with swallowing or speaking
  • Increased spasms or blinking of the eyelids
  • Lip puckering or smacking
  • Low or high blood pressure
  • High fever
  • Loss of balance control
  • Irregular or fast heartbeat or pulse
  • Yellowing of the skin or eyes
  • Mask-like face
  • Fast or difficult breathing
  • Puffing of the cheeks
  • Convulsions or seizures
  • Unusually pale skin
  • Fine or rapid, worm-like movements of the tongue
  • Desire to keep moving or restlessness
  • Uncontrolled chewing movements
  • Shuffling walk
  • Twisting movements of the body
  • Slowed movements
  • Muscle spasms, particularly affecting the back and neck
  • Unusual bruising or bleeding
  • Stiffness of the legs and arms
  • Rash on the skin
  • Inability to move the eyes
  • Unusual weakness or tiredness
  • Shaking and trembling of the hands and fingers
  • Difficulty urination
  • Uncontrolled movements of the legs or arms
  • Constipation (severe)
  • Loss of bladder control
  • Uncontrolled twisting movements of the trunk, legs, arms or neck
  • Severe muscle stiffness
  • Increased sweating
  • Unusual body positions and/or facial expressions
  • Sore throat and/or fever

If patients develop any other side-effects when taking Loxapine, medical help should be sought.

It's also important that patients and their caregivers are aware of the symptoms of a Loxapine overdose. If too much medication is taken at once or if Loxapine is taken too often, patients may experience a life-threatening emergency. Symptoms of a Loxapine overdose may include:

  • Dizziness (severe)
  • Uncontrolled movements, muscle jerking, stiffness or trembling (severe)
  • Drowsiness (severe)
  • Unusual weakness or tiredness (severe)
  • Troubled breathing (severe)

If patients exhibit the above symptoms, emergency medical help must be sought straight away. Patients or their caregivers should call 911, access help from their nearest Emergency Room or contact a Poison Control Center immediately.

If too much Loxapine has been taken, patients or their caregivers should obtain medical help immediately and should not wait for the symptoms of an overdose to become apparent.

Dosage

When patients are first prescribed Loxapine, they are usually advised to take 20-50mg per day. However, this should be taken as two to four doses throughout the day, rather than as one, single dose. If the patient responds well to treatment but their symptoms persist, their dose may be increased. However, patients are not usually prescribed more than 250mg of Loxapine per day.

It is essential that patients take Loxapine in accordance with their doctor's instructions and that they do not take more or less medication than has been prescribed to them.

If patients forget to take a dose of Loxapine, they should take it as soon as they remember to. However, if their next dose is almost due, patients may have to skip the missed dose completely. If so, patients should take their next dose at the normal time and continue with their usual treatment schedule. Patients should not take a double dose of Loxapine unless they are advised to do so by a medical professional.

If patients are unsure how or when to take their medication, they should contact their physician or pharmacist for advice.

Potential Drug Interactions:

Before patients take Loxapine, they should tell their doctor if they are using any other medicines. This includes prescription medicines, over-the-counter medications, vitamins and/or supplements. As some medicines can interact with each other, it may not be safe for patients to take Loxapine alongside certain other substances.

For example, Loxapine is not usually prescribed alongside the following medicines:

  • Metoclopramide
  • Bromopride

Similarly, the use of Loxapine in conjunction with the following medications is not usually recommended:

  • Bromazepam
  • Morphine
  • Bupropion
  • Morphine Sulfate Liposome
  • Carbamazepine
  • Oxymorphone
  • Donepezil
  • Pentazocine
  • Milnacipran
  • Doxylamine
  • Periciazine
  • Flibanserin
  • Sodium Oxybate
  • Hydrocodone
  • Tiotropium
  • Hydromorphone
  • Zotepine
  • Lithium

However, if doctors believe it is in the patient's best interests to prescribe Loxapine in conjunction with one the medicines listed above, they may modify the patient's dose or instruct them to take their medication at a specific time of day. Taking the medications at separate times may help to prevent an interaction occurring and can ensure that patients are able to benefit from treatment with both medicines.

Furthermore, if patients take Loxapine alongside the following substance, they may suffer from increased side-effects:

  • Betel Nut

Once patients have started using Loxapine, they should obtain medical advice before they take any new medicines, vitamins or supplements.

Warnings

If patients have any other medical conditions or health problems, it is important that they tell their doctor before they start taking Loxapine. There are some conditions which can affect treatment with Loxapine and these may include:

  • Intestinal blockage
  • Brain tumor
  • Difficult urination
  • Breast cancer, particularly if the cancer is prolactin-dependent
  • Glaucoma
  • Blood vessel or heart disease
  • Seizures
  • Neuroleptic malignant syndrome (NMS)
  • Coma
  • Urinary retention
  • Depression

Specific studies on the effects of Loxapine on the pediatric population have not yet been carried out. Due to this, pediatric patients are not usually treated with Loxapine.

Although geriatric patients can be treated with Loxapine, it should only be used to treat the appropriate conditions, such as schizophrenia. Loxapine should not be used to treat psychosis caused by dementia. Furthermore, if older patients are prescribed Loxapine, they may have an increased risk of developing a movement disorder, known as tardive dyskinesia.

Unless patients are advised to do so by a healthcare practitioner, they should not suddenly stop taking Loxapine. If treatment is to be discontinued, doctors may advise the patient to gradually reduce their dose of Loxapine as this can help to prevent withdrawal symptoms from occurring.

During treatment with Loxapine, patients will have regular consultations with their physician. This will enable the doctor to modify the dose of Loxapine, if necessary, confirm that the medication is working and check that it is not having any unwanted effects.

If Loxapine is taken in conjunction with other central nervous system (CNS) depressants, it will add to their effects. Due to this, patients should not take any of the following medications, unless they are advised to do so by a healthcare professional:

  • Allergy medication
  • Seizure medication
  • Muscle relaxants
  • Barbiturates
  • Narcotics
  • Prescribed pain medication
  • Cold and flu remedies
  • Antihistamines
  • Cough syrup
  • Tranquilizers
  • Sleeping medications
  • Anesthetics, including dental anesthetics

If patients are due to undergo any medical tests or procedures, they must inform the relevant healthcare practitioners that they are taking Loxapine. As this medication can affect the use of anesthetics, patients must tell their physician or dentist that they are taking Loxapine before any procedures or dental work is carried out.

In some patients, Loxapine may cause a movement disorder, known as tardive dyskinesia. If patients exhibit the following symptoms, they should seek medical help straight away:

  • Puffing of the cheeks
  • Lip puckering or smacking
  • Uncontrolled chewing movements
  • Rapid, worm-like movements of the tongue
  • Uncontrolled movements of the legs or arms

Patients could develop neuroleptic malignant syndrome (NMS) when taking Loxapine and should stop taking the medication and seek immediate medical help if they experience the following symptoms:

  • Difficulty breathing
  • Convulsions or seizures
  • Fast heartbeat
  • Low or high blood pressure
  • High fever
  • Loss of bladder control
  • Increased sweating
  • Unusually pale skin
  • Tiredness
  • Severe muscle stiffness

When taking Loxapine, patients may feel drowsy or less alert than they usually do. This may occur more frequently when the patient's dose of Loxapine is increased. Patients may feel drowsy upon waking, even if the medication is taken at bedtime. If affected in this way, patients should not operate machinery, drive or perform any potentially dangerous tasks.

In some cases, patients may feel lightheadedness, faintness or dizziness when getting up from a lying or sitting position. Patients should get up slowly in order to try and reduce these side-effects. If this persists, patients should notify their physician.

When taking Loxapine, patients may experience dryness of the mouth. In order to relieve these side effects, patients may suck sugarless candy, chew gum or use a saliva substitute. However, patients should notify their physician or dentist if this side-effect continues for longer than a period of two weeks. A persistent dry mouth can increase the risk of tooth decay, infections and/or dental disease.

As a category C medication, Loxapine should only be used during pregnancy if the benefits of taking the medication outweigh the risks. If Loxapine is used during the third trimester of pregnancy, babies may experience withdrawal and/or extrapyramidal effects following the birth.

If patients become pregnant while taking Loxapine, they should notify their physician straight away.

If patients breastfeed whilst taking Loxapine, the medication could be excreted in their breast milk and may cause harm to the infant. Due to this, patients should not breastfeed whilst they are taking Loxapine and should not breastfeed soon after their last dose of Loxapine as the medication may still be in their system.

Before using Loxapine, patients should tell their physician if they have any known allergies. In rare cases, patients may exhibit an allergic reaction whilst taking Loxapine and, if so, they will require emergency medical treatment. If a patient is experiencing an allergic reaction, they may exhibit the following symptoms:

  • Hoarseness
  • Gasping for breath
  • Hives
  • Difficulty swallowing
  • Itching
  • Difficulty breathing
  • Swelling affecting the lips, tongue, throat, mouth face or hands

Storage

When storing medication at home, patients should ensure that it is in a safe location and that children and/or pets cannot gain access to it. In order to store Loxapine properly, patients should follow the manufacturer's instructions and/or the medication guidelines.

Generally, Loxapine can be kept at room temperature but should not be exposed to light, moisture or heat.

If patients are advised to stop taking Loxapine or if the medication reaches its use-by date, patients should dispose of it carefully. It is not safe to throw Loxapine out with regular household waste as it may pose a risk to other people. Instead, patients or their caregivers should contact a physician's office or pharmacist and make use of a specialist medicine disposal service.

Summary

Without effective treatment, schizophrenia can be an extremely debilitating condition. If patients experience confused thinking and/or hallucinations, they may feel very distressed or frightened and this could result in them act irrationally or in potentially dangerous ways.

However, patients can obtain relief from their symptoms with the appropriate medication. When Loxapine is used successfully, periods of psychosis are reduced or eliminated completely, and patients tend to feel calmer and less agitated.

Whilst Loxapine is not a cure for schizophrenia, it can be used on a long-term basis. When the appropriate dose of medication is used, Loxapine can successfully reduce the patient's symptoms and enable them to function more effectively.