Loxapine (Loxitane)

Brand Names:

Loxitane, Adasuve  ®

  • Capsules: 5mg, 10mg, 25mg, 50mg
  •  Aerosol powder: 10mg

All FDA black box warnings are at the end of this fact sheet. Please review before taking this medication.

What Is Loxapine And What Does It Treat?

Loxapine is a medication that works in the brain to treat schizophrenia.  It is also known as a first generation antipsychotic (FGA) or typical antipsychotic.  Loxapine rebalances dopamine and it has some activity on serotonin to improve thinking, mood, and behavior. 

Symptoms of schizophrenia include:

  • Hallucinations - imagined voices or images that seem real
  • Delusions - beliefs that are not true (e.g., other people are reading your thoughts)
  • Disorganized thinking or trouble organizing your thoughts and making sense
  • Little desire to be around other people
  • Trouble speaking clearly
  • Lack of motivation

Loxapine may help some or all of these symptoms.

Loxapine is also FDA approved for the treatment of acute agitation associated with schizophrenia or bipolar disorder in adults. Acute treatment of depressive episodes of bipolar disorder

This medication sheet will focus primarily on schizophrenia. You can find more information about bipolar disorder on our About Mental Health conditions page.

What Is The Most Important Information I Should Know About Loxapine?

Schizophrenia requires long-term treatment.  Do not stop taking loxapine, even when you feel better.

Only your healthcare provider can determine the length of loxapine treatment that is right for you.

Missing doses of loxapine may increase your risk for a relapse in your symptoms.

Do not stop taking loxapine or change your dose without talking to with your healthcare provider first.

For loxapine to work properly, it should be taken everyday as ordered by your healthcare provider. 

Are There Specific Concerns About Loxapine And Pregnancy?

If you are planning on becoming pregnant, notify your healthcare provider to best manage your medications.  People living with schizophrenia who wish to become pregnant face important decisions. This is a complex decision since untreated schizophrenia has risks to the fetus, as well as the mother.  It is important to discuss the risks and benefits of treatment with your doctor and caregivers.

Caution is advised with breast-feeding since it is not known whether loxapine is excreted in breast milk.

What Should I Discuss With My Healthcare Provider Before Taking Loxapine?

  • Symptoms of your condition that bother you the most
  • If you have thoughts of suicide or harming yourself
  • Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
  • If you ever had muscle stiffness, shaking, tardive dyskinesia, neuroleptic malignant syndrome, or weight gain caused by a medication
  • If you experience side effects from your medications, discuss them with your provider.  Some side effects may pass with time, but others may require changes in the medication. 
  • Any psychiatric or medical problems you have, such as heart rhythm problems, long QT syndrome, heart attacks, diabetes, high cholesterol, or seizures
  • If you have a family history of diabetes or heart disease
  • All other medications you are currently taking (including over the counter products, herbal and nutritional supplements) and any medication allergies you have
  • Other non-medication treatment you are receiving, such as talk therapy or substance abuse treatment.  Your provider can explain how these different treatments work with the medication.
  • If you are pregnant, plan to become pregnant, or are breast-feeding
  • If you smoke, drink alcohol, or use illegal drugs

How Should I Take Loxapine?

Loxapine is usually taken twice a day.

Typically, patients begin at a low dose of medicine and the dose is increased slowly over several weeks.  Only your healthcare provider can determine the correct dose for you.

The dose usually ranges from 10mg to 250mg daily.  Only your healthcare provider can determine the correct dose for you.

Use a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take your medication.  You may also ask a family member a friend to remind you or check in with you to be sure you are taking your medication.

The inhalation form is used once daily.

What Happens If I Miss A Dose Of Loxapine?

If you miss a dose of loxapine, take it as soon as you remember, unless it is closer to the time of your next dose.  Discuss this with your healthcare provider.  Do not double your next dose or take more than what is prescribed.

What Should I Avoid While Taking Loxapine?

Avoid drinking alcohol or using illegal drugs while you are taking loxapine. They may decrease the benefits (e.g. worsen your confusion) and increase adverse effects (e.g. sedation) of the medication. 

What Happens If I Overdose With Loxapine?

If an overdose occurs call your doctor or 911.  You may need urgent medical care. You may also contact the poison control center at 1-800-222-1222.

A specific treatment to reverse the effects of loxapine does not exist.

What Are Possible Side Effects Of Loxapine?

Common Side Effects

Low blood pressure; fainting, sleepiness, metallic taste in the mouth

Rare Side Effects

Changes in the body's ability to adjust temperature, vision problems, sensitivity to sunlight, seizures.

Haloperidol may increase the blood levels of a hormone called prolactin.  Side effects of increased prolactin levels include females losing their period, production of breast milk and males losing their sex drive or possibly experiencing erectile problems.  Long term (months or years) of elevated prolactin can lead to osteoporosis or increased risk of bone fractures.

Serious Side Effects

Some people may develop muscle related side effects while taking haloperidol.  The technical terms for these are “extrapyramidal effects” (EPS) and “tardive dyskinesia” (TD).  Symptoms of EPS include restlessness, tremor, and stiffness.  TD symptoms include slow or jerky movements that one cannot control, often starting in the mouth with tongue rolling or chewing movements.  

All antipsychotics have been associated with the risk of sudden cardiac death due to an arrhythmia (irregular heart beat).  To minimize this risk, antipsychotic medications should be used in the smallest effective dose when the benefits outweigh the risks.  Your doctor may order an EKG to monitor for irregular heart-beat.

Neuroleptic malignant syndrome is a rare, life threatening adverse effect of antipsychotics which occurs in <1% of patients.  Symptoms include confusion, fever, extreme muscle stiffness, and sweating.  If any of these symptoms occur, contact your healthcare provider immediately.

Are There Any Risks Of Taking Loxapine For Long Periods Of Time?

Tardive dyskinesia (TD) is a side effect that develops with prolonged use of antipsychotics.  If you develop symptoms of TD, such as grimacing, sucking, and smacking of lips, or other movements that you cannot control, contact your healthcare provider immediately.  All patients taking either first or second generation antipsychotics should have an Abnormal Involuntary Movement Scale (AIMS) completed regularly by their healthcare provider to monitor for TD.  

All antipsychotics have been associated with the risk of sudden cardiac death due to an arrhythmia (irregular heart beat).  To minimize this risk, antipsychotic medications should be used in the smallest effective dose when the benefits outweigh the risks.  Your doctor may order an EKG to monitor for irregular heart beat.

Neuroleptic malignant syndrome is a rare, life threatening adverse effect of antipsychotics which occurs in <1% of patients.  Symptoms include confusion, fever, extreme muscle stiffness, and sweating.  If any of these symptoms occur, contact your healthcare provider immediately.

What Other Medications May Interact With Loxapine?

Other medications taken into the lungs may interfere with the effectiveness of the Adasuve aerosol formuation of loxapine.  You should check with your doctor if you also use any type of inhaler for asthma or COPD.

How Long Does It Take For Loxapine To Work?

It is very important to tell your doctor how you feel things are going during the first few weeks after you start taking loxapine. It will probably take several weeks to see big enough changes in your symptoms to decide if loxapine is the right medication for you.

Antipsychotic treatment is generally needed lifelong for persons with schizophrenia. Your doctor can best discuss the duration of treatment you need based on your symptoms and illness.

  • Hallucinations, disorganized thinking, and delusions may improve in the first 1-2 weeks
  • Sometimes these symptoms do not completely go away
  • Motivation and desire to be around other people can take at least 1-2 weeks to improve
  • Symptoms continue to get better the longer you take loxapine.
  • It may take 2-3 months before you get the full benefit of loxapine.

Provided by

College of Psychiatric and Neurologic Pharmacists

(June 2016)

 

Summary of FDA Black Box Warnings

Increased Mortality in Elderly Patients with Dementia Related Psychosis

  • Both first generation (typical) and second generation (atypical) antipsychotics are associated with an increased risk of mortality in elderly patients when used for dementia related psychosis.
  • Although there were multiple causes of death in studies, most deaths appeared to be due to cardiovascular causes (e.g. sudden cardiac death) or infection (e.g. pneumonia).
  • Antipsychotics are not indicated for the treatment of dementia-related psychosis.

Bronchospasm:

            Loxapine inhalation can cause bronchospasm that has the potential to lead to respiratory distress and arrest. Administer only in a registered enrolled healthcare facility with immediate access to on-site equipment and personnel trained to manage acute bronchospasm including advanced airway management (intubation and mechanical ventilation).

            Prior to administering loxapine inhalation, screen patients regarding a current diagnosis or history of asthma, COPD, or other lung diseases associated with bronchospasm, acute respiratory symptoms or signs, current use of medications used to treat airway disease and examine patients for respiratory abnormalities. Loxapine can cause sedation, which can mask the signs of bronchospasm.