Loxapine is a first-generation antipsychotic medication typically used for the treatment of schizophrenia. It is important to use this medication as prescribed and to consult with your doctor or healthcare provider prior to starting any other medications (prescribed or over the counter) while taking Loxapine, as adverse effects can occur.

Loxapine brand names

  • Oxilapine
  • Loxitane (discontinued in 2021)
  • Adusave

What is loxapine prescribed for?

Loxapine capsules are most commonly prescribed for the treatment of patients with schizophrenia. Adusave, a powder that is inhaled, is prescribed for the treatment of severe agitation in schizophrenia and bipolar disorder.

According to The Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2022) [1], symptoms of schizophrenia include:

  • Hallucinations: seeing, smelling, feeling, tasting, or hearing things that are not there
  • Delusions: believing things are happening that are irrational or not based in reality
  • Disordered or incoherent speech
  • Unusual physical movement, such as being non-responsiveto environmental occurrences, not speaking, or repeated movements
  • Negative symptoms, such as appearing expressionless, lack of interest, or isolation from others

How does loxapine work?

Loxapine works by reducing or inhibiting a neurotransmitter called dopamine, which results in a calming of brain activity and reduces symptoms of schizophrenia. It requires consistent use to work effectively, as it does not cure schizophrenia, but rather helps to alleviate the symptoms of the condition, including mood, behavior, and thinking [2].

How is loxapine usually taken?

Loxapine can be taken as a capsule or as an aerosol powder (Adusave). Generic brand capsules are available in 5mg, 10mg, 25mg, and 50mg strengths and are swallowed whole, while the powder is 10mg and is inhaled once per day (similar to an asthma inhaler).

For the treatment of schizophrenia, your doctor will likely prescribe a starting dose of 10mg to be taken twice per day. Your dose will then increase over the next week or two, until a therapeutic level is reached, which will be evident when you notice an improvement in some of your symptoms.

Your dose will slowly be decreased until it reaches the ideal level, which is usually between 20-60mg per day [3][4]. Your dose will never exceed 250mg per day.

For the treatment of agitation in schizophrenia or bipolar disorder, you will be prescribed 10mg per day, to be inhaled in one dose.

Loxapine will not be prescribed to treat psychotic symptoms in the elderly, due to the potential risks and side effects of the medication [3].

How long does loxapine stay in your system?

After you begin this treatment, you may notice improvements in some of your symptoms within the first week or two, but it will take several weeks until you know whether the medication is helping you or not. Some of your other symptoms may take 2-3 months to improve. Be sure to discuss these changes with your doctor, along with any side effects that you experience.

Because of the nature of schizophrenia, you may need to remain on this medication for the rest of your life. Loxapine does not cure schizophrenia but will help you to manage your symptoms. Therefore, you should continue to take it as prescribed by your doctor, even when you start to feel better [5].

Loxapine side effects

When starting a new medication, it is common to experience side effects, some of which may reduce or disappear over time. If you experience ongoing or problematic side effects, consult your doctor.

Common side effects of oral Loxapine include:

  • Stomach upset, including constipation, diarrhea, nausea, or vomiting
  • Dizziness and unsteadiness
  • Dry mouth
  • Excessive saliva
  • Sleepiness or lightheadedness
  • Low blood pressure
  • Urinary retention

When inhaled, loxapine may cause a change or loss of taste. It can also make it more difficult for you to breathe; if this happens, you should contact your doctor immediately.

A rare side effect of loxapine is an increase in a hormone called prolactin. This can cause missed periods or the production of breast milk in women, and a decrease in sex drive in men. Extended periods of increased prolactin can lead to osteoporosis, a weakening of the bones [6].

Serious side effects of loxapine can occur. If you experience any of the following, consult your doctor, as you may need to reduce or change your medication prescription:

  • Muscle-related changes, includingmuscle stiffness, shaking, slow or jerky movements, and uncontrollable tongue or mouth movements.
  • Irregular heartbeat, which will require regular monitoring by your doctor, due to the increased risk of heart disease
  • Low blood pressure leading to increased falls and injury
  • Difficulty breathing or swallowing
  • Fever and sweating
  • Yellowing of the skin or eyes
  • Allergic reactions, such as rash, swelling of the mouth or face, or tight chest

Loxapine precautions

Before starting this medication, consult with your doctor and inform them of any past or present mental or physical health issues you have experienced, as this may impact your ability to take loxapine safely.

Because of the potential side effects of loxapine, you should tell your doctor if you have experienced any heart, blood, or liver disease, seizures, breast cancer, or side effects of other medications.

If you have experienced asthma, COPD, or other breathing-related conditions, you will not be prescribed Adusave, the loxapine aerosol powder, due to the risk of further complications related to these conditions [3].

Tell your doctor about all medications you are currently taking or plan to take (including vitamins, dietary supplements, and herbal products), as they may cause adverse reactions or reduce the effectiveness of loxapine.

If taken during the third trimester of pregnancy, loxapine can cause side effects or withdrawal symptoms once the baby is born, and can also be passed to your baby through breast milk. Discuss with your doctor if you are pregnant or plan to get pregnant so that you can weigh up the medication's benefits and risks to continue receiving proper treatment for your condition.

As loxapine can make you very drowsy, particularly when just starting treatment, it is advised not to drive while taking this medication or until you know how it affects you.

Loxapine interactions

Various medications can increase the side effects of loxapine, particularly those related to sedation and slowing of the central nervous system. Sedatives, tranquilizers, antihistamines, opiate painkillers, antidepressants, antipsychotics, and medications for seizures and anxiety may interact with loxapine, increasing side effects or risks [3][4].

Similarly, alcohol and recreational drugs may also increase the sedating effects of loxapine, increasing risks of breathing difficulties, heart conditions, or oversedation, and may decrease the effectiveness of the medication.

Loxapine storage

Always keep all medications out of reach of children.

Store loxapine in its original packaging, in airtight containers, and at room temperature (never above 86 F).

If you need to dispose of medication that is out of date or no longer needed, contact a medical professional to ensure it is disposed of appropriately. Never flush medications down the toilet or put them in the bin, as this can create unnecessary risks.

What to do if you overdose on loxapine

If you overdose on loxapine, contact a medical professional or Poison Control on 1-800-222-1222. A severe overdose may cause slowed breathing, irregular or slowed heartbeat, seizure, or coma. If you show any symptoms of overdose, call 911 immediately.

Frequently asked questions about loxapine

Loxapine vs clozapine: what is the difference?

Loxapine and clozapine are both antipsychotic drugs, used in the treatment of schizophrenia. They are similar in their structure and effectiveness but differ in terms of side effects.

Clozapine is likely to cause more unwanted side effects, such as excessive drooling and weight gain, and requires regular blood tests for the monitoring of white blood cell count. These factors can lead to noncompliance (skipping doses), thus reducing the effectiveness of the treatment.

Loxapine has been found to be safer for extended use, due to having significantly less side effects than clozapine. It has also been found to manage acute symptoms very well, such as agitation and aggression, so those taking the medication can notice positive effects of their treatment faster [7].

Does loxapine cause weight gain?

Compared to many other antipsychotic medications, such as quetiapine and olanzapine, which can cause excessive weight gain, loxapine has been found to cause almost no increase in weight or appetite [8]. Some studies have even indicated that loxapine can be helpful in reducing the weight gain from other antipsychotic medications [9].

Resources:

  1. American Psychiatric Association. (March 2022). Schizophrenia Spectrum and Other Psychotic Disorders. In The Diagnostic and Statistical Manual of Mental Disorders(5th ed., text rev.). APA. Retrieved from https://doi.org/10.1176/appi.books.9780890425787.x02_Schizophrenia_Spectrum
  2.  Popovic, D., Nuss, P., & Vieta, E. (2015). Revisiting Loxapine: A Systematic Review. Annals of General Psychiatry, 14, 15. Retrieved from https://doi.org/10.1186/s12991-015-0053-3
  3. Lannett Company Inc. (2019). Loxapine- Loxapine Capsule. DailyMed National Library of Medicine. Retrieved from https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=509bad3c-b563-4042-b270-d28bde19f224&type=display
  4. The College of Psychiatric and Neurologic Pharmacists (CPNP) and the National Alliance on Mental Illness (NAMI). (n.d). Loxapine (Loxitane). NAMI. Retrieved from https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Loxapine-(Loxitane)
  5. National Institute of Mental Health. (n.d). Schizophrenia. NIH. Retrieved from https://www.nimh.nih.gov/health/topics/schizophrenia
  6. American Society of Health-System Pharmacists. (n.d). Loxapine. MedlinePlus. Retrieved from https://medlineplus.gov/druginfo/meds/a682311.html
  7. Shrestha, S., Agha, R. S., Khan, Z., Shah, K., & Jain, S. (2021). Considering Loxapine Instead of Clozapine: A Case Series and Literature Review. Cureus, 13(1), e12919. Retrieved from https://doi.org/10.7759/cureus.12919
  8. Doss F. W. (1979). The Effect of Antipsychotic Drugs on Body Weight: A Retrospective Review. The Journal of Clinical Psychiatry, 40(12), 528–530. Retrieved from https://pubmed.ncbi.nlm.nih.gov/40965/
  9. Jain, S., Andridge, R., & Hellings, J. A. (2016). Loxapinefor Reversal of Antipsychotic-Induced Metabolic Disturbances: A Chart Review. Journal of autism and developmental disorders, 46(4), 1344–1353. Retrieved from https://doi.org/10.1007/s10803-015-2675-3