Amoxapine
ASENDIN
What it isTricyclic antidepressant that is also a D2 antagonist; depression.
Why it mattersIt combines antidepressant and antipsychotic action in one molecule, which occasionally suits psychotic depression.
What it changes⚑ The D2 blockade brings extrapyramidal effects, tardive dyskinesia and neuroleptic malignant syndrome — unexpected from a tricyclic. It is the metabolite of loxapine.
FDA-approved for
- depression (~1980)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Depression | Adult | 50 mg BID-TID | 200-300 mg/day | 400 mg/day (600 mg/day in hospitalized refractory patients) |
| Depression | Elderly | 25 mg BID-TID | 100-150 mg/day | 300 mg/day |
Titration Maintain 300 mg/day for at least 2 weeks before increasing above 300 mg/day.
Renal Undefined
Hepatic Undefined
Instructions
- Doses over 300 mg/day must be given in divided doses
- When effective dose is established, may give as single dose (not exceeding 300 mg) at bedtime
Contraindications
- MAOIs (concurrently or within 14 days) due to risk of hyperpyretic crises, severe convulsions, and death
- Acute recovery phase following myocardial infarction
Cautions
- Tardive dyskinesia
- Neuroleptic malignant syndrome
- Seizures
- Sedative and anticholinergic effects
Adverse reactions
- Drowsiness
- Dry mouth
- Constipation
- Blurred vision
Pregnancy No teratogenic effect in animals; embryotoxicity and fetotoxic effects (intrauterine death, stillbirth, decreased birth weight) seen in animals at 3-10x human dose.
Lactation Undefined
⚠ BOXED WARNING
- Suicidal thoughts and behaviors in patients under 25
Cost, est. cash$10–$500/month
Generic entry1989
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilitySeizures, coma, arrhythmia and neuroleptic-like toxicity make overdose especially dangerous.
Active metabolites
Mechanism of action: Amoxapine ballicule
Open Amoxapine in the interactive console ↗
Memory aids: mascots and interaction avatars
Tricycle symbol → tricyclic antidepressant (TCA)
Spooky mascot → D2-blocking like an antipsychotic
He’s ascendin’ and holding a “send-in”
