Loxapine
LOXITANE
What it isFirst-generation antipsychotic structurally related to clozapine; schizophrenia, and inhaled for acute agitation.
Why this oneThe inhaled form acts within ten minutes without an injection.
What limits itInhalation can cause bronchospasm and requires a REMS with spirometry. Extrapyramidal effects; its metabolite amoxapine is an antidepressant.
FDA-approved for
- schizophrenia (1975)
- agitation (inhaled) (2012)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Schizophrenia | Adults | 10 mg BID | 60–100 mg/day (divided BID–QID) | 250 mg/day |
Renal Undefined
Hepatic Undefined
Instructions
- Administer in divided doses 2–4 times daily.
- Increase fairly rapidly over the first 7–10 days to symptom control.
- Maintenance: reduce to lowest effective dose (often 20–60 mg/day).
Contraindications
- Comatose or severe drug-induced CNS depression (alcohol, barbiturates, narcotics)
Cautions
- Neuroleptic malignant syndrome
- Tardive dyskinesia
- Extrapyramidal symptoms and dystonia
- Seizures
- Orthostatic hypotension/syncope
- Anticholinergic effects (incl. paralytic ileus, urinary retention)
Adverse reactions
- Sedation/drowsiness
- EPS (tremor, rigidity, akathisia, masked facies)
- Tardive dyskinesia
- Anticholinergic effects (dry mouth, constipation, blurred vision, urinary retention)
- Orthostatic hypotension, tachycardia
- Weight change
Pregnancy Use only if benefit justifies risk; third-trimester exposure risks neonatal EPS/withdrawal.
Lactation Undefined
⚠ BOXED WARNINGS
- Increased mortality in elderly patients with dementia-related psychosis
- Bronchospasm with the inhaled form
Cost, est. cash$10–$300/month
Generic entry1988
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityMetabolic effects, extrapyramidal symptoms/tardive dyskinesia and agent-specific QT or orthostatic risk.
Active metabolites
Mechanism of action: Loxapine ballicule
Open Loxapine in the interactive console ↗
Memory aids: mascots and interaction avatars
Spooky mascot → antipsychotic
