Generic Name

Loxapine Hydrochloride

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Classification

FDA Approved Indications

• Schizophrenia
• Locally established off-label uses (e.g., agitation in certain settings)

Mechanism of Action

Loxapine acts by antagonizing dopamine D2 receptors and, to a lesser extent, serotonin receptors, which reduces psychotic symptoms.

Dosage and Administration

Adult: Typically, 10-50 mg daily in divided doses; dosage individualized based on response and tolerability.

Pediatric: Use is not well-established; generally reserved for adult patients.

Geriatric: Start at lower doses; monitor closely for side effects.

Renal Impairment: Use with caution; adjust dose based on clinical response and tolerability.

Hepatic Impairment: Use with caution; hepatic function should be monitored.

Pharmacokinetics

Absorption: Well-absorbed orally, but bioavailability is reduced due to first-pass metabolism.

Distribution: Widely distributed; crosses the blood-brain barrier.

Metabolism: Primarily hepatic; metabolized via CYP450 enzymes.

Excretion: Excreted mainly in urine and feces as metabolites.

Half Life: Approximately 16 hours

Contraindications

• Comcomitant use with certain medications that prolong QT interval
• Hypersensitivity to loxapine or other phenothiazines

Precautions

• History of epilepsy
• Cardiovascular disease
• Liver disease
• History of seizures
• Pregnancy category C; risk-benefit assessment advised

Adverse Reactions - Common

• Sedation (Common)
• Orthostatic hypotension (Common)
• Dry mouth (Common)
• Extrapyramidal symptoms (Common)

Adverse Reactions - Serious

• Neuroleptic malignant syndrome (Rare)
• QT prolongation and arrhythmias (Rare)
• Agranulocytosis (Rare)

Drug-Drug Interactions

• Other CNS depressants
• Medications prolonging QT interval (e.g., certain antiarrhythmics, antibiotics)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Take medication exactly as prescribed.
• Avoid alcohol and CNS depressants unless advised by the healthcare provider.
• Report any signs of dehydration, fever, or abnormal movements.
• Be aware of potential sedation and orthostatic hypotension.

Special Considerations

Black Box Warnings:

• Increased mortality in elderly patients with dementia-related psychosis

Genetic Factors: Pharmacogenetic variations may affect metabolism; consider genetic testing if treatment failure or adverse effects occur.

Lab Test Interference: May increase prolactin levels; can induce leukopenia or neutropenia.

Overdose Management

Signs/Symptoms: Severe hypotension, extrapyramidal symptoms, sedation, seizures, coma.

Treatment: Supportive care; gastric lavage; activated charcoal; management of cardiac dysrhythmias; IV fluids; monitoring and correction of electrolytes.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable for typical shelf life; check specific product labeling.