Loxapine is a typical antipsychotic used to treat schizophrenia. Loxapine is taken by mouth, typically once or twice daily. It can cause more movement-related side effects compared with atypical antipsychotics, such as aripiprazole (Abilify). It used to be sold under the brand name Loxitane, which is no longer available. Oral loxapine is now only available as generic capsules.
Schizophrenia
Loxapine is an antipsychotic medication. It's not exactly clear how loxapine works, but it's thought to regulate dopamine and serotonin levels in your brain. Dopamine and serotonin are natural chemicals that affect your thoughts and mood. Imbalances in these chemical levels might cause symptoms of schizophrenia, such as seeing things that aren't there (hallucinations) and believing things that aren't real (delusions).
Source:Â DailyMed
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Difficulty with speaking or swallowing
lip smacking or puckering
loss of balance control
mask-like face
puffing of the cheeks
rapid or fine, worm-like movements of the tongue
restlessness or desire to keep moving
shuffling walk
slowed movements
stiffness of the arms and legs
trembling and shaking of the fingers and hands
uncontrolled chewing movements
uncontrolled movements of the arms or legs
Less common
Constipation (severe)
difficult urination
inability to move the eyes
muscle spasms, especially of the neck and back
skin rash
twisting movements of the body
Rare
Difficult or fast breathing
fast heartbeat or irregular pulse
fever (high)
high or low blood pressure
increased blinking or spasms of the eyelid
increased sweating
loss of bladder control
muscle stiffness (severe)
seizures
sore throat and fever
uncontrolled twisting movements of the neck, trunk, arms, or legs
unusual bleeding or bruising
unusual facial expressions or body positions
unusual tiredness or weakness
unusually pale skin
yellow eyes or skin
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Dizziness, faintness, or lightheadedness when suddenly getting up from a lying or sitting position
drowsiness (severe)
irregular, fast or slow, or shallow breathing
loss of consciousness
muscle trembling, jerking, stiffness, or uncontrolled movements (severe)
pale or blue lips, fingernails, or skin
troubled breathing (severe)
unusual tiredness or weakness (severe)
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Blurred vision
confusion
dizziness, lightheadedness, or fainting
drowsiness
dryness of the mouth
Less common
Constipation (mild)
decreased sexual ability
enlargement of the breasts (males and females)
headache
increased sensitivity of the skin to sunlight
missing menstrual periods
nausea or vomiting
trouble with sleeping
unusual secretion of milk
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
A good option if other schizophrenia medications haven't worked or have caused bothersome side effects
Dose can be adjusted by your provider based on your response
Available as a lower-cost generic medication
More likely to cause trouble controlling movements compared to other treatment options
Can raise your heart rate and lower your blood pressure
Risk of developing abnormal muscle movements that might not go away after you stop taking loxapine
Loxapine can cause drowsiness, sleepiness, and dizziness. Don't drive or do anything that requires concentration until you know how loxapine affects you.
Loxapine can cause your blood pressure to drop when you change positions. This can cause falls and fainting. Be very careful when you stand after sitting or lying down.
Talk to your provider if you have a history of heart conditions. Loxapine can raise your pulse. It can also lower your blood pressure.
Loxapine is an anticholinergic medication. This class of medications can cause constipation, dry mouth, and blurred vision. It can also worsen conditions, such as glaucoma and difficulty urinating. Taking loxapine with other medications, such as benztropine (Cogentin), trihexyphenidyl (Artane), and diphenhydramine (Benadryl), can worsen these side effects. Let your provider know if any of these symptoms become bothersome.
Antipsychotic medications can cause abnormal muscle movements called tardive dyskinesia. Usually, this problem goes away when you stop the medication, but there's a chance it might not. Let your healthcare provider know if you start having muscle twitches, smacking your lips, sticking your tongue out, or having trouble controlling your face or mouth.
Loxapine can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk factors: Older adults with dementia-related psychosis
People over the age of 65 who also have dementia sometimes have some schizophrenia-like symptoms, such as hallucinations. Older people with dementia-related psychosis have a higher risk of death if they take medications like loxapine. Because of this risk, loxapine shouldn't be used in people 65 years and older with dementia-related psychosis. Let your provider know if you or your loved one has dementia before starting loxapine.
Risk factors: Long-term use | Taking high doses of loxapine or other antipsychotics | Older age | Female and 65 years or older
Loxapine, like all antipsychotics, can cause uncontrollable movements (tardive dyskinesia) involving your face, tongue, and other body parts. Symptoms include shaking, muscle stiffness, or feeling like you can't sit still. This condition might go away once you stop the medication, but there's a chance it can become permanent. The risk is greatest if you've been taking loxapine for a long time or have been taking high doses, but it can also occur at any point during treatment or at any dose. Tell your provider right away if you notice any unusual movements.
Loxapine can cause a rare but life-threatening condition called neuroleptic malignant syndrome (NMS). Symptoms of NMS include high fever, muscle stiffness, confusion, sweating, and changes in heart rate and blood pressure. If you notice any of these symptoms, get medical help right away.
Risk factors: Conditions or taking medications that make you dizzy or less alert
Loxapine can cause a sudden drop in blood pressure, sleepiness, and problems with balance. Dizziness, falls, and fainting can happen due to a sudden drop in blood pressure when you change positions, such as going from sitting to standing. To avoid falling, change positions slowly until your body is used to the medication.
Risk factors: History of low white blood cell count
Loxapine can lower the amount of white blood cells (WBCs) in your body. WBCs help your body fight off infections and diseases. Having fewer WBCs means you're more likely to get sick. If you notice a fever or that you're getting sick more easily, let your provider know right away. Blood tests might be done before you start loxapine and during the first few months of taking this medication to make sure that you have a healthy amount of white blood cells. If the amount of white blood cells in your body is too low, you'll need to stop the medication.
Risk factors: History of seizures | Conditions that make it easier to have seizures
Loxapine can make you more likely to have seizures, especially if you have a history of seizures or have conditions that make it easier to have a seizure. Let your provider know if you've had seizures in the past before starting the medication, so your provider can monitor you more closely.
Risk factors: Long-term use
Loxapine can cause vision changes, especially if it's taken for a long time. Let your provider know right away if you notice any changes in your vision.
Loxapine can cause the prolactin levels in your blood to go up. Prolactin is a hormone in your body that affects lactation and the reproductive system. High prolactin levels can lead to milky nipple discharge, enlarged male breasts, sexual dysfunction, absent or irregular menstrual periods, and weak bones. Let your provider know if you experience these symptoms.
The dose depends on how severe your symptoms are and how you've responded to other medications for schizophrenia in the past.
In general, the typical starting dose is 10 mg by mouth twice a day. Your healthcare provider will raise your dose rather quickly over the first 7 to 10 days until your symptoms of schizophrenia are controlled. The typical maintenance dose ranges from 20 mg to 100 mg daily. The maximum daily dose is 250 mg.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
In a coma or sedated state caused by alcohol or medications
Allergy to loxapine or amoxapine
Psychotic and behavioral disorders
Tourette syndrome in adults and children
Hyperactivity in children
Management of psychotic disorders
Schizophrenia
Nausea and vomiting
Restlessness and anxiety before surgery
Tetanus
Manic episodes of bipolar disorder
Hiccups that won't go away
Severe behavioral issues in children 1 to 12 years old (e.g., aggressive behavior, frustration, explosive or hyperexcitable behavior)
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American Heart Association. (2023). Low blood pressure - when blood pressure is too low.
Chartwell RX, LLC. (2023). Loxapine capsule [package insert]. DailyMed.
Patel, K. R., et al. (2014). Schizophrenia: Overview and treatment options. Pharmacy and Therapeutics.
Singh, A. N., et al. (2003). Effect of loxapine on peripheral dopamine-like and serotonin receptors in patients with schizophrenia. Journal of Psychiatry & Neuroscience.
Vanina, Y., et al. (2002). Body weight changes associated with psychopharmacology. Psychiatric Services.
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