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Brand names: Loxitane®, Adasuve®
Generic name: loxapine (LOKS a peen)
All FDA black box warnings are at the end of this fact sheet. Please review before taking this medication.
Loxapine is a medication that works in the brain to treat schizophrenia. It is also known as a first generation antipsychotic (FGA) or typical antipsychotic. Loxapine rebalances dopamine to improve thinking, mood, and behavior.
Symptoms of schizophrenia include:
Loxapine may help some or all of these symptoms.
Loxapine powder for inhalation (Adasuve®) is FDA approved for the treatment of acute agitation associated with schizophrenia or bipolar disorder in adults.
Loxapine may also be helpful when prescribed "off-label" for other mental health conditions. "Off-label" means that it has not been approved by the Food and Drug Administration for this condition. Your mental health provider should justify his or her thinking in recommending an "off-label" treatment. They should be clear about the limits of the research around that medication and if there are any other options.
Schizophrenia requires long-term treatment. Do not stop taking loxapine, even when you feel better.
With input from you, your health care provider will assess how long you will need to take the medicine.
Missing doses of loxapine may increase your risk for a relapse in your symptoms.
Do not stop taking loxapine or change your dose without talking to with your healthcare provider first.
For loxapine to work properly, it should be taken every day as ordered by your healthcare provider.
If you are planning on becoming pregnant, notify your healthcare provider to best manage your medications. People living with schizophrenia who wish to become pregnant face important decisions. This is a complex decision since untreated schizophrenia has risks to the fetus, as well as the mother. It is important to discuss the risks and benefits of treatment with your doctor and caregivers.
Antipsychotic use during the third trimester of pregnancy has a risk for abnormal muscle movements (extrapyramidal symptoms [EPS]) and/or withdrawal symptoms in newborns following delivery. Symptoms in the newborn may include agitation, feeding disorder, hypertonia, hypotonia, respiratory distress, somnolence, and tremor; these effects may be self-limiting or require hospitalization.
Caution is advised with breast-feeding since it is not known whether loxapine is excreted in breast milk.
Loxapine is usually taken twice a day.
Typically, patients begin at a low dose of medicine and the dose is increased slowly over several weeks.
The dose usually ranges from 10mg to 250mg daily. Only your healthcare provider can determine the correct dose for you.
Use a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take your medication. You may also ask a family member or a friend to remind you or check in with you to be sure you are taking your medication.
The inhalation form is used once daily.
If you miss a dose of loxapine, take it as soon as you remember, unless it is closer to the time of your next dose. Discuss this with your healthcare provider. Do not double your next dose or take more than what is prescribed.
Avoid drinking alcohol or using illegal drugs while you are taking loxapine. They may decrease the benefits (e.g. worsen your confusion) and increase adverse effects (e.g. sedation) of the medication.
If an overdose occurs call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1-800-222-1222.
A specific treatment to reverse the effects of loxapine does not exist.
Common side effects
Oral: Low blood pressure, fainting, sleepiness
Powder for inhalation: Distortion in sense of taste, respiratory distress
Rare side effects
Loxapine may increase the blood levels of a hormone called prolactin. Side effects of increased prolactin levels include females losing their period, production of breast milk and males losing their sex drive or possibly experiencing erectile problems. Long term (months or years) of elevated prolactin can lead to osteoporosis or increased risk of bone fractures.
Serious side effects
Some people may develop muscle related side effects while taking loxapine. The technical terms for these are “extrapyramidal symptoms” (EPS) and “tardive dyskinesia” (TD). Symptoms of EPS include restlessness, tremor, and stiffness. TD symptoms include slow or jerky movements that one cannot control, often starting in the mouth with tongue rolling or chewing movements.
All antipsychotics have been associated with the risk of sudden cardiac death due to an arrhythmia (irregular heartbeat). To minimize this risk, antipsychotic medications should be used in the smallest effective dose when the benefits outweigh the risks. Your doctor may order an EKG to monitor for irregular heartbeat.
Neuroleptic malignant syndrome is a rare, life threatening adverse effect of antipsychotics which occurs in <1% of patients. Symptoms include confusion, fever, extreme muscle stiffness, and sweating. If any of these symptoms occur, contact your healthcare provider immediately.
All antipsychotics can cause sedation, dizziness, or orthostatic hypotension (a drop in blood pressure when standing up from sitting or lying down). These side effects may lead to falls which could cause bone fractures or other injuries. This risk is higher for people with conditions or other medications that could worsen these effects. If falls or any of these symptoms occur, contact your healthcare provider.
Tardive dyskinesia (TD) is a side effect that develops with prolonged use of antipsychotics. If you develop symptoms of TD, such as grimacing, sucking, and smacking of lips, or other movements that you cannot control, contact your healthcare provider immediately. All patients taking either first or second generation antipsychotics should have an Abnormal Involuntary Movement Scale (AIMS) completed regularly by their healthcare provider to monitor for TD.
Other medications taken into the lungs may interfere with the effectiveness of the Adasuve aerosol formulation of loxapine. You should check with your doctor if you also use any type of inhaler for asthma or COPD.
It is very important to tell your doctor how you feel things are going during the first few weeks after you start taking loxapine. It will probably take several weeks to see big enough changes in your symptoms to decide if loxapine is the right medication for you.
Antipsychotic treatment is generally needed lifelong for persons with schizophrenia. Your doctor can best discuss the duration of treatment you need based on your symptoms and illness.
Increased mortality in elderly patients with dementia-related psychosis
Bronchospasm (Powder for inhalation)
©2019 The College of Psychiatric and Neurologic Pharmacists (CPNP) and the National Alliance on Mental Illness (NAMI). CPNP and NAMI make this document available under the Creative Commons Attribution-No Derivatives 4.0 International License. Last Updated: January 2016.
This information is being provided as a community outreach effort of the College of Psychiatric and Neurologic Pharmacists. This information is for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not an exhaustive review of information about the medication. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions. Never delay seeking professional medical advice or disregard medical professional advice as a result of any information provided herein. The College of Psychiatric and Neurologic Pharmacists disclaims any and all liability alleged as a result of the information provided herein.
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