Amoxapine

Indications

Amoxapine is used for: Depression

Adult Dose

Oral Depression Adult: Initially, 50 mg bid or tid, may be increased up to 100 mg bid or tid by the end of 1st wk, based on response. For severely depressed patient in hospital: Up to 600 mg daily. Elderly: Initially, 25 mg bid or tid, may be increased up to 50 mg bid or tid by the end of 1st wk based on response. Max: 300 mg daily.

Child Dose

Renal Dose

Administration

May be taken with or without food.

Contra Indications

Acute recovery phase following MI, Uncorrected narrow angle glaucoma, Severe cardiovascular disorder

Precautions

Patient w/ history of urinary retention, angle-closure glaucoma (w/o iridectomy), increased intraocular pressure; history of convulsive disorder, overt/latent seizure disorder; CV (e.g. MI, stroke, tachycardia, conduction abnormalities) and cerebrovascular diseases, hypovolaemia, decreased GI motility, paralytic ileus, BPH, xerostomia, visual problem, DM. Elderly. Hepatic and renal impairment. Pregnancy and lactation. Patient Counselling This drug may cause drowsiness, if affected, do not drive or operate machinery. Monitoring Parameters Monitor closely for clinical worsening, suicidality or unusual behavioural changes. Monitor heart rate, BP, and ECG esp in older adults and patient w/ pre-existing cardiac disease. Measure wt, BMI, and blood glucose.

Pregnancy-Lactation

Interactions

May enhance the effects of barbiturates and other CNS depressants.

Adverse Effects

Side effects of Amoxapine : Drowsiness, dry mouth, constipation, blurred vision; anxiety, insomnia, restlessness, nervousness, palpitations, tremors, confusion, excitement, nightmares, ataxia, alteration in EEG pattern, paraesthesia, tinnitus, disorientation, seizure, hypomania, numbness, incoordination, disturbed concentration, hyperthermia; oedema, skin rash, drug fever, urticaria, photosensitisation, pruritus, vasculitis, hepatitis; prolactin level elevation; nausea, epigastric distress, vomiting, flatulence, abdominal pain, peculiar taste, diarrhoea; dizziness, headache, fatigue, weakness, excessive appetite, increased perspiration; disturbance of accommodation, mydriasis, delayed micturition, urinary retention, nasal stuffiness; hypotension, HTN, syncope, tachycardia; leucopenia, agranulocytosis; increased/decreased libido, impotence, menstrual irregularity, breast enlargement, galactorrhoea (in females), syndrome of inappropriate antidiuretic hormone secretion; lacrimation, wt gain/loss, altered liver function, painful ejaculation. Rarely, tardive dyskinesia. Potentially Fatal: Rarely, neuroleptic malignant syndrome (NMS).

Mechanism of Action

Amoxapine, a dibenzoxazepine TCA, is the N-desmethyl derivative of loxapine w/ actions similar to amitriptyline. It reduces the reuptake of norepinephrine and serotonin, and significantly blocks dopamine receptor activity.