Home Drug Guide Loxapine Hydrochloride

Drug Guide

Generic Name

Loxapine Hydrochloride

Brand Names Loxitane C, Loxitane Im

Classification

Therapeutic: Antipsychotic

Pharmacological: Thioxanthene derivative

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

Assessment: Monitor mental status, extrapyramidal symptoms, cardiovascular status, and blood counts.

Diagnoses:

  • Risk for falls
  • Impaired skin integrity (due to sedation)
  • Risk for cardiac arrhythmias

Implementation: Administer as prescribed; monitor for side effects; educate patient about potential adverse effects.

Evaluation: Assess therapeutic effectiveness and adverse reactions; adjust dose as necessary.

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.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.