Home Drug Guide Loxapine Succinate

Drug Guide

Generic Name

Loxapine Succinate

Brand Names Loxitane

Classification

Therapeutic: Antipsychotic

Pharmacological: First-generation (typical) antipsychotic

FDA Approved Indications

  • Schizophrenia

Mechanism of Action

Loxapine blocks specific dopamine D2 receptor sites in the brain, which helps to reduce psychotic symptoms. It also has some antagonistic activity at serotonin and adrenergic receptors.

Dosage and Administration

Adult: Typically 10-50 mg two to three times daily, adjusted based on response and tolerability.

Pediatric: Not commonly used in pediatric patients; consult specialist for specific cases.

Geriatric: Use with caution; start at lower end of dosing range due to increased sensitivity.

Renal Impairment: Adjustment may be needed; closely monitor response.

Hepatic Impairment: Use with caution; dose adjustment may be required.

Pharmacokinetics

Absorption: Well absorbed orally

Distribution: Widely distributed in body tissues, crosses the blood-brain barrier

Metabolism: Primarily hepatic via CYP1A2 and CYP2D6 enzymes

Excretion: Primarily via urine as metabolites; some fecal excretion

Half Life: Approximately 10-30 hours, variable depending on individual.

Contraindications

  • Known hypersensitivity to loxapine or other phenothiazines.
  • Blockage of certain heart rhythm abnormalities (e.g., QT prolongation).

Precautions

  • History of seizure disorders.
  • Elderly patients with dementia-related psychosis treated with antipsychotics are at increased risk of death; use with caution. Monitor for neuroleptic malignant syndrome and extrapyramidal symptoms.

Adverse Reactions - Common

  • Drowsiness, sedation (Common)
  • Extrapyramidal symptoms (EPS) (Common)
  • Dry mouth (Common)
  • Constipation (Common)

Adverse Reactions - Serious

  • Neuroleptic malignant syndrome (Rare)
  • Tardive dyskinesia (Less common with long-term use)
  • QT prolongation, cardiac arrhythmias (Rare)
  • Seizures (Rare)

Drug-Drug Interactions

  • CNS depressants (additive sedation)
  • Other medications prolonging QT interval (e.g., certain antiarrhythmics, antibiotics)
  • Other antipsychotics

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor mental status, observe for signs of EPS, tardive dyskinesia, and neuroleptic malignant syndrome. Regularly check cardiac status, including EKG if indicated.

Diagnoses:

  • Risk for falls due to sedation or orthostatic hypotension
  • Risk for peripheral anticholinergic effects

Implementation: Administer with food to decrease GI upset. Monitor for adverse effects, especially in elderly.

Evaluation: Assess improvement in psychotic symptoms, monitor for adverse effects, and adjust dose accordingly.

Patient/Family Teaching

  • Do not operate machinery until you know how this medication affects you.
  • Report any signs of involuntary movements or muscle stiffness.
  • Avoid alcohol and other CNS depressants.
  • Follow dosing schedule closely.

Special Considerations

Black Box Warnings:

  • Increased mortality in elderly patients with dementia-related psychosis.
  • Risk of suicidal thoughts and behaviors in children, adolescents, and young adults.

Genetic Factors: Metabolism via CYP1A2; genetic variations may affect drug levels.

Lab Test Interference: May alter certain laboratory tests, including liver function tests.

Overdose Management

Signs/Symptoms: Severe EPS, sedation, hypotension, seizures, coma.

Treatment: Supportive care, monitor vital signs, activated charcoal if recent ingestion, and manage complications per standard protocols.

Storage and Handling

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

Stability: Stable under recommended storage conditions.

🛡️ 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.