|
Indications and Dosage
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-tid increased as necessary after 5-7 days up to 150 mg daily. Max: 300 mg daily. |
|
Administration
May be taken with or without food.
|
|
Contraindications
Acute recovery phase following MI. Concomitant or w/in 14 days of MAOI use.
|
|
Special 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.
|
|
Adverse Reactions
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). |
|
Patient Counseling Information
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.
|
|
Overdosage
Symptoms: Grand mal convulsion, status epilepticus, coma, acidosis, acute tubular necrosis, rhabdomyolysis, myoglobinuria. Management: Symptomatic and supportive treatment w/ special attention to control of seizures. Induce emesis, then employ gastric lavage and activated charcoal. IV diazepam and/or phenytoin may be given to treat seizures.
|
|
Drug Interactions
May enhance the effects of barbiturates and other CNS depressants.
Potentially Fatal: May cause hypertensive crisis and severe convulsion w/ MAOIs. |
|
Food Interaction
May enhance response to alcohol.
|
|
Action
Description:
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. Onset: 1-2 wk; may require 4-6 wk. Pharmacokinetics: Absorption: Rapidly and well absorbed from the GI tract. Time to peak plasma concentration: W/in 1-2 hr. Distribution: Widely distributed throughout body tissues. Enters breast milk. Volume of distribution: 0.9-1.2 L/kg. Plasma protein binding: Approx 90%. Metabolism: Extensively metabolised in the liver via hydroxylation, principally to 8-hydroxyamoxapine (8-OH-amoxapine), and to a lesser extent, to 7-hydroxyamoxapine (7-OH-amoxapine). Metabolites undergo conjugation to form glucuronides. Excretion: Via urine (mainly as glucuronides, <5% as unchanged drug). Elimination half-life: 8 hr; 30 hr (as 8-OH-amoxapine). |
|
Chemical Structure
 Source: National Center for Biotechnology Information. PubChem Database. Amoxapine, CID=2170, https://pubchem.ncbi.nlm.nih.gov/compound/Amoxapine (accessed on Jan. 20, 2020) |
|
Storage
Store between 20-25°C.
|
|
MIMS Class
|
|
ATC Classification
N06AA17 - amoxapine ; Belongs to the class of non-selective monoamine reuptake inhibitors. Used in the management of depression.
|
|
References
Amoxapine Tablet (Actavis Pharma, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 21/09/2016. Anon. Amoxapine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 21/09/2016. Buckingham R (ed). Amoxapine. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 21/09/2016. McEvoy GK, Snow EK, Miller J et al (eds). Amoxapine. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 21/09/2016.
|
Sign Out
