ADVERSE REACTIONS
CNS Effects
Manifestations of adverse effects on the central nervous system, other than extrapyramidal effects, have been seen infrequently. Drowsiness, usually mild, may occur at the beginning of therapy or when dosage is increased. It usually subsides with continued loxapine therapy. The incidence of sedation has been less than that of certain aliphatic phenothiazines and slightly more than the piperazine phenothiazines. Dizziness, faintness, staggering gait, shuffling gait, muscle twitching, weakness, insomnia, agitation, tension, seizures, akinesia, slurred speech, numbness, and confusional states have been reported. Neuroleptic malignant syndrome (NMS) has been reported (see WARNINGS).
Extrapyramidal Symptoms
Neuromuscular (extrapyramidal) reactions during the administration of loxapine have been reported frequently, often during the first few days of treatment. In most patients, these reactions involved parkinsonian-like symptoms such as tremor, rigidity, excessive salivation, and masked facies. Akathisia (motor restlessness) also has been reported relatively frequently. These symptoms are usually not severe and can be controlled by reduction of loxapine dosage or by administration of antiparkinson drugs in usual dosage.
Dystonia
Class Effect
Symptoms of dystonia, prolonged abnormal contractions of muscle groups, may occur in susceptible individuals during the first few days of treatment. Dystonic symptoms include: spasm of the neck muscles, sometimes progressing to tightness of the throat, swallowing difficulty, difficulty breathing, and/or protrusion of the tongue. While these symptoms can occur at low doses, they occur more frequently and with greater severity with high potency and at higher doses of first generation antipsychotic drugs. An elevated risk of acute dystonia is observed in males and younger age groups.
Persistent Tardive Dyskinesia
As with all antipsychotic agents, tardive dyskinesia may appear in some patients on long-term therapy or may appear after drug therapy has been discontinued. The risk appears to be greater in elderly patients on high-dose therapy, especially females. The symptoms are persistent and in some patients appear to be irreversible. The syndrome is characterized by rhythmical involuntary movement of the tongue, face, mouth or jaw (e.g., protrusion of tongue, puffing of cheeks, puckering of mouth, chewing movements). Sometimes these may be accompanied by involuntary movements of extremities.
There is no known effective treatment for tardive dyskinesia; antiparkinson agents usually do not alleviate the symptoms of this syndrome. It is suggested that all antipsychotic agents be discontinued if these symptoms appear. Should it be necessary to reinstitute treatment, or increase the dosage of the agent, or switch to a different antipsychotic agent, the syndrome may be masked. It has been suggested that fine vermicular movements of the tongue may be an early sign of the syndrome, and if the medication is stopped at that time the syndrome may not develop.
Cardiovascular Effects
Tachycardia, hypotension, hypertension, orthostatic hypotension, lightheadedness, and syncope have been reported.
A few cases of ECG changes similar to those seen with phenothiazines have been reported. It is not known whether these were related to loxapine administration.
Hematologic
Rarely, agranulocytosis, thrombocytopenia, leukopenia.
Skin
Dermatitis, edema (puffiness of face), pruritus, rash, alopecia, and seborrhea have been reported with loxapine.
Anticholinergic Effects
Dry mouth, nasal congestion, constipation, blurred vision, urinary retention, and paralytic ileus have occurred.
Gastrointestinal
Nausea and vomiting have been reported in some patients. Hepatocellular injury (i.e., SGOT/SGPT elevation) has been reported in association with loxapine administration and rarely, jaundice and/or hepatitis questionably related to loxapine treatment.
Other Adverse Reactions
Weight gain, weight loss, dyspnea, ptosis, hyperpyrexia, flushed facies, headache, paresthesia, and polydipsia have been reported in some patients. Rarely, galactorrhea, amenorrhea, gynecomastia, and menstrual irregularity of uncertain etiology have been reported.
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REPORTS OF SUSPECTED LOXAPINE SIDE EFFECTS / ADVERSE REACTIONS
Below is a sample of reports where side effects / adverse reactions may be related to Loxapine. The information is not vetted and should not be considered as verified clinical evidence.
Possible Loxapine side effects / adverse reactions in 37 year old female
Reported by a health professional (non-physician/pharmacist) from United States on 2011-10-04
Patient: 37 year old female
Reactions: Blood Potassium Decreased, Disseminated Intravascular Coagulation, Finger Amputation, Toxicity TO Various Agents, Extremity Necrosis, Cardiogenic Shock, Blood Glucose Increased
Adverse event resulted in: hospitalization
Suspect drug(s):
Tramadol HCL
Dosage: oral
Administration route: Oral
Indication: Product Used FOR Unknown Indication
Warfarin Sodium
Dosage: oral
Administration route: Oral
Indication: Product Used FOR Unknown Indication
Insulin (Insulin)
Indication: Cardiogenic Shock
Amlodipine
Dosage: oral
Administration route: Oral
Indication: Product Used FOR Unknown Indication
Loxapine
Dosage: oral
Administration route: Oral
Indication: Product Used FOR Unknown Indication
Other drugs received by patient: Carbamazepine
Possible Loxapine side effects / adverse reactions in 37 year old female
Reported by a health professional (non-physician/pharmacist) from United States on 2011-10-05
Patient: 37 year old female
Reactions: Cardiogenic Shock
Adverse event resulted in: hospitalization
Suspect drug(s):
Loxapine
Administration route: Oral
Indication: Product Used FOR Unknown Indication
Amlodipine
Administration route: Oral
Indication: Product Used FOR Unknown Indication
Warfarin Sodium
Administration route: Oral
Indication: Product Used FOR Unknown Indication
Tramadol HCL
Administration route: Oral
Indication: Product Used FOR Unknown Indication
Carbamazepine
Administration route: Oral
Indication: Product Used FOR Unknown Indication
Possible Loxapine side effects / adverse reactions in 37 year old female
Reported by a physician from United States on 2011-10-10
Patient: 37 year old female
Reactions: Cardiogenic Shock
Adverse event resulted in: hospitalization
Suspect drug(s):
Amlodipine
Administration route: Oral
Indication: Product Used FOR Unknown Indication
Tramadol HCL
Administration route: Oral
Indication: Product Used FOR Unknown Indication
Carbamazepine
Administration route: Oral
Indication: Product Used FOR Unknown Indication
Warfarin Sodium
Administration route: Oral
Indication: Product Used FOR Unknown Indication
Loxapine
Administration route: Oral
Indication: Product Used FOR Unknown Indication
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