Adult Dosing
Depression in patients with neurotic or reactive depressive disorders, endogenous, psychotic depressions
Adult
- Initial dose: 50 mg PO bid-tid
- Titrate the dose to 100 mg bid-tid by end of the first wk, depending on tolerance
- Titrate the dose above 300 mg daily in divided doses, if 300 mg ineffective for at least 2 wks
- Effective dose is achieved, may be given as a single bedtime dose; no single dose to exceed 300 mg
Geriatric
- Initial dose: 25 mg PO bid-tid
- Titrate the dose to 50 mg bid-tid by end of the first wk, depending on tolerance; titrate the dose up to 300 mg
- Max: 300 mg/day
- Effective dose is achieved, may be given as a single bedtime dose; no single dose to exceed 300 mg
Maintenance
- Use the lowest dose that maintains remission; if symptoms recur, increase to the earlier doses until they are controlled
- Maintenance dose =300 mg/day can be given as a single bedtime dose
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
See Supplemental Patient Information
- Worsening of depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior may occur in patients with major depressive disorder (MDD); risk may persist until significant remission occurs
- Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders [US Black Box Warning]
- Younger patients are more prone to suicidality; suicidality risk did not increased in patients >24 yrs of age, and risk decreased in patients >65 yrs of age [US Black Box Warning]
- Monitor and closely observe patients for clinical worsening, suicidality, or unusual changes in behavior specially during the initial few months of a course of drug therapy, or at times of dose modifications [US Black Box Warning]
- Anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have occurred in adults and pediatric patients
- Consider changing the therapeutic regimen or discontinuation of therapy on persistent worsening of depression, on experiencing emergent suicidality or abrupt onset of severe symptoms suggesting worsening of depression or suicidality or were not part of the patient's presenting symptoms
- When discontinuing treatment, taper the dose to avoid adverse reactions. If treatment is to be discontinued or the dose reduced, gradually taper dose
- Advise families and caregivers for close observation for the emergence of agitation, irritability, unusual changes in behavior, emergence of suicidality, and report such symptoms immediately to health care providers
- Amoxapine is not indicated for the treatment of bipolar disorder. Therefore, prior to starting treatment in patients with depressive symptoms, determine if patient is at risk for bipolar disorder. Screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression
- Tardive dyskinesia may occur in patient treated with neuroleptic drugs
- Risk of developing the syndrome and the likelihood that it will become irreversible are believed to increase as the duration of treatment and the total cumulative dose of neuroleptic drugs administered to the patient increase. With low dose treatment the syndrome may develop less commonly
- Discontinue the treatment if sign/symptoms of tardive dyskinesia appear
- Life-threatening serotonin syndrome or NMS-like reactions may occur, particularly with co-administration of antipsychotic drugs. Patients should be monitored for the emergence of NMS-like signs and symptoms
- Management of NMS include immediate discontinuation of antipsychotic drugs and other drugs not essential to concurrent therapy, intensive symptomatic treatment and medical monitoring; and treatment of any concomitant serious medical problems for which specific treatments are available
Cautions: Use cautiously in
- History of neuroleptic malignant syndrome
- Urinary retention
- Angle-closure glaucoma
- Increase in intraocular pressure
- History of urinary retention
- Cardiovascular disorders
- History of convulsive disorder
- Bipolar disorder
- Elderly patients
- Patient <25 yrs of age
- Suicide risk
- GI/GU obstruction
- Prostatic hypertrophy
- Schizophrenia
Supplemental Patient Information
- Caution patients against driving, operating machinery, or performing other hazardous activities that require mental alertness due to the possibility of drowsiness
Pregnancy Category:C
Breastfeeding: No data is available on use of drug, so another drug may be preferred while nursing a newborn or preterm infant. If amoxapine is required by the mother, it is not a reason to discontinue breastfeeding. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 3 March 2011). As per manufacture data, caution should be exercised.
Pricing data from www.DrugStore.com in U.S.A.
- Amoxapine 100 MG TABS [Bottle] (WATSON LABS)
30 mg = $39.99
90 mg = $119.96 - Amoxapine 150 MG TABS [Bottle] (WATSON LABS)
30 mg = $43.99
90 mg = $109.98 - Amoxapine 25 MG TABS [Bottle] (WATSON LABS)
60 mg = $25.99
180 mg = $68.99
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
