• Monitor patient’s mental status (orientation, mood, behavior) before and periodically during therapy.
• Assess positive (delusions, hallucinations, agitation) and negative (social withdrawal) symptoms of schizophrenia.
• Assess weight and BMI initially and throughout therapy. Refer as appropriate for nutritional/weight management and medical management.
• Monitor BP (sitting, standing, lying) and pulse rate before and frequently during dose adjustment.
• Observe patient carefully when administering medication to ensure that medication is actually taken and not hoarded or cheeked.
• Monitor patient for onset of akathisia (restlessness or desire to keep moving) and extrapyramidal side effects (parkinsonian: difficulty speaking or swallowing, loss of balance control, pill rolling of hands, mask-like face, shuffling gait, rigidity, tremors; and.dystonic: muscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs) every 2 mo during therapy and 8–12 wk after therapy has been discontinued. Report these symptoms; reduction in dosage or discontinuation of medication may be necessary. Trihexyphenidyl, diphenhydramine, or benztropine may be used to control symptoms. Benzodiazepines may alleviate akathisia.
• Monitor for tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities; lip smacking or puckering; puffing of cheeks; uncontrolled chewing; rapid or worm-like movements of tongue, excessive eye blinking). Tardive dyskinesia is dose related initially but may increase with cumulative dose. Report immediately; may be irreversible.
• Monitor frequency and consistency of bowel movements. Increasing bulk and fluids in the diet may help minimize constipation.
• Loxapine lowers the seizure threshold. Institute seizure precautions for patients with history of seizures.
• Monitor for symptoms related to hyperprolactinemia (menstrual abnormalities, galactorrhea, sexual dysfunction).
• Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, convulsions, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control). Report symptoms immediately.
• Assess for falls risk. Drowsiness, orthostatic hypotension, and motor and sensory instability increase risk. Institute prevention if indicated.
• Inhaln: May cause severe bronchospasm. Assess for history of pulmonary disease (asthma, COPD) and examine with auscultation for respiratory abnormalities including wheezing.
  • Monitor for signs and symptoms of bronchospasm every 15 min for at least 1 hr after inhalation.

Lab Test Considerations:

• Monitor CBC and differential before and periodically throughout therapy.
  • Obtain fasting blood glucose and cholesterol levels initially and periodically during therapy.
  • Monitor liver function studies and urine bilirubin and bile concentrations if patient develops jaundice.

Toxicity and Overdose:

• Antiemetic effects of loxapine may block the action of ipecac. Overdose is treated by gastric lavage, barbiturates to control seizures, and supportive care for fluctuations in body temperature. Hypotension may be corrected by use of IV fluids, norepinephrine, or phenylephrine. Avoid use of epinephrine, as it may worsen hypotension.