amoxapine

Contraindicated in:

Angle-closure glaucoma;
Recent MI;
QTc interval prolongation;
Cardiac arrhythmia;
HF.

Use Cautiously in:

Pre-existing cardiovascular disease;
Prostatic hyperplasia (increased susceptibility to urinary retention);
History of seizures (threshold may be lowered);
May ↑ risk of suicide attempt/ideation especially during early treatment or dose adjustment; risk may be greater in children or adolescents
;
OB: Safety not established in pregnancy;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Safety and effectiveness not established in children;
Geri: Appears on Beers list. ↑ risk of adverse reactions in older adults, including falls secondary to sedative and anticholinergic effects and orthostatic hypotension. Avoid use in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension, ARRHYTHMIAS

Derm: photosensitivity, rash

EENT: blurred vision, dry eyes

Endo: gynecomastia, sexual dysfunction

GI: constipation, dry mouth, paralytic ileus

GU: testicular swelling, urinary retention

Hemat: blood dyscrasias

Metab: ↑appetite, weight gain

Neuro: fatigue, sedation, extrapyramidal reactions, NEUROLEPTIC MALIGNANT SYNDROME, SUICIDAL THOUGHTS/BEHAVIORS, tardive dyskinesia

Misc: fever

Interactions ⬆ ⬇

Drug-drug:

Amoxapine is metabolized in the liver by the cytochrome P450 2D6 enzyme, and its action may be affected by drugs that compete for metabolism by this enzyme, including other antidepressants, phenothiazines, carbamazepine, and class 1C antiarrhythmics, including propafenone and flecainide; when these drugs are used concurrently with amoxapine, may need to ↓ dose of one or the other or both. Concurrent use of other drugs that inhibit the activity of the enzyme, including cimetidine, quinidine, amiodarone, and ritonavir, may result in ↑ effects of amoxapine.
May cause hypotension, tachycardia, and potentially fatal reactions when used with MAO inhibitors; avoid concurrent use; discontinue 2 wk before starting amoxapine.
Concurrent use with SSRIs may result in ↑ toxicity and should be avoided; fluoxetine should be stopped 5 wk before starting amoxapine.
Clonidine may result in hypertensive crisis and should be avoided.
Levodopa may delay/↓ absorption of levodopa or ↑ BP.
Rifampin and rifabutin may ↓ levels and effects.
↑risk of extrapyramidal reactions with other drugs causing extrapyramidal reactions, including phenothiazines.

Availability ⬆ ⬇

(Generic available)

Tablets: 25 mg; 50 mg; 100 mg; 150 mg

Route/Dosage ⬆ ⬇

PO (Adults ): 50 mg 2–3 times daily; ↑ to 100 mg 2–3 times daily by end of 1 wk (not to exceed 300 mg/day in outpatients, 600 mg/day in divided doses in hospitalized patients). Once optimal dose is achieved, may be given as a single bedtime dose; no single dose to exceed 300 mg.
PO Geriatric Patients ): 25 mg 2–3 times daily; may ↑ to 50 mg 2–3 times daily (not to exceed 300 mg/day).

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Potentiates the effects of serotonin and norepinephrine in the CNS.
Has significant anticholinergic properties.
Also has antianxiety effect related to sedative properties.

Therapeutic effects:

Antidepressant and antianxiety action.

Classifications ⬆ ⬇

Therapeutic Classification: antidepressants

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed following oral administration.

Distribution: Widely distributed to tissues.

Protein Binding: 92%.

Metabolism/Excretion: Extensively metabolized by the liver, primarily by the CYP2D6 isoenzyme; the CYP2D6 enzyme system exhibits genetic polymorphism (∼7% of population may be poor metabolizers and may have significantly ↑ amoxapine concentrations and an ↑ risk of adverse effects)..

Half-Life: 8 hr.

Time/Action Profile ⬆ ⬇

(antidepressant effect)

ROUTE	ONSET	PEAK	DURATION
PO	within 1–2 wk	2–6 wk	days–wks

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication as directed. Abrupt discontinuation may cause nausea, headache, and malaise.
Inform patient of the possibility of extrapyramidal symptoms and tardive dyskinesia. Instruct patient to report these symptoms immediately.
May cause drowsiness and blurred vision. Caution patient to avoid driving and other activities requiring alertness until response to drug is known.
Orthostatic hypotension, sedation, and confusion are common during early therapy, especially in older adults. Protect patient from falls and advise patient to make position changes slowly.
Refer patient to nutritional or weight management program as appropriate.
Advise patient to avoid alcohol or other CNS depressant drugs during and for 3–7 days after therapy.
Advise patient, family, and caregivers to look for suicidality, especially during early therapy or dose changes. Notify health care provider immediately if thoughts about suicide or dying, attempts to commit suicide, new or worse depression or anxiety, agitation or restlessness, panic attacks, insomnia, new or worse irritability, aggressiveness, acting on dangerous impulses, mania, or other changes in mood or behavior occur.
Instruct patient to notify health care provider if dry mouth or constipation persists or if urinary retention, uncontrolled movements, or rigidity occur. Sugarless candy or gum may ↓ dry mouth, and an ↑ in fluid intake or bulk may prevent constipation. If these symptoms persist, dosage ↓ or discontinuation may be necessary. Consult health care provider if dry mouth persists for >2 wk.
Advise patient to inform health care provider if breast enlargement or sexual dysfunction occurs.
Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
Inform patient to monitor dietary intake. ↑ appetite may lead to undesired weight gain.
Advise patient to notify health care provider of medication regimen before treatment or surgery.
Therapy for depression is usually prolonged. Emphasize the importance of follow-up exams to monitor effectiveness and side effects and to improve coping skills.
Treatment is not a cure since symptoms can recur after discontinuation of medication.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

Pronunciation ⬆ ⬇

Code ⬆

NDC Code

0591- Actavis Pharma, Inc.
- 0591-5713-
  - 0591-5713-00- 76900 TABLET in 1 BAG (0591-5713-00)

0591- Actavis Pharma, Inc.
- 0591-5713- Amoxapine
  - 0591-5713-01- 100 TABLET in 1 BOTTLE, PLASTIC (0591-5713-01)

0591- Actavis Pharma, Inc.
- 0591-5713-
  - 0591-5713-77- 92304 TABLET in 1 CONTAINER (0591-5713-77)

0591- Actavis Pharma, Inc.
- 0591-5714-
  - 0591-5714-00- 57100 TABLET in 1 BAG (0591-5714-00)

0591- Actavis Pharma, Inc.
- 0591-5714- Amoxapine
  0591-5714-01- 100 TABLET in 1 BOTTLE, PLASTIC (0591-5714-01)

0591- Actavis Pharma, Inc.
- 0591-5714-
  - 0591-5714-77- 68568 TABLET in 1 CONTAINER (0591-5714-77)

0591- Actavis Pharma, Inc.
- 0591-5715-
  0591-5715-00- 38500 TABLET in 1 BAG (0591-5715-00)

0591- Actavis Pharma, Inc.
- 0591-5715- Amoxapine
  0591-5715-01- 100 TABLET in 1 BOTTLE, PLASTIC (0591-5715-01)

0591- Actavis Pharma, Inc.
- 0591-5715-
  - 0591-5715-77- 46152 TABLET in 1 CONTAINER (0591-5715-77)

0591- Actavis Pharma, Inc.
- 0591-5716-
  0591-5716-00- 28600 TABLET in 1 BAG (0591-5716-00)

0591- Actavis Pharma, Inc.
- 0591-5716- Amoxapine
  0591-5716-30- 30 TABLET in 1 BOTTLE, PLASTIC (0591-5716-30)

0591- Actavis Pharma, Inc.
- 0591-5716-
  - 0591-5716-77- 34284 TABLET in 1 CONTAINER (0591-5716-77)

53296- Medichem S.A.
- 53296-0018-
  53296-0018-0- 75 kg in 1 DRUM (53296-0018-0)

62135- Chartwell RX, LLC
- 62135-700- Amoxapine
  62135-700-90- 90 TABLET in 1 BOTTLE (62135-700-90)

62135- Chartwell RX, LLC
- 62135-701- Amoxapine
  - 62135-701-90- 90 TABLET in 1 BOTTLE (62135-701-90)

62135- Chartwell RX, LLC
- 62135-702- Amoxapine
  - 62135-702-90- 90 TABLET in 1 BOTTLE (62135-702-90)

62135- Chartwell RX, LLC
- 62135-703- Amoxapine
  - 62135-703-30- 30 TABLET in 1 BOTTLE (62135-703-30)

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Indications ⬇

Contraind./Precautions ⬆ ⬇