Loxapine
Generic: loxapine succinate · Brand: Loxitane® / Adasuve® · Class: 1st Generation Antipsychotic (Mid Potency)
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How It Works
Loxapine is a first-generation (typical) mid-potency antipsychotic with a unique profile that bridges first and second-generation characteristics — it is metabolized to amoxapine, which has antidepressant properties, and it blocks serotonin receptors in addition to dopamine. Available in oral and a unique inhaled formulation (Adasuve) approved for rapid treatment of acute agitation in schizophrenia or bipolar disorder. The inhaled form works within 10 minutes and is administered in clinical settings only. Oral loxapine is used for maintenance treatment of schizophrenia.
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What It Treats
SchizophreniaFDA-approved for oral maintenance treatment of schizophrenia
Acute AgitationFDA-approved inhaled form (Adasuve) for rapid treatment of agitation in schizophrenia or bipolar disorder — clinical use only
Bipolar AgitationInhaled Adasuve specifically approved for bipolar agitation as well
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Dosing Overview
| Population | Start | Typical Range | Max |
|---|---|---|---|
| Adults Schizophrenia (oral) | 10 mg 4x daily | 60–100 mg/day | 250 mg/day |
| Adults Acute Agitation (inhaled) | 10 mg single dose | 10 mg | 10 mg/day |
| Older Adults Start low | 5–10 mg/day | 20–60 mg/day | 100 mg/day |
Oral capsules taken 2–4 times daily. Inhaled Adasuve administered only in clinical settings due to bronchospasm risk — patients must be monitored for 1 hour after inhalation. Not for home use.
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Side Effects
Common
- Sedation
- Dizziness
- Dry mouth
- Constipation
- Blurred vision
- Muscle stiffness (moderate EPS)
- Nausea
- Elevated prolactin
Call us if you notice
- Tardive dyskinesia (involuntary movements)
- Neuroleptic malignant syndrome (NMS)
- Severe muscle stiffness or rigidity
- High fever with muscle changes
- Severe restlessness (akathisia)
- Unusual eye movements or neck spasms
- Bronchospasm (inhaled form only)
- Respiratory distress (inhaled form)
Loxapine has a somewhat more favorable EPS profile than high-potency agents. The inhaled form is a significant innovation for acute agitation but is restricted to clinical settings due to respiratory risks.
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Tips for Success
Same Time DailyTake at the same time each day for consistent levels in your system.
With FoodTaking with food reduces nausea and stomach upset.
Don't Stop AbruptlyAlways taper with your provider guidance — stopping suddenly can cause rebound symptoms.
Avoid AlcoholAlcohol increases sedation and side effects significantly.
Tell All ProvidersLet other prescribers know what you are taking — interactions matter.
Track SymptomsNote any unusual movements, mood changes, or new symptoms and share with your provider.
Inhaled Form is Clinical OnlyAdasuve (inhaled loxapine) is only given in medical settings — never at home. Patients are monitored for 1 hour after use.
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Important Safety Information
Tardive Dyskinesia — BLACK BOX WARNING: Long-term use can cause permanent involuntary movements of the face, tongue, lips, or limbs. Risk increases with dose and duration. Report any unusual movements immediately — early detection is critical.
Neuroleptic Malignant Syndrome (NMS): A rare but life-threatening reaction causing high fever, severe muscle rigidity, confusion, and unstable vital signs. Seek emergency care immediately if these occur.
Elderly Patients with Dementia: First-generation antipsychotics carry a black box warning for increased risk of death in elderly patients with dementia-related psychosis. Not approved for this use.
QT Prolongation: Many first-generation antipsychotics can affect heart rhythm. Tell your provider about any heart conditions or other medications that affect the heart.
Pregnancy & Breastfeeding: Discuss risks and benefits with your provider. Do not stop without consultation.
Drug Interactions: First-generation antipsychotics interact with many medications including other CNS depressants and anticholinergics. Always share your full medication list.
Bronchospasm Risk (Inhaled Form): Adasuve can cause bronchospasm, especially in patients with asthma or COPD. It is contraindicated in these patients and only administered in settings with equipment to manage respiratory emergencies.
Questions? I am here.
Reach me between appointments if you have concerns about side effects, notice mood changes, or have questions about your medication.
360-389-3712
info@rootedmindspsychiatry.com