Loxapine

Introduction

Written by Lee Holland, PharmD, MPH
Medically reviewed by Alex Brewer, PharmD, MBA
Updated on September 7, 2023

Loxapine (LOKS a peen) is a generic medication prescribed for schizophrenia. Loxapine belongs to a group of drugs called antipsychotics.

Boxed warning: Increased risk of death in certain older adults

Loxapine oral capsule has a boxed warning about the increased risk of death in older adults (people ages 65 years and above) with dementia-related psychosis. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA).

For details, see the “Interactions and warnings for loxapine” section.

Side effects of loxapine

Loxapine may cause mild or serious side effects. More common mild side effects of loxapine and its serious side effects are listed below. This article doesn’t include all possible side effects of the drug. Side effects can vary based on your age, overall health, and any other medications you take.

To learn more about loxapine’s side effects, ask your doctor or pharmacist. You can also refer to the prescribing information for loxapine listed in the “Resources” section.

Mild side effects

More common mild side effects reported with loxapine are listed below.

This article doesn’t include all possible mild side effects of the drug. To learn more about loxapine’s side effects, refer to the prescribing information for loxapine listed in the “Resources” section.

With many drugs, mild side effects may go away within a few days or a couple of weeks. If the side effects are bothersome, tell your doctor or pharmacist. They may be able to suggest ways to manage them.

Loxapine oral capsule’s mild side effects include:

• weight gain
• dry mouth
• nausea
• headache
• mild allergic reaction*

* For details about this side effect, see the “Interactions and warnings for loxapine” section.

Serious side effects

Serious side effects of loxapine are listed below.

This article doesn’t include all possible serious side effects of the drug. To learn more about loxapine’s side effects, refer to the prescribing information for loxapine listed in the “Resources” section.

With many drugs, serious side effects are possible but not common. If you have serious side effects from this drug, call your doctor right away. If you’re having severe symptoms or a medical emergency, call 911 or a local emergency number.

In general, loxapine’s serious side effects include:

• tardive dyskinesia, which causes involuntary or uncontrolled, repetitive body movements
• neuroleptic malignant syndrome, a life threatening reaction that causes a fast heartbeat, high fever, and stiff muscles
• dystonia, which is uncontrolled or slow movement caused by involuntary muscle contractions
• liver damage
• falls
• seizures
• low blood pressure when rising
• blood cell problems, including low white blood cell count
• boxed warning: increased risk of death in older adults with dementia-related psychosis*
• severe allergic reaction*

* For details about these side effects, see the “Interactions and warnings for loxapine” section.

Common questions about loxapine

Below you’ll find answers to a few commonly asked questions about loxapine.

What brand names are available for loxapine?

Loxapine is a generic medication. A brand-name version of loxapine oral capsule isn’t available. There is a brand-name version of loxapine that’s inhaled. It’s called Adasuve. But it’s not available as a generic medication.

A generic medication is an identical copy of the active drug in a brand-name medication. (An active drug is the ingredient that makes a medication work.) Generic drugs are believed to be as effective and safe as brand-name drugs. And generic drugs typically cost less compared with brand-name drugs.

If you have questions about brand-name versus generic loxapine, talk with your doctor or pharmacist.

Is loxapine similar to clozapine?

Yes, loxapine is similar to clozapine. Both drugs are antipsychotics approved to treat schizophrenia. However, clozapine is usually prescribed to people with schizophrenia that didn’t respond to other drugs.

Loxapine and clozapine both have a boxed warning* about the increased risk of death in older adults (people ages 65 years and above) with dementia-related psychosis. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA).

But unlike loxapine, clozapine has other boxed warnings as well. For example, clozapine has a boxed warning about the risk of seizures. Loxapine can also cause this side effect, but the risk appears to be greater with clozapine.

If you have questions about drugs used to treat schizophrenia, talk with your doctor or pharmacist.

* For details about this side effect, see the “Interactions and warnings for loxapine” section.

How does loxapine work? And how long does it take to start working?

Loxapine’s exact mechanism of action (how it works) isn’t known for sure. The drug is thought to calm certain parts of the brain that cause schizophrenia symptoms. It can start working in as little as 30 minutes after you take a dose.

If you’d like to know more about this, talk with your doctor or pharmacist.

Uses of loxapine

The Food and Drug Administration (FDA) approves prescription drugs such as loxapine for certain conditions. The approved use for loxapine is described below.

Use for schizophrenia

Doctors may prescribe loxapine oral capsule for treating schizophrenia. It’s used for this purpose in older adults (people ages 65 years and above). It’s usually prescribed as a long-term treatment because schizophrenia is a serious condition that requires lifelong treatment.

Schizophrenia is a rare, long-term mental health condition. Early symptoms include sleep problems, irritability, agitation, anxiety, and being suspicious. More severe, later symptoms include:

• hallucinations, which involve seeing and hearing things that are not real
• delusions, which involve believing in things that are not true
• paranoia, which involves believing you’re being persecuted or spied on

Schizophrenia may cause other symptoms, too. And it can increase the risk of self-harm, alcohol or drug misuse, and death from suicide. Treatment can help reduce these risks and manage symptoms.

Interactions and warnings for loxapine

Below, you’ll find information about loxapine’s possible interactions and warnings.

Interactions of loxapine

Certain things may affect how a drug works. These include getting vaccines, consuming alcohol or certain foods, or taking the drug with other medications. This effect is called a drug interaction.

Before you take loxapine, ask your doctor to check for possible interactions. Be sure to tell them about any of the following you take or use:

• prescription or over-the-counter drugs
• vitamins, herbs, or supplements

To learn about drug-condition interactions, see the “Warnings for loxapine” section below.

Warnings for loxapine

Loxapine should be taken cautiously by certain people.

Boxed warning: Increased risk of death in certain older adults

Loxapine has a boxed warning about the increased risk of death in older adults (people ages 65 years and older) with dementia-related psychosis. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA).

Loxapine is not approved to treat dementia-related psychosis in older adults. It should not be used for this purpose.

Studies of antipsychotic drugs, including loxapine, have shown an increased risk of death in certain older adults. This involved those receiving treatment for dementia-related psychosis with antipsychotic drugs. Causes of death varied, but deaths due to heart problems and infections were most common.

If you have concerns about the increased risk of death in older adults with dementia-related psychosis, tell your doctor. They’ll likely recommend a drug other than loxapine for older adults.

To learn more, talk with your doctor or pharmacist.

Other warnings

Loxapine could cause harm to people with certain health conditions. This effect is called a drug-condition interaction. Other factors can also affect whether loxapine is a safe option for you. These warnings may differ based on the form of loxapine you take.

Ask your doctor about specific warnings for loxapine, and be sure to tell your doctor about your:

• current health, including any allergies to medications
• past health conditions or surgeries

Allergic reaction

Loxapine can cause an allergic reaction in some people. Severe allergic reactions are rare but possible.

If you’ve had an allergic reaction to loxapine or any of its ingredients, your doctor will likely not prescribe loxapine. They can tell you about medications that are safer options for you.

A mild allergic reaction may cause the following symptoms:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)

A severe allergic reaction may cause the following symptoms:

• swelling under your skin, usually in your hands, feet, eyelids, or lips
• swelling of your mouth, throat, or tongue, which can cause breathing problems

If you have an allergic reaction to loxapine, call your doctor right away. If you have severe symptoms, call 911 or a local emergency number.

Overdose of loxapine

You should not take more loxapine than your doctor prescribes. For some drugs, doing so may lead to harmful effects or overdose.

If you think you’ve taken too much loxapine, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have concerning symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.

Pregnancy or breastfeeding and loxapine

Information about loxapine and pregnancy and breastfeeding are described below.

Loxapine and pregnancy

There are risks to taking loxapine during pregnancy. But there are also risks with having unmanaged schizophrenia while pregnant. (Keep in mind that loxapine is used for managing schizophrenia.)

If you’re planning a pregnancy or can become pregnant, talk with your doctor about schizophrenia treatment options during pregnancy. Together, you can discuss the risks and benefits of your treatment options and decide whether or not you should take loxapine during pregnancy.

Loxapine and breastfeeding

Loxapine should not be taken while breastfeeding. If you’re breastfeeding or planning to do so, talk with your doctor before taking this medication. Your doctor may recommend other ways to feed your child during treatment with loxapine.

What to ask your doctor

Let your doctor know if you have questions about loxapine or would like more details about it.

Here’s a list of some possible questions you may want to ask your doctor:

• Should I avoid certain drugs while taking loxapine?
• How can I manage the side effects of loxapine?
• What are my options if I’m unable to afford loxapine?

Resources

• Clozapine tablets, for oral use. (2021). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/9f10ba5d-40f7-42bf-bda8-d262abeb0059/spl-doc
• Food and Drug Administration. (2023). Orange Book: Approved drug products with therapeutic equivalence evaluations. https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm
• Loxapine capsules, USP. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/74ac619f-216b-4a79-b23a-158f4e44d25d/spl-doc

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.