amoxapine (Rx)

Brand and Other Names:Asendin
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 25mg
  • 50mg
  • 100mg
  • 150mg
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Depression

Initiate at low dose (25 mg q8-12hr) and gradually titrate upward every 5-7 days up to 200-300 mg PO qHS

If dose exceeds 300 mg/day, administer in divided doses q12hr

Outpatient: Not to exceed 400 mg/day

Inpatient: May require higher doses, up to 600 mg/day divided q12hr

Not recommended

Use caution; avoid use

Depression

Initiate at low dose (25 mg q8-12hr) and gradually titrate upward every 5-7 days up to 200-300 mg PO qHS

If dose exceeds 300 mg/day, administer in divided doses q12hr  

Outpatient: Not to exceed 400 mg/day

Inpatient: May require higher doses, up to 600 mg/day divided q12hr

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Interactions

Interaction Checker

and amoxapine

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Constipation (12-14%)

            Dry mouth (12-14%)

            Sedation (12-14%)

            1-10%

            Anxiety

            Ataxia

            Blurred vision

            Confusion

            Dizziness

            Edema

            Headache

            Fatigue

            Nausea

            Nervousness/restlessness

            Prolactin levels increased

            Rash

            Sweating

            Tremor

            Weakness

            <1%

            Agranulocytosis

            Diarrhea

            ECG changes

            EPS

            Flatulence

            Galactorrhea

            Hypertension

            Leukopenia

            Menstrual irregularity

            Mydriasis

            Orthostatic hypotension

            Seizure

            Urinary retention

            Urticaria

            Vomiting

            Tachycardia

            Sexual dysfunction

            Frequency Not Defined

            neuroleptic malignant syndrome (rare)

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            Warnings

            Black Box Warnings

            In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 yr of age) taking antidepressants for major depressive disorders and other psychiatric illnesses

            This increase was not seen in patients aged >24 years; a slight decrease in suicidal thinking was seen in adults >65 years

            In children and young adults, risks must be weighed against the benefits of taking antidepressants

            Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during initial 1-2 months of therapy and dosage adjustments

            The patient’s family should communicate any abrupt changes in behavior to the healthcare provider

            Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy

            This drug is not approved for use in pediatric patients

            Contraindications

            Hypersensitivity

            Severe cardiovascular d/o

            Uncorrected narrow angle glaucoma

            Within 14 day of MAOIs (risk of serotonin syndrome); if linezolid or IV methylene blue (MAOIs) must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity; may resume 24 hr after last linezolid or methylene blue dose, or after 2 weeks of monitoring, whichever comes first

            Any drugs or conditions that prolong QT interval

            Acute recovery post-MI

            Cautions

            BPH, urinary/GI retention, incr IOP, hyperthyroidism, opne angle glaucoma, seizure d/o, brain tumor, respiratory impairment, hyperthyroidism

            Clinical worsening & suicide ideation may occur despite medication in adolescents & young adults (18-24 yo)

            Risk of anticholinergic side effects

            Possibility of tardive dyskinesia & NMS

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: enters breast milk; use with caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Neurotransmitter (esp NE & serotonin) reuptake inhibitor; anticholinergic

            Pharmacokinetics

            Half-Life: 8-30 hr

            Peak Plasma Time: 90 min

            Bioavailability: Almost complete absorption

            Metabolites: 8-hydroxyamoxapine

            Vd: 0.9-1.2 L/kg

            Protein binding: 90%

            Excretion: Urine (60%); Feces: (18%)

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            Images

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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