Dosing & Uses
Dosage Forms & Strengths
powder for oral inhalation
- 10mg/single-use inhaler
Schizophrenia & Bipolar I Agitation
Indicated for acute treatment of agitation associated with schizophrenia or bipolar I disorder in adults
10 mg inhaled PO once within a 24-hr period
Must be administered only by a healthcare professional
Dosing Considerations
Because of the risk of bronchospasm, is only available through a restricted program under a risk evaluation and mitigation strategy (REMS) and must be administered only in an enrolled healthcare facility
Prior to administering, screen all patients for a history of asthma, COPD, or other pulmonary disease, and examine patients (including chest auscultation) for respiratory signs (eg, wheezing)
Administration
Step 1. Open pouch and remove inhaler from package (indicator light on inhaler is off)
Step 2. Firmly pull the plastic tab from the rear of the inhaler; check that the green light turns on to indicate that the inhaler is ready for use
Use the inhaler within 15 minutes after removing the tab to prevent automatic deactivation of the inhaler; the green light will turn off, indicating that the inhaler is not usable
Discard the inhaler after one use
Step 3. Explain procedure to patient; inform the patient that the inhaler may produce a flash of light and a clicking sound, and it may become warm during use
Step 4. Instruct the patient to hold the inhalator away from the mouth and breathe out fully to empty the lungs
Step 5. Instruct the patient to put the mouthpiece of the inhaler between the lips, close the lips, and inhale through the mouthpiece with a steady deep breath; check that the green light turns off indicating that the dose has been delivered
Step 6. Instruct the patient to remove the mouthpiece from the mouth and hold the breath for as long as possible, up to 10 seconds
NOTE: If the green light remains on after the patient inhales, the dose has NOT been delivered; instruct the patient to repeat Steps 4-6 up to 2 additional times; if the green light still does not turn off, discard the inhaler and use a new one
Safety and efficacy not established
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (1)
- amisulpride
amisulpride, loxapine inhaled. Either increases toxicity of the other by Other (see comment). Contraindicated. Comment: Increases risk of neuroleptic malignant syndrome.
Serious - Use Alternative (24)
- apomorphine
loxapine inhaled decreases effects of apomorphine by pharmacodynamic antagonism. Contraindicated.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, loxapine inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- bromocriptine
loxapine inhaled decreases effects of bromocriptine by pharmacodynamic antagonism. Contraindicated.
- cabergoline
loxapine inhaled decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.
- calcium/magnesium/potassium/sodium oxybates
loxapine inhaled, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- dopamine
loxapine inhaled decreases effects of dopamine by pharmacodynamic antagonism. Contraindicated.
- fentanyl
fentanyl, loxapine inhaled. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
- fentanyl intranasal
fentanyl intranasal, loxapine inhaled. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
- fentanyl transdermal
fentanyl transdermal, loxapine inhaled. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
- fentanyl transmucosal
fentanyl transmucosal, loxapine inhaled. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
- hydrocodone
hydrocodone, loxapine inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- levodopa
loxapine inhaled decreases effects of levodopa by pharmacodynamic antagonism. Contraindicated.
- lisuride
loxapine inhaled decreases effects of lisuride by pharmacodynamic antagonism. Contraindicated.
- methyldopa
loxapine inhaled decreases effects of methyldopa by pharmacodynamic antagonism. Contraindicated.
- metoclopramide intranasal
loxapine inhaled, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
loxapine inhaled increases toxicity of metoclopramide intranasal by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potential for additive effects, including increased frequency and severity of tardive dyskinesia, other extrapyramidal symptoms, and neuroleptic malignant syndrome. - mometasone inhaled
mometasone inhaled increases toxicity of loxapine inhaled by Other (see comment). Avoid or Use Alternate Drug. Comment: Agents used to treat airway disease may enhance the toxic effect of inhaled loxapine.
- olopatadine intranasal
loxapine inhaled and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- pramipexole
loxapine inhaled decreases effects of pramipexole by pharmacodynamic antagonism. Contraindicated.
- ropinirole
loxapine inhaled decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.
- rotigotine
loxapine inhaled decreases effects of rotigotine by pharmacodynamic antagonism. Contraindicated.
- safinamide
loxapine inhaled decreases effects of safinamide by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Dopamine antagonists may decrease safinamide effects and exacerbate Parkinson disease symptoms.
- selinexor
selinexor, loxapine inhaled. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.
- sodium oxybate
loxapine inhaled, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- sufentanil SL
sufentanil SL, loxapine inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
Monitor Closely (254)
- abobotulinumtoxinA
abobotulinumtoxinA increases effects of loxapine inhaled by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects.
- aclidinium
loxapine inhaled increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
aclidinium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - albuterol
loxapine inhaled increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alfentanil
alfentanil and loxapine inhaled both increase sedation. Use Caution/Monitor.
- almotriptan
almotriptan, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- alprazolam
alprazolam and loxapine inhaled both increase sedation. Use Caution/Monitor.
- amitriptyline
loxapine inhaled and amitriptyline both increase sedation. Use Caution/Monitor.
- amobarbital
amobarbital and loxapine inhaled both increase sedation. Use Caution/Monitor.
- amoxapine
loxapine inhaled and amoxapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.
loxapine inhaled and amoxapine both increase sedation. Use Caution/Monitor. - anticholinergic/sedative combos
loxapine inhaled increases effects of anticholinergic/sedative combos by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
anticholinergic/sedative combos decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - apomorphine
loxapine inhaled and apomorphine both increase sedation. Use Caution/Monitor.
- arformoterol
loxapine inhaled increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- aripiprazole
aripiprazole and loxapine inhaled both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
aripiprazole and loxapine inhaled both increase sedation. Use Caution/Monitor. - armodafinil
loxapine inhaled increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- atracurium
loxapine inhaled increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atracurium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - atropine
loxapine inhaled increases effects of atropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - atropine IV/IM
loxapine inhaled increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - azelastine
azelastine and loxapine inhaled both increase sedation. Use Caution/Monitor.
- baclofen
baclofen and loxapine inhaled both increase sedation. Use Caution/Monitor.
- belladonna alkaloids
loxapine inhaled increases effects of belladonna alkaloids by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
belladonna alkaloids decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - belladonna and opium
loxapine inhaled increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
belladonna and opium and loxapine inhaled both increase sedation. Use Caution/Monitor.
belladonna and opium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - benperidol
benperidol and loxapine inhaled both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
benperidol and loxapine inhaled both increase sedation. Use Caution/Monitor. - benzphetamine
loxapine inhaled increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- benztropine
loxapine inhaled increases effects of benztropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
benztropine decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - brexanolone
brexanolone, loxapine inhaled. Either increases toxicity of the other by sedation. Use Caution/Monitor.
- brompheniramine
brompheniramine and loxapine inhaled both increase sedation. Use Caution/Monitor.
- buprenorphine
buprenorphine and loxapine inhaled both increase sedation. Use Caution/Monitor.
- buprenorphine buccal
buprenorphine buccal and loxapine inhaled both increase sedation. Use Caution/Monitor.
- buprenorphine, long-acting injection
loxapine inhaled increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.
- butabarbital
butabarbital and loxapine inhaled both increase sedation. Use Caution/Monitor.
- butalbital
butalbital and loxapine inhaled both increase sedation. Use Caution/Monitor.
- butorphanol
butorphanol and loxapine inhaled both increase sedation. Use Caution/Monitor.
- caffeine
loxapine inhaled increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbinoxamine
carbinoxamine and loxapine inhaled both increase sedation. Use Caution/Monitor.
- carisoprodol
carisoprodol and loxapine inhaled both increase sedation. Use Caution/Monitor.
- chloral hydrate
chloral hydrate and loxapine inhaled both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide and loxapine inhaled both increase sedation. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine and loxapine inhaled both increase sedation. Use Caution/Monitor.
- chlorpromazine
chlorpromazine and loxapine inhaled both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
chlorpromazine and loxapine inhaled both increase sedation. Use Caution/Monitor. - chlorzoxazone
chlorzoxazone and loxapine inhaled both increase sedation. Use Caution/Monitor.
- cinnarizine
cinnarizine and loxapine inhaled both increase sedation. Use Caution/Monitor.
- cisatracurium
loxapine inhaled increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
cisatracurium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - clemastine
clemastine and loxapine inhaled both increase sedation. Use Caution/Monitor.
- clomipramine
loxapine inhaled and clomipramine both increase sedation. Use Caution/Monitor.
- clonazepam
clonazepam and loxapine inhaled both increase sedation. Use Caution/Monitor.
- clonidine
clonidine, loxapine inhaled. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects; potential delirium.
- clorazepate
clorazepate and loxapine inhaled both increase sedation. Use Caution/Monitor.
- clozapine
clozapine and loxapine inhaled both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
clozapine and loxapine inhaled both increase sedation. Use Caution/Monitor. - codeine
codeine and loxapine inhaled both increase sedation. Use Caution/Monitor.
- cyclizine
loxapine inhaled increases effects of cyclizine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
cyclizine and loxapine inhaled both increase sedation. Use Caution/Monitor.
cyclizine decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - cyclobenzaprine
loxapine inhaled increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
cyclobenzaprine and loxapine inhaled both increase sedation. Use Caution/Monitor.
cyclobenzaprine decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - cyproheptadine
cyproheptadine and loxapine inhaled both increase sedation. Use Caution/Monitor.
- dantrolene
dantrolene and loxapine inhaled both increase sedation. Use Caution/Monitor.
- daridorexant
loxapine inhaled and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- darifenacin
loxapine inhaled increases effects of darifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
darifenacin decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - desflurane
desflurane and loxapine inhaled both increase sedation. Use Caution/Monitor.
- desipramine
loxapine inhaled and desipramine both increase sedation. Use Caution/Monitor.
- deutetrabenazine
loxapine inhaled and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
loxapine inhaled and deutetrabenazine both increase sedation. Use Caution/Monitor. - dexchlorpheniramine
dexchlorpheniramine and loxapine inhaled both increase sedation. Use Caution/Monitor.
- dexfenfluramine
loxapine inhaled increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexmedetomidine
dexmedetomidine and loxapine inhaled both increase sedation. Use Caution/Monitor.
- dexmethylphenidate
loxapine inhaled increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextroamphetamine
loxapine inhaled increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextromethorphan
dextromethorphan, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- dextromoramide
dextromoramide and loxapine inhaled both increase sedation. Use Caution/Monitor.
- diamorphine
diamorphine and loxapine inhaled both increase sedation. Use Caution/Monitor.
- diazepam
diazepam and loxapine inhaled both increase sedation. Use Caution/Monitor.
- dicyclomine
loxapine inhaled increases effects of dicyclomine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
dicyclomine decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - diethylpropion
loxapine inhaled increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- difelikefalin
difelikefalin and loxapine inhaled both increase sedation. Use Caution/Monitor.
- difenoxin hcl
difenoxin hcl and loxapine inhaled both increase sedation. Use Caution/Monitor.
- dihydroergotamine
dihydroergotamine, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- dimenhydrinate
dimenhydrinate and loxapine inhaled both increase sedation. Use Caution/Monitor.
- diphenhydramine
loxapine inhaled increases effects of diphenhydramine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
diphenhydramine and loxapine inhaled both increase sedation. Use Caution/Monitor.
diphenhydramine decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - diphenoxylate hcl
diphenoxylate hcl and loxapine inhaled both increase sedation. Use Caution/Monitor.
- dipipanone
dipipanone and loxapine inhaled both increase sedation. Use Caution/Monitor.
- dobutamine
loxapine inhaled increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- donepezil transdermal
donepezil transdermal, loxapine inhaled. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor.
- dopamine
loxapine inhaled increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopexamine
loxapine inhaled increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dosulepin
loxapine inhaled and dosulepin both increase sedation. Use Caution/Monitor.
- doxepin
loxapine inhaled and doxepin both increase sedation. Use Caution/Monitor.
- doxylamine
doxylamine and loxapine inhaled both increase sedation. Use Caution/Monitor.
- droperidol
droperidol and loxapine inhaled both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
droperidol and loxapine inhaled both increase sedation. Use Caution/Monitor. - eletriptan
eletriptan, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- ephedrine
loxapine inhaled increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine
loxapine inhaled increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine racemic
loxapine inhaled increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ergoloid mesylates
ergoloid mesylates, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- ergotamine
ergotamine, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- estazolam
estazolam and loxapine inhaled both increase sedation. Use Caution/Monitor.
- ethanol
loxapine inhaled and ethanol both increase sedation. Use Caution/Monitor.
- etomidate
etomidate and loxapine inhaled both increase sedation. Use Caution/Monitor.
- fenfluramine
loxapine inhaled increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fentanyl
fentanyl, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- fesoterodine
loxapine inhaled increases effects of fesoterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
fesoterodine decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - flavoxate
loxapine inhaled increases effects of flavoxate by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
flavoxate decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - flibanserin
flibanserin, loxapine inhaled. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- fluphenazine
fluphenazine and loxapine inhaled both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
fluphenazine and loxapine inhaled both increase sedation. Use Caution/Monitor. - flurazepam
flurazepam and loxapine inhaled both increase sedation. Use Caution/Monitor.
- formoterol
loxapine inhaled increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- frovatriptan
frovatriptan, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- ganaxolone
loxapine inhaled and ganaxolone both increase sedation. Use Caution/Monitor.
- glycopyrrolate
loxapine inhaled increases effects of glycopyrrolate by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
glycopyrrolate decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - glycopyrrolate inhaled
glycopyrrolate inhaled decreases levels of loxapine inhaled by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
glycopyrrolate inhaled decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.
loxapine inhaled increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - glycopyrronium tosylate topical
glycopyrronium tosylate topical, loxapine inhaled. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.
- guanfacine
guanfacine, loxapine inhaled. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects; potential delirium.
- haloperidol
haloperidol and loxapine inhaled both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
haloperidol and loxapine inhaled both increase sedation. Use Caution/Monitor. - henbane
loxapine inhaled increases effects of henbane by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
henbane decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - homatropine
loxapine inhaled increases effects of homatropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
homatropine decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - hydromorphone
hydromorphone and loxapine inhaled both increase sedation. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and loxapine inhaled both increase sedation. Use Caution/Monitor.
- hyoscyamine
loxapine inhaled increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
hyoscyamine decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - hyoscyamine spray
loxapine inhaled increases effects of hyoscyamine spray by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
hyoscyamine spray decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - iloperidone
iloperidone and loxapine inhaled both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
iloperidone and loxapine inhaled both increase sedation. Use Caution/Monitor. - imipramine
loxapine inhaled and imipramine both increase sedation. Use Caution/Monitor.
- incobotulinumtoxinA
loxapine inhaled, incobotulinumtoxinA. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects.
- ipratropium
loxapine inhaled increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
ipratropium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - isoproterenol
loxapine inhaled increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketamine
ketamine and loxapine inhaled both increase sedation. Use Caution/Monitor.
- ketotifen, ophthalmic
loxapine inhaled and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.
- lemborexant
lemborexant, loxapine inhaled. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.
- levalbuterol
loxapine inhaled increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levomilnacipran
levomilnacipran, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- levorphanol
levorphanol and loxapine inhaled both increase sedation. Use Caution/Monitor.
- linezolid
linezolid, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- lisdexamfetamine
loxapine inhaled increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lithium
lithium, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- lofepramine
loxapine inhaled and lofepramine both increase sedation. Use Caution/Monitor.
- lofexidine
loxapine inhaled and lofexidine both increase sedation. Use Caution/Monitor.
- loprazolam
loprazolam and loxapine inhaled both increase sedation. Use Caution/Monitor.
- lorazepam
lorazepam and loxapine inhaled both increase sedation. Use Caution/Monitor.
lorazepam, loxapine inhaled. Mechanism: unknown. Use Caution/Monitor. Risk of resp. depression, hypotension. - lorcaserin
lorcaserin, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- lormetazepam
lormetazepam and loxapine inhaled both increase sedation. Use Caution/Monitor.
- lurasidone
lurasidone, loxapine inhaled. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.
- maprotiline
loxapine inhaled and maprotiline both increase sedation. Use Caution/Monitor.
- maraviroc
maraviroc, loxapine inhaled. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.
- marijuana
loxapine inhaled and marijuana both increase sedation. Use Caution/Monitor.
- meclizine
loxapine inhaled increases effects of meclizine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
meclizine decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - melatonin
loxapine inhaled and melatonin both increase sedation. Use Caution/Monitor.
- meperidine
meperidine and loxapine inhaled both increase sedation. Use Caution/Monitor.
meperidine, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction). - meprobamate
loxapine inhaled and meprobamate both increase sedation. Use Caution/Monitor.
- metaproterenol
loxapine inhaled increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaxalone
metaxalone and loxapine inhaled both increase sedation. Use Caution/Monitor.
- methadone
methadone and loxapine inhaled both increase sedation. Use Caution/Monitor.
methadone, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction). - methamphetamine
loxapine inhaled increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methocarbamol
methocarbamol and loxapine inhaled both increase sedation. Use Caution/Monitor.
- methscopolamine
loxapine inhaled increases effects of methscopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
methscopolamine decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - methylenedioxymethamphetamine
loxapine inhaled increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methylergonovine
methylergonovine, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- methylphenidate
loxapine inhaled increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.
- metoclopramide
loxapine inhaled and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
- midazolam
midazolam and loxapine inhaled both increase sedation. Use Caution/Monitor.
- midazolam intranasal
midazolam intranasal, loxapine inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.
- midodrine
loxapine inhaled increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- milnacipran
milnacipran, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- mirtazapine
loxapine inhaled and mirtazapine both increase sedation. Use Caution/Monitor.
- modafinil
loxapine inhaled increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- morphine
morphine and loxapine inhaled both increase sedation. Use Caution/Monitor.
- motherwort
loxapine inhaled and motherwort both increase sedation. Use Caution/Monitor.
- moxonidine
loxapine inhaled and moxonidine both increase sedation. Use Caution/Monitor.
- nabilone
loxapine inhaled and nabilone both increase sedation. Use Caution/Monitor.
- nalbuphine
nalbuphine and loxapine inhaled both increase sedation. Use Caution/Monitor.
- naratriptan
naratriptan, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- norepinephrine
loxapine inhaled increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nortriptyline
loxapine inhaled and nortriptyline both increase sedation. Use Caution/Monitor.
- olanzapine
loxapine inhaled and olanzapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
loxapine inhaled and olanzapine both increase sedation. Use Caution/Monitor. - oliceridine
oliceridine, loxapine inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- onabotulinumtoxinA
loxapine inhaled increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
onabotulinumtoxinA decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - opium tincture
opium tincture and loxapine inhaled both increase sedation. Use Caution/Monitor.
- orphenadrine
orphenadrine and loxapine inhaled both increase sedation. Use Caution/Monitor.
- oxazepam
oxazepam and loxapine inhaled both increase sedation. Use Caution/Monitor.
- oxybutynin
loxapine inhaled increases effects of oxybutynin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
oxybutynin decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - oxybutynin topical
loxapine inhaled increases effects of oxybutynin topical by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
oxybutynin topical decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - oxybutynin transdermal
oxybutynin transdermal decreases levels of loxapine inhaled by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
oxybutynin transdermal decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.
loxapine inhaled increases effects of oxybutynin transdermal by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - oxycodone
oxycodone and loxapine inhaled both increase sedation. Use Caution/Monitor.
- oxymorphone
oxymorphone and loxapine inhaled both increase sedation. Use Caution/Monitor.
- paliperidone
loxapine inhaled and paliperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
loxapine inhaled and paliperidone both increase sedation. Use Caution/Monitor. - pancuronium
loxapine inhaled increases effects of pancuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
pancuronium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - papaveretum
papaveretum and loxapine inhaled both increase sedation. Use Caution/Monitor.
- papaverine
loxapine inhaled and papaverine both increase sedation. Use Caution/Monitor.
- paroxetine
paroxetine, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- pentazocine
pentazocine and loxapine inhaled both increase sedation. Use Caution/Monitor.
- pentobarbital
pentobarbital and loxapine inhaled both increase sedation. Use Caution/Monitor.
- perphenazine
loxapine inhaled and perphenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
loxapine inhaled and perphenazine both increase sedation. Use Caution/Monitor. - phendimetrazine
loxapine inhaled increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenelzine
phenelzine, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- phenobarbital
phenobarbital and loxapine inhaled both increase sedation. Use Caution/Monitor.
- phentermine
loxapine inhaled increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine
loxapine inhaled increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine PO
loxapine inhaled increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- pholcodine
loxapine inhaled and pholcodine both increase sedation. Use Caution/Monitor.
- pimozide
loxapine inhaled and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
loxapine inhaled and pimozide both increase sedation. Use Caution/Monitor. - pirbuterol
loxapine inhaled increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pralidoxime
loxapine inhaled increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
pralidoxime decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - primidone
primidone and loxapine inhaled both increase sedation. Use Caution/Monitor.
- procarbazine
procarbazine, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- prochlorperazine
loxapine inhaled and prochlorperazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
loxapine inhaled and prochlorperazine both increase sedation. Use Caution/Monitor. - promethazine
loxapine inhaled and promethazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
promethazine and loxapine inhaled both increase sedation. Use Caution/Monitor.
promethazine, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction). - propantheline
loxapine inhaled increases effects of propantheline by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
propantheline decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - propofol
propofol and loxapine inhaled both increase sedation. Use Caution/Monitor.
- propylhexedrine
loxapine inhaled increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- protriptyline
loxapine inhaled and protriptyline both increase sedation. Use Caution/Monitor.
- quazepam
quazepam and loxapine inhaled both increase sedation. Use Caution/Monitor.
- quetiapine
loxapine inhaled and quetiapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
loxapine inhaled and quetiapine both increase sedation. Use Caution/Monitor. - ramelteon
loxapine inhaled and ramelteon both increase sedation. Use Caution/Monitor.
- rapacuronium
loxapine inhaled increases effects of rapacuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
rapacuronium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - remimazolam
remimazolam, loxapine inhaled. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.
- rimabotulinumtoxinB
loxapine inhaled, rimabotulinumtoxinB. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Anticholinergics may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.
- risperidone
loxapine inhaled and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
loxapine inhaled and risperidone both increase sedation. Use Caution/Monitor. - rizatriptan
rizatriptan, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- rocuronium
loxapine inhaled increases effects of rocuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
rocuronium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - rotigotine
loxapine inhaled and rotigotine both increase sedation. Use Caution/Monitor.
- salmeterol
loxapine inhaled increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- scopolamine
loxapine inhaled increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
scopolamine decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - scullcap
loxapine inhaled and scullcap both increase sedation. Use Caution/Monitor.
- secobarbital
secobarbital and loxapine inhaled both increase sedation. Use Caution/Monitor.
- selegiline
selegiline, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- sevoflurane
sevoflurane and loxapine inhaled both increase sedation. Use Caution/Monitor.
- shepherd's purse
loxapine inhaled and shepherd's purse both increase sedation. Use Caution/Monitor.
- sodium sulfate/?magnesium sulfate/potassium chloride
sodium sulfate/?magnesium sulfate/potassium chloride increases effects of loxapine inhaled by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant.
- sodium sulfate/potassium sulfate/magnesium sulfate
sodium sulfate/potassium sulfate/magnesium sulfate increases effects of loxapine inhaled by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant.
- solifenacin
loxapine inhaled increases effects of solifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
solifenacin decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - sufentanil
sufentanil and loxapine inhaled both increase sedation. Use Caution/Monitor.
- sumatriptan
sumatriptan, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- sumatriptan intranasal
sumatriptan intranasal, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- tapentadol
tapentadol and loxapine inhaled both increase sedation. Use Caution/Monitor.
- temazepam
temazepam and loxapine inhaled both increase sedation. Use Caution/Monitor.
- terbutaline
loxapine inhaled increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tetrabenazine
loxapine inhaled and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.
- thioridazine
loxapine inhaled and thioridazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
loxapine inhaled and thioridazine both increase sedation. Use Caution/Monitor. - thiothixene
loxapine inhaled and thiothixene both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
loxapine inhaled and thiothixene both increase sedation. Use Caution/Monitor. - tiotropium
loxapine inhaled increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
tiotropium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - tolterodine
loxapine inhaled increases effects of tolterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
tolterodine decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - topiramate
loxapine inhaled and topiramate both increase sedation. Modify Therapy/Monitor Closely.
- tramadol
tramadol and loxapine inhaled both increase sedation. Use Caution/Monitor.
- tranylcypromine
tranylcypromine, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- trazodone
loxapine inhaled and trazodone both increase sedation. Use Caution/Monitor.
- triazolam
triazolam and loxapine inhaled both increase sedation. Use Caution/Monitor.
- triclofos
triclofos and loxapine inhaled both increase sedation. Use Caution/Monitor.
- trifluoperazine
loxapine inhaled and trifluoperazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
loxapine inhaled and trifluoperazine both increase sedation. Use Caution/Monitor. - trihexyphenidyl
loxapine inhaled increases effects of trihexyphenidyl by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
trihexyphenidyl decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - trimipramine
loxapine inhaled and trimipramine both increase sedation. Use Caution/Monitor.
- triprolidine
triprolidine and loxapine inhaled both increase sedation. Use Caution/Monitor.
- trospium chloride
loxapine inhaled increases effects of trospium chloride by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
trospium chloride decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - vecuronium
loxapine inhaled increases effects of vecuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
vecuronium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - venlafaxine
venlafaxine, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- vilazodone
vilazodone, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- xylometazoline
loxapine inhaled increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- yohimbine
loxapine inhaled increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziconotide
loxapine inhaled and ziconotide both increase sedation. Use Caution/Monitor.
- ziprasidone
loxapine inhaled and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
loxapine inhaled and ziprasidone both increase sedation. Use Caution/Monitor. - zolmitriptan
zolmitriptan, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- zotepine
loxapine inhaled and zotepine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
loxapine inhaled and zotepine both increase sedation. Use Caution/Monitor.
Minor (6)
- brimonidine
brimonidine increases effects of loxapine inhaled by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.
- chasteberry
chasteberry decreases effects of loxapine inhaled by pharmacodynamic antagonism. Minor/Significance Unknown. (Theoretical interaction).
- ethanol
ethanol, loxapine inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.
- eucalyptus
loxapine inhaled and eucalyptus both increase sedation. Minor/Significance Unknown.
- sage
loxapine inhaled and sage both increase sedation. Minor/Significance Unknown.
- smoking
smoking decreases levels of loxapine inhaled by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.
Adverse Effects
>10%
Respiratory adverse effects in patients with COPD (19%)
Dysgeusia (14%)
Sedation (12%)
1-10%
Throat irritation (3%)
<1%
Bronchospasm (0.8%)
Akathisia (0.4%)
Neck dystonia and oculogyration (0.4%)
Warnings
Black Box Warnings
Bronchospasm
- Can cause bronchospasm that has the potential to lead to respiratory distress and respiratory arrest
- Administer only in an enrolled healthcare facility that has immediate access on-site to supplies and personnel and ready access to emergency response services; facilities must have a short-acting bronchodilator, including a nebulizer and inhalation solution, for immediate treatment of bronchospasm
- Prior to administering, screen patients regarding a current diagnosis, history, or symptoms of asthma, COPD and other lung diseases, and examine (including chest auscultation) patients for respiratory signs
- Monitor for signs and symptoms of bronchospasm following treatment
Dementia-related psychosis
- Patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death as shown in short-term controlled trials
- The deaths appeared to be either cardiovascular (eg, heart failure, stroke, sudden death) or infectious (eg, pneumonia) in nature
- This drug is not approved for the treatment of patients with dementia-related psychosis
Contraindications
Current diagnosis or history of asthma, COPD, or other lung disease associated with bronchospasm
Acute respiratory symptoms or signs (eg, wheezing)
Current use of medications to treat airways disease, such as asthma or COPD
History of bronchospasm following treatment
Known hypersensitivity (including serious skin reactions) to loxapine or amoxapine
Cautions
Can cause bronchospasm (see Black Box Warnings)
Monitor for signs and symptoms of bronchospasm following administration; perform a physical exam, including chest auscultation at least q15min for at least 1 hr after the dose
Increased mortality in elderly patients with demential-related psychosis (see Black Box Warnings)
Antipsychotic drugs can cause neuroleptic malignant syndrome; symptoms include hyperpyrexia, muscle rigidity, altered mental status, and autonomic instability; associated findings include increased CPK, rhabdomyolysis, increased urine and serum myoglobin, and renal failure
May cause hypotension, orthostatic hypotension, and syncope
Lowers seizure threshold; use caution in patients with history of seizures
May cause cognitive and motor impairment
May cause sedation and somnolence; use caution when driving or operating machinery and when coadministered with other drugs known to cause CNS depression
May cause anticholinergic adverse reactions, including exacerbation of glaucoma and urinary retention; caution when coadministered with other drugs that elicit anticholinergic effects
Increased incidence of stroke and transient ischemic attack in elderly patients with dementia-related psychosis treated with antipsychotic drugs
Pregnancy & Lactation
Pregnancy
There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to atypical antipsychotics during pregnancy; healthcare providers are encouraged to register patients by contacting the National Pregnancy Registry for Atypical Antipsychotics at 1-866- 961-2388 or online at http://womensmentalhealth.org/ clinical-and-researchprograms/pregnancyregistry/
Neonates exposed to antipsychotic drugs, during the third trimester are at risk for extrapyramidal and/or withdrawal symptoms following delivery
The available data from published case reports and pharmacovigilance cases with loxapine in pregnant women are insufficient to determine a drug-associated risk for major birth defects, miscarriage or adverse maternal or fetal outcomes
There are risks to mother associated with untreated schizophrenia or bipolar I disorder and with exposure to antipsychotics, including loxapine during pregnancy
Extrapyramidal and/or withdrawal symptoms, including agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, and feeding disorder reported in neonates exposed to antipsychotic drugs, including loxapine, during third trimester of pregnancy; these symptoms have varied in severity
Monitor neonates for extrapyramidal and/or withdrawal symptoms and manage symptoms appropriately; some neonates recovered within hours or days without specific treatment; others required prolonged hospitalization
Animal data
- In animal reproduction studies, increased embryofetal toxicity and death in rat fetuses and offspring were observed when pregnant rats were orally administered loxapine, during period of organogenesis, at doses approximately less or equal to maximum recommended human dose (MRHD) based on mg/m2 body surface area
Lactation
There is no available information on presence of loxapine in human milk, effects on breastfed infant, or on milk production
The drug is present in milk of lactating dogs; when a drug is present in animal milk, it is likely that the drug will be present in human milk
The developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for drug and any potential adverse effects on breastfed child from therapy or from underlying maternal condition
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.Pharmacology
Mechanism of Action
Typical antipsychotic (dibenzoxazepine subclass of tricyclic antipsychotic agents); mechanism of action is unknown, but is theorized to antagonize central dopamine D2 and serotonin 5-HT2a receptors
Absorption
Peak Plasma Time: 2 minutes
Peak Plasma Concentration: 257 ng/mL
AUC: 66 ng•h/mL (0-2 hr); 188 ng•h/mL (infinity)
Distribution
Protein Bound: 96.6%
Metabolism
Metabolized extensively in the liver by hydroxylation; forms 8-OH-loxapine by CYP1A2 and forms 7-OH-loxapine by CYP3A4 and CYP2D6
Metabolized by N-oxidation to form loxapine N-oxide by flavanoid monoamine oxidases
Demethylated to form amoxapine Because there are multiple metabolic pathways, the risk of metabolic interactions caused by an effect on an individual isoform is minimal
Because there are multiple metabolic pathways, the risk of metabolic interactions caused by an effect on an individual isoform is minimal
Elimination
Half-life: 7.16 hr (range 6-8 hr)
Excretion: feces (unconjugated metabolites); urine (conjugated metabolites)
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Formulary
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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.
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