loxapine inhaled (Rx)

Brand and Other Names:Adasuve
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Dosing & Uses

AdultPediatric

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

Next:

Interactions

Interaction Checker

and loxapine inhaled

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              Serious - Use Alternative (23)

              • 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.

              • 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 (250)

              • 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.

              • 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.

              • 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.

              • 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).

              • 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.

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              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%)

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              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

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              Pregnancy & Lactation

              Pregnancy Category: C

              Neonates exposed to antipsychotic drugs during the 3rd trimester of pregnancy are at risk for extrapyramidal and/or withdrawal symptoms following delivery

              These complications vary in severity; in some cases, symptoms have been self-limited, while in other cases neonates have required intensive care unit support and prolonged hospitalization

              Lactation: Unknown whether distributed in breast milk

              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

              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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              Images

              No images available for this drug.
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              Patient Handout

              A Patient Handout is not currently available for this monograph.
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              Formulary

              FormularyPatient Discounts

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              • 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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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.