Amoxapine

Generic name: Amoxapine

Drug class: Tricyclic antidepressants

Dosage form: Oral tablet (25 mg, 50 mg, 100 mg, 150 mg)

Route of administration: Oral

Dose:

• Adults: Initial dose: 50 mg orally 2 to 3 times a day; Maintenance dose: 100 mg orally 2 to 3 times a day; Maximum dose: 600 mg/day
• Geriatric patients: Initial dose: 25 mg orally 2 to 3 times a day; Maintenance dose: 50 mg orally 2 to 3 times a day; Maximum dose: 300 mg/day

Mechanism of action: Amoxapine is a tricyclic antidepressant that inhibits the reuptake of norepinephrine and, to a lesser extent, serotonin, at adrenergic nerve endings. It also blocks dopamine receptors, contributing to its antidepressant effects.

Drug usage cases:

• Relief of symptoms of depression in patients with neurotic or reactive depressive disorders, as well as endogenous and psychotic depression
• Depression accompanied by agitation or anxiety

Drug contraindications:

• Hypersensitivity to amoxapine or any of its components
• Recent myocardial infarction (heart attack)
• Concurrent use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOIs
• Angle-closure glaucoma
• Severe liver or kidney impairment
• Asthma
• Difficulty in urination
• Bipolar disorder
• Neuroleptic malignant syndrome
• Tardive dyskinesia

Side effects:

• Common: Drowsiness, constipation, dry mouth, blurred vision
• Less common: Anxiety, ataxia, confusion, dizziness, headache, fatigue, nausea, nervousness/restlessness, excessive appetite, rash, increased perspiration, tremor, palpitations, nightmares, excitement, weakness, ECG changes, edema, increased prolactin levels
• Rare: Diarrhea, flatulence, hypertension

Warnings:

• May cause suicidal thoughts and behaviors, especially in individuals under 25 and over 65 years old
• Risk of tardive dyskinesia, a movement disorder characterized by involuntary movements
• Potential for neuroleptic malignant syndrome, a life-threatening condition with symptoms such as high fever, muscle rigidity, altered mental status, and autonomic dysregulation
• May cause drowsiness; use caution when driving or operating heavy machinery
• Use with caution in patients with a history of seizures, cardiovascular disease, or urinary retention
• Gradual dose reduction is recommended to minimize withdrawal symptoms upon discontinuation

Use during pregnancy or breastfeeding:

Amoxapine is classified as a pregnancy category C drug, indicating that risk to the fetus cannot be ruled out. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Amoxapine is excreted in breast milk; therefore, caution should be exercised when administering to nursing mothers. The decision to use amoxapine during breastfeeding should be made after careful consideration of the potential risks and benefits.