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Amoxapine

 
  Generic Name: Amoxapine (a MOX a peen)
 
  Brand Names: Asendin  
     
   
 

What is amoxapine?

Amoxapine is in a group of drugs called tricyclic antidepressants. Amoxapine affects chemicals in the brain that may become unbalanced.

Amoxapine is used to treat symptoms of depression, anxiety, or agitation.

Amoxapine may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about amoxapine?

Do not use this medication if you are allergic to amoxapine, or if you have recently had a heart attack. Do not use amoxapine if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

What should I discuss with my healthcare provider before taking amoxapine?

Do not use this medication if you are allergic to amoxapine, or if you have recently had a heart attack. Do not use amoxapine if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take amoxapine before the MAO inhibitor has cleared from your body.

Before taking amoxapine, tell your doctor if you are allergic to any drugs, or if you have:

  • heart disease;

  • a history of heart attack, stroke, or seizures;

  • kidney disease;

  • schizophrenia or other mental illness;

  • diabetes (amoxapine may raise or lower blood sugar);

  • glaucoma; or

  • problems with urination.

If you have any of these conditions, you may not be able to use amoxapine, or you may need a dosage adjustment or special tests during treatment.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

FDA Pregnancy Category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Amoxapine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Older adults may be more likely to have side effects from this medicine. Do not give this medication to anyone under 18 years old without the advice of a doctor.

How should I take amoxapine?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from this medication. Follow the directions on your prescription label.

It may take up to 3 weeks of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 3 weeks of treatment. Store amoxapine at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of amoxapine can be fatal.

Symptoms of an amoxapine overdose may include uneven heartbeats, increase or decrease in urination, drowsiness, agitation, confusion, hallucinations, seizure (convulsions), or coma.

What should I avoid while taking amoxapine?

Avoid drinking alcohol. It can cause dangerous side effects when taken together with amoxapine.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, medicine for seizures, or other antidepressants). They can add to sleepiness caused by amoxapine.

Grapefruit and grapefruit juice may interact with amoxapine. Discuss the use of grapefruit products with your doctor before increasing or decreasing the amount of grapefruit products in your diet.

Amoxapine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Amoxapine can make your skin more sensitive to sunlight and sunburn may result. Use a sunscreen (minimum SPF 15) and wear protective clothing if you must be out in the sun.

Amoxapine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have any of these serious side effects:
  • fast, pounding, or uneven heart rate;

  • chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;

  • sudden numbness or weakness, especially on one side of the body;

  • sudden headache, confusion, problems with vision, speech, or balance;

  • feeling light-headed, fainting;

  • restless muscle movements in your eyes, tongue, jaw, or neck;

  • tremors or uncontrollable shaking; or

  • fever with confusion, muscle stiffness, sweating, and fast or uneven heartbeats.

Less serious side effects may be more likely to occur, such as:

  • nausea, vomiting, stomach pain, constipation, diarrhea;

  • dry mouth, unpleasant taste;

  • increased appetite, weight changes;

  • weakness, lack of coordination;

  • numbness or tingly feeling;

  • feeling dizzy, drowsy, or tired;

  • nightmares;

  • blurred vision, headache;

  • low fever;

  • mild skin rash;

  • breast swelling (in men or women); or

  • decreased sex drive, impotence, or difficulty having an orgasm.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.

Amoxapine Dosing Information

Usual Adult Dose for Depression:

For the relief of symptoms of depression in patients with neurotic or reactive depressive disorders as well as endogenous and psychotic depressions:

Initial dose: 50 mg 2 or 3 times daily. Depending on tolerance, the dosage may be increased to 100 mg 2 or 3 times daily by the end of the first week. An initial dosage of 300 mg daily may be given, but notable sedation may occur in some patients during the first few days of therapy at this level. Increases above 300 mg daily should be made only if 300 mg daily has been ineffective during a trial period of at least two weeks. When an effective dosage is established, the drug may be given in a single dose (not to exceed 300 mg) at bedtime.

Maintenance: 200 to 300 mg daily.
Three weeks is an adequate trial period providing the dosage has reached 300 mg daily (or the lower level of tolerance) for at least two weeks. If no response is seen at 300 mg, the dosage may be increased (depending on tolerance) up to 400 mg daily. Hospitalized patients who have been refractory to antidepressant therapy and who have no history of convulsive seizures may have their dosage cautiously raised up to 600 mg daily in divided doses.

Amoxapine may be given in a single daily dose up to 300 mg, preferably at bedtime. If the total daily dosage exceeds 300 mg, it should be given in divided doses.

Usual Geriatric Dose for Depression:

For the relief of symptoms of depression in patients with neurotic or reactive depressive disorders as well as endogenous and psychotic depressions:

Initial dose: 25 mg 2 or 3 times daily. If no intolerance is observed, the dosage may be increased by the end of the first week to 50 mg 2 or 3 times daily. Although 100 to 150 mg daily may be adequate for many elderly patients, some may require a higher dosage. Careful increases up to 300 mg daily may be appropriate for such individuals.

Once an effective dose has been established, amoxapine may be given as a single bedtime dose, not to exceed 300 mg.

What other drugs will affect amoxapine?

Before taking amoxapine, tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft).

Before taking amoxapine, tell your doctor if you are currently using any of the following drugs:

  • cimetidine (Tagamet); or

  • heart rhythm medications such as flecainide (Tambocor), propafenone (Rhythmol), or quinidine (Cardioquin, Quinidex, Quinaglute).

If you are using any of these drugs, you may not be able to use amoxapine, or you may need dosage adjustments or special tests during treatment.

There are many other medicines that can interact with amoxapine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

Where can I get more information?

  • Your pharmacist has information about amoxapine written for health professionals that you may read.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 8.02. Revision Date: 4/12/2009 4:38:32 PM.;
 
 
 
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