Amoxapine

Amoxapine is a prescription medication used to treat depression.

Amoxapine is in a class of medications called tricyclic antidepressants (TCAs). It works by increasing the amounts of certain natural substances in the brain that are needed to maintain mental balance.

This medication comes in tablet form and is taken one or more times a day. If you take amoxapine once a day, you should take it at bedtime.

Common side effects of amoxapine include drowsiness, dry mouth, constipation, and blurred vision

Amoxapine can also cause drowsiness. Do not drive or operate heavy machinery until you know how amoxapine affects you.

Amoxapine is a prescription medication used to treat depression.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Amoxapine may be found in some form under the following brand names:

• Asendin

Serious side effects have been reported with amoxapine. See the “Amoxapine Precautions” section.

Common side effects of amoxapine include the following:

• drowsiness
• dry mouth
• constipation
• blurred vision
• anxiety
• insomnia
• restlessness
• nervousness
• palpitations
• tremors
• confusion
• excitement
• nightmares
• ataxia
• alterations in EEG patterns
• edema
• skin rash
• nausea

This is not a complete list of amoxapine side effects. Ask your doctor or pharmacist for more information.

Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• Monoamine oxidase (MAO) inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate)
• anticoagulants (blood thinners) such as warfarin (Coumadin)
• medications that block a protein in the body (CYP2D6) such as quinidine (Qualaquin), fluoxetine (Prozac,Sarafem), amitriptyline (Elavil), and paroxetine (Paxil)
• antihistamines
• cimetidine (Tagamet)
• flecainide (Tambocor)
• levodopa (Sinemet, Larodopa)
• lithium (Eskalith, Lithobid)
• medications for high blood pressure, seizures, Parkinson's disease, asthma, colds, or allergies
• methylphenidate (Ritalin)
• muscle relaxants
• propafenone (Rhythmol)
• sedatives
• selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), and sertraline (Zoloft)
• sleeping pills and tranquilizers
• thyroid medications
• alcohol

This is not a complete list of amoxapine drug interactions. Ask your doctor or pharmacist for more information.

Serious side effects have been reported with amoxapine including the following:

• Clinical Worsening and Suicide Risk. Tell your healthcare provider right away if you have any of the following signs or symptoms especially if they are new, worse, or worry you:
  •   thoughts about suicide or dying
  •   attempts to commit suicide
  •   new or worse depression/anxiety
  •   feeling very agitated or restless
  •   panic attacks
  •   trouble sleeping (insomnia)
  •   acting on dangerous impulses
  •   other unusual changes in behavior or mood

All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases.

Families and caregivers of patients being treated with antidepressants for major depressive disorder or other indications, both psychiatric and nonpsychiatric, should be alerted about the need to monitor patients for the emergence of agitation, irritability, unusual changes in behavior, and the other symptoms described above, as well as the emergence of suicidality, and to report such symptoms immediately to health care providers. Such monitoring should include daily observation by families and caregivers.

• Neuroleptic Malignant Syndrome (NMS). Neuroleptic Malignant Syndrome (NMS) is a rare and potentially fatal side effect and has been reported in association with antipsychotic drugs and with amoxapine. Call your doctor immediately if the person being treated develops symptoms such as high fever; stiff muscles; shaking; confusion; sweating; changes in pulse, heart rate, or blood pressure; or muscle pain and weakness. Treatment should be stopped if the person being treated has NMS.
• Tardive Dyskinesia (TD). Tardive Dyskinesia (TD) is a serious, sometimes permanent side effect. TD may develop in patients treated with neuroleptic (i.e., antipsychotic) drugs. (Amoxapine is not an antipsychotic, but it has substantive neuroleptic activity.) TD includes uncontrollable movements of the face, tongue, and other parts of the body. The risk of developing TD and the chance that it will become permanent is thought to increase with the length of therapy and the overall dose taken by the patient. This condition can develop after a brief period of therapy at low doses, although this is much less common. There is no known treatment for TD, but it may go away partially or completely if therapy is stopped.
• Seizures. Amoxapine should be used cautiously in people with a seizure disorder, who have had seizures in the past, or who have conditions that increase their risk for seizures.

Amoxapine can also cause drowsiness. Do not drive or operate heavy machinery until you know how amoxapine affects you.

Amoxapine should be used with caution in patients with a history of urinary retention, angle-closure glaucoma, or increased intraocular pressure.

Patients with cardiovascular disorders should be watched closely. Tricyclic antidepressant drugs, particularly when given in high doses, can induce sinus tachycardia, changes in conduction time, and arrhythmias. Myocardial infarction and stroke have been reported with drugs of this class.

Do not take amoxapine if you:

• are allergic to amoxapine or to any of its ingredients
• take a monoamine oxidase inhibitor (MAOI). Ask your healthcare provider or pharmacist if you are not sure if you take an MAOI, including the antibiotic linezolid
• stopped taking an MAOI in the last 2 weeks unless directed to do so by your physician
• are in an acute recovery period after a myocardial infarction

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of amoxapine, there are no specific foods that you must exclude from your diet when receiving this medication.

Before taking amoxapine, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• tell your doctor and pharmacist if you are allergic to amoxapine, doxepin (Sinequan), any other medications, or any of the inactive ingredients in amoxapine
• are being treated with electroshock therapy (procedure in which small electric shocks are administered to the brain to treat certain mental illnesses)
• have or have ever had a heart attack, glaucoma (an eye disease)
• have or have ever had an enlarged prostate (a male reproductive organ)
• have or have ever had difficulty urinating
• have or have ever had seizures
• have or have ever had overactive thyroid gland, or liver, kidney, or heart disease
• are pregnant, plan to become pregnant. If you become pregnant while taking amoxapine, call your doctor immediately.
• are breast-feeding
• if you are having surgery, including dental surgery
• drink alcohol. Alcohol can add to the drowsiness caused by this medication.
• have stopped taking an MAO inhibitor within the past 14 days. Your doctor will probably tell you not to take amoxapine. If you stop taking amoxapine, you should wait at least 14 days before you start to take an MAO inhibitor.

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Amoxapine falls into category C. There are no well-controlled studies that have been done in pregnant women. Amoxapine should be used during pregnancy only if the possible benefit outweighs the possible risk to the unborn baby.

Tell your doctor if you are breastfeeding or plan to breastfeed.

Amoxapine has been detected in human breast milk. Because of the possibility for adverse reactions in nursing infants from amoxapine, a choice should be made whether to stop nursing or to stop use of this medication. The importance of the drug to the mother should be considered.

Take amoxapine exactly as prescribed.

Amoxapine comes in tablet form and is taken one or more times a day. Once an effective dose is obtained, a single dose at bedtime is recommended.

If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of amoxapine at the same time.

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The dose your doctor recommends may be based on the following:

• the condition being treated
• other medical conditions you have
• other medications you are taking
• how you respond to this medication
• your age

The recommended dose range of amoxapine (Asendin) is 200 to 300 mg daily.

• In general, lower dosages are recommended for elderly patients.

Some hospitalized patients who have been refractory to antidepressant therapy and who have no history of convulsive seizures may have doses given up to 600 mg daily in divided doses.

If you take too much amoxapine, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

• Store amoxapine at 20-25°C (68-77°F).
• Keep this and all medicines out of the reach of children.