Parenteral Manual

Loxapine Hydrochloride

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
LOXAPAC
Classification: 
Antipsychotic
Original Date: 
August 2016
Indications: 
  • Management of psychotic disorders such as schizophrenia
  • Symptom control of acute agitation associated with schizophrenia or bipolar 1 disorder
Reconstitution and Stability: 
  • Available as 50 mg/mL ampoule
  • Store between 15 C - 30 C
Compatibility: 
  • No information available
Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM YES  (IM use only)
IV Direct NO
IV Intermittent Infusion NO
IV Continuous Infusion NO

 

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:

  • Psychosis: 5 to 25 mg/dose IM Q 6 hours PRN (weight based dosing not available)

     - less than 12 yrs or less than 40 kg: 6.25 – 12.5 mg/dose, MAX 50 mg/day

     - 13 - 17 yrs or greater than 40 kg: 12.5 – 25 mg/dose, MAX 100 mg/day

Adults:

  •  Psychosis: 12.5 - 50 mg/dose IM Q 4 - 6 hours or longer; dose and interval are dependent on patient response (Max 100 mg/day)
Potential hazards of parenteral administration: 
  • Children may be more susceptible to the adverse effects of antipsychotics including extrapyramidal effects, sedation, weight gain

Common Adverse Effects:

  • Sedation, confusion, memory impairment
  • Anticholinergic effects:  dry mouth, blurred vision, urinary retention, constipation
  • Extrapyramidal effects:

     - acute dystonic reactions (spasms of neck and face muscles, tongue protrusion, oculogyric movement)

                     - higher risk of acute dystonia in males and younger patients

     - akathisia (motor restlessness)

     - pseudoparkinsonism (tremor, rigidity, excessive salivation, masked facies)

Serious Adverse Effects:

  • Delirium
  • Hypotension, orthostatic hypotension, syncopeTachycardia
  • ECG abnormalities (QTc prolongation)
  • Neuroleptic malignant syndrome – muscle rigidity, fever/hyperthermia, altered mental status, autonomic instability (irregular pulse, labile blood pressure, tachycardia, diaphoresis, cardiac dysrhythmia)

                      - higher risk in young males and with dehydration

  • Rare reports of hematologic adverse effects
  • Esophageal dysmotility and aspiration
  • Impaired core body temperature regulation – caution with strenuous exercise, heat exposure, dehydration
  • May lower seizure threshold - caution in patients at risk for seizure (history of seizure, head trauma, brain damage, alcoholism, concurrent therapy with medications that may lower seizure threshold)
Notes: 
  • Reserve injection for patients with severe symptoms or if unable to take oral administration
  • May potentiate the action of CNS depressants
  • May cause photosensitivity
  • May be associated with ocular changes
  • Caution with other medications possessing anticholinergic effects
  • Dyskinesias after abrupt withdrawal of antipsychotic
  • Hyperprolactinemia/endocrine effects with long term use (galactorrhea, amenorrhea, gynecomastia, menstrual irregularity)
  • Weight gain
References: 

Loxapac IM product monograph, Sandoz (last revision 14July2014)

Loxapine Hydrochloride CPhA monograph, CPhA (last revision Oct2013)

The information contained on this website is provided for informational purposes only, as a guide to assist physicians, nurses and other healthcare providers in deciding on the appropriate care required for a particular patient. At all times, physicians, nurses and other healthcare providers must exercise their independent clinical judgment, based on their knowledge, training and experience, taking into account the specific facts and circumstances of each patient, when deciding on the appropriate course of investigation and/or treatment to recommend in a particular clinical situation.

CHEO has made every effort to ensure that the information contained on this website is as current and accurate as possible. However, changes can occur due to ongoing research and the constant influx of new information. Where possible, hospitals and healthcare practitioners should verify the information before acting on it.

Reliance on any information in this website is at the user's own risk. CHEO is not responsible or liable for any harm, loss or other consequences from the use or misuse of the information on this website.