Xylac (Loxapine) 2.5mg

 First Generation (typical) Antipsychotic

“ALERT: US Boxed Warning

Increased mortality in elderly patients with dementia-related psychosis:

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Loxapine is not approved for the treatment of patients with dementia-related psychosis.”

CSA NA – FDA Approved – REMS (N) – Can Ship

Loxapine/Xylac is a dibenzoxazepine antipsychotic that blocks the D1 and D2 dopamine receptors postsynaptically in the mesolimbic pathway in the brain with some serotonin 5-HT2 antagonism as well.  The brains response to altered chemistry results in desired effects.

Loxapine/Xylac is officially indicated for schizophrenia and agitation associated with schizophrenia or bipolar I disorder.  (may be used for other conditions not listed)

Before starting Loxapine/Xylac make sure your physician is aware of any allergies or medications you currently take, if you have kidney disease, liver disease, a history of seizures, cardiovascular disease, dementia or are pregnant or breastfeeding. 

This medication also required regular bloodwork and follow up with your physician to monitor for adverse reactions

10-250mg divided into 2-4 daily dosages depending on what condition it is used for and patient response. 

How to Take: Follow instructions provided by physician/pharmacy label, take consistently at same times each day unless otherwise directed, store at room temperature.

You Need to Avoid: Operating heavy machinery or driving at least until you know how the medication affects you.  Do not stop this medication suddenly, make sure your physician is aware and can create a tapering schedule so you can come off slowly and prevent any withdrawal symptoms.   This medication has many drug interactions so ask your pharmacist before starting any over the counter medications or supplements.

Orthostatic hypotension, tachycardia, syncope, weight gain, constipation, hunger, dry mouth, alopecia, polydipsia (extreme thirst), urinary retention, impotence, blurred vision, increased serum prolactin, increased liver enzymes, weakness, agitation, dizziness, drowsiness, fatigue, temperature dysregulation, slurred speech, headache, insomnia, withdrawal syndrome, and extrapyramidal reaction (involuntary movement)

Note- this is not a complete list of side effects, of which are generally dosage dependent.  When higher doses are required the physician has weighed the risks and found the benefits to be greater, however regular monitoring (blood sugar, cholesterol, blood pressure, etc.) is important to make sure this does not change. May rarely cause neuroleptic malignant syndrome.

1. What can I do if this medication sedates me too much?
   It is a common side effect but in most cases the tablet can be split for smaller dosages to alleviate fatigue.  Discuss with your pharmacist or physician a plan to manage this or potential alternative medications.
2. This medication has a lot of scary side effects, is it safe?
   All medications have side effects however this medication works on a lot of different neurotransmitter receptors in the brain which can lead to a variety of intentional and unintentional effects.  These are mostly dosage dependant and in lower doses the risk is minimal.  In all cases regular lab work will allow your physician to see if your blood sugar, cholesterol etc. start to move in the wrong direction so action can be taken before they become a problem.
3. What are extra-pyramidal reactions?
   Blocking dopamine in the extra-pyramidal system in the central nervous system that regulates posture and skeletal muscle tone may cause a variety of movement disorders.  This can include dystonic reactions (muscular spasms, usually repetitive), akathisia (motor restlessness/uneasiness), pseudoparkinsonism (drug induced Parkinsonism – tremor, rigidity, bradykinesia, etc.), tardive dyskinesia (involuntary complex muscle movements in lower face and extremities).  These side effects are generally dose dependant and generally occur with long term use of medications that block dopamine.  If any of these effects may be occurring, speak to your physician as soon as possible to discuss your options.
4. Why would my doctor give me an antipsychotic? Does this mean I am psychotic?
   This medication can be used for many conditions outside of its original classification.  It commonly is also used for nonpsychotic mood disorders, but this class of medication was given its name back when we knew a lot less about their capabilities.
5. What is Neuroleptic Malignant Syndrome?
   NMS is a rare but serious reaction from significant blockade of dopamine which can occur from antipsychotic medications or from being on high dosages of levodopa (dopamine analogue) and stopping suddenly.  Presents initially as muscle cramps, tremors, fever, unstable blood pressure, and sudden changes in mental status.  As it progresses over 8-40 hours it can lead to complications of rhabdomyolysis, hyperkalemia, kidney failure, or seizures.  Seek medical attention immediately if this reaction is suspected.