Antidepressant Medications Anti-depressant Drugs Antidepressant: amoxipine, Asenden
Antidepressant: amoxipine, Asenden
Generic Name: amoxipine
Brand Name(s): Asenden
Common Use: Antidepressant
Amoxapine ( Asenden ) is a tricyclic antidepressant of
the dibenzoxazepine class. The mechanism of clinical action of amoxapine
in man is not well understood. Amoxapine ( Asenden ) is not a monoamine
oxidase (MAO) inhibitor.
The relief of symptoms of depression. Patients who have
failed to respond satisfactorily to other antidepressants may show response
to amoxapine ( Asenden ).
Hypersensitivity to dibenzoxazepine compounds. It should
not be given concomitantly with MAO inhibitors. When replacing MAO inhibitors
with amoxapine, a minimum of 14 days should be allowed to elapse after
the former is discontinued. Amoxapine ( Asenden ) should then be initiated
cautiously with gradual increase in dosage until optimum response is achieved.
Although it is not known whether gradual withdrawal will
decrease the incidence of withdrawal emergent neurological signs, gradual
withdrawal would appear to be advisable.
Since amoxapine ( Asenden ) has a sedative component to
its action, patients should be advised against driving or engaging in
activities requiring mental alertness and physical coordination until
their response to the drug has been well established.
Patients should be warned that the effects of other drugs
acting on the CNS, such as alcohol, barbiturates and other CNS depressants,
may be potentiated by amoxapine.
Amoxapine ( Asenden ) should be discontinued prior to elective
surgery for as long as the clinical situation will allow.
Abrupt cessation of treatment with tricyclic antidepressants
after prolonged administration may produce nausea, headache and malaise.
These symptoms are not indicative of addiction. Withdrawal emergent dyskinesia
has been reported with amoxapine
Adverse Side Effects
Although some of the adverse reactions included in the following
list have not been reported with amoxapine, pharmacological similarities
among the tricyclic antidepressants require that each of the reactions
be considered when prescribing amoxapine. With amoxapine, as with other
tricyclic antidepressant drugs, the side effects most often reported are
sedation and anticholinergic effects. Drowsiness, fatigue, excitement,
agitation, restlessness, insomnia, nightmares, hypomania, anxiety, confusion,
disorientation, disturbed concentration, delusions, hallucinations, activation
of latent psychosis. Seizures, alteration in EEG patterns, dizziness,
tremors, extrapyramidal symptoms, numbness, tingling, paresthesias of
the extremities, peripheral neuropathy, tinnitus, syndrome of inappropriate
ADH (antidiuretic hormone) secretion. Extrapyramidal symptoms reported
with amoxapine include: akinesia, akathisia, chorea, cogwheel rigidity,
dysarthria, mask-like facies, oculogyric crisis, torticollis and dyskinesia,
including tardive dyskinesia. Although most of these symptoms have been
reported infrequently, the possibility of their occurrence should be borne
in mind when prescribing amoxapine. As with antipsychotic agents, tardive
dyskinesia may appear in some patients on long-term therapy with amoxapine
or may appear after drug therapy has been discontinued (withdrawal tardive
dyskinesia). The risk appears to be greater in elderly patients on high-dose
therapy, especially females. Therefore, it is suggested that amoxapine
be discontinued if symptoms of tardive dyskinesia appear, and the patient
be switched to a different antidepressant. Hypotension, hypertension,
tachycardia, palpitations, syncope, atrial arrhythmias (including premature
atrial contractions and fibrillation), heart block, stroke and cardiac
arrest have been reported with amoxapine. A quinidine-like effect and
other reversible ECG changes such as flattening or inversion of T waves,
bundle branch block, depressed ST segments, prolonged conduction time
and asystole have been reported with other tricyclic antidepressants.
Dry mouth, blurred vision, disturbances of accom- modation, mydriasis,
constipation, nasal stuffiness, delayed micturition, sublingual adenitis,
paralytic ileus, urinary retention, dilation of the urinary tract, precipitation
of latent and aggravation of existing glaucoma, vertigo. Increased or
decreased libido, impotence, menstrual irregularity, testicular swelling,
painful ejaculation, inhibition of orgasm, breast enlargement and galactorrhea
in the female, gynecomastia in the male, elevation and lowering of blood
sugar levels, and increased prolactin levels. Pruritus, skin rash, photosensitization,
edema, drug fever, leukopenia, urticaria, petechiae, obstructive jaundice,
bone marrow depression, including agranulocytosis, eosinophilia, purpura
and thrombocytopenia, toxic epidermal necrolysis and neuroleptic malignant
syndrome. Nausea, epigastric distress, vomiting, flatulence, abdominal
pain, diarrhea, peculiar taste, stomatitis. Weakness, headache, weight
gain or loss, excessive appetite, anorexia, increased perspiration, urinary
frequency, lacrimation, alopecia, parotid swelling, black tongue, hepatitis.
Toxic manifestations of overdosage differ significantly
from those of other tricyclic antidepressants. CNS effects such as drowsiness,
delirium, lethargy with diminished deep tendon reflexes and particularly
grand mal convulsions, occur frequently, and treatment should be directed
primarily toward prevention or control of seizures. Status epilepticus
may develop and constitutes a neurologic emergency. Coma and acidosis
are other serious complications of substantial overdosage in some cases.
Treatment should be symptomatic and supportive, but with
special attention to prevention or control of seizures.
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