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.

Overdose

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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