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What is Amoxapine
Amoxapine is an antidepressant of the dibenzoxazepine class. It is a cyclic antidepressant chemically distinct from other cyclic compounds for depression, such as tricyclic antidepressants (TCAs), but possesses some pharmacologic actions that are similar to TCAs, including norepinephrine reuptake inhibition.
Amoxapine differs from other conventional antidepressants in that it also has dopamine antagonist properties, and, it appears to have a low propensity for serotonergic effects.
Amoxapine is indicated for the treatment of major depression in adults, including depression with psychotic features, concurrent anxiety, or agitation.
Due to the availability of antidepressants with a more acceptable tolerability and safety profile, amoxapine is generally not considered a first-line treatment option.
Product labels for all antidepressants contain a warning related to an increased risk of suicidality in children, adolescents, and young adults during the initial stages of therapy with an antidepressant, whether treating depression or other psychiatric conditions.
Therefore, the necessity of pharmacologic therapy should be carefully considered in these populations, taking into account the risks of treatment versus clinical need.
Indications
- depression
Side Effects
- abdominal pain
- acute generalized exanthematous pustulosis (AGEP)
- agranulocytosis
- alopecia
- anorexia
- anxiety
- appetite stimulation
- asthenia
- ataxia
- atrial fibrillation
- AV block
- blurred vision
- breast enlargement
- confusion
- constipation
- cycloplegia
- depression
- diarrhea
- dizziness
- drowsiness
- dysgeusia
- edema
- EEG changes
- ejaculation dysfunction
- eosinophilia
- fatigue
- fever
- flatulence
- galactorrhea
- hallucinations
- headache
- hepatitis
- hyperhidrosis
- hyperprolactinemia
- hypertension
- hyperthermia
- hypotension
- ileus
- impotence (erectile dysfunction)
- increased urinary frequency
- insomnia
- jaundice
- lacrimation
- leukopenia
- libido decrease
- libido increase
- mania
- menstrual irregularity
- mydriasis
- myocardial infarction
- nasal congestion
- nausea
- neuroleptic malignant syndrome
- nightmares
- ocular hypertension
- orthostatic hypotension
- palpitations
- pancreatitis
- paresthesias
- parotitis
- petechiae
- photosensitivity
- pruritus
- purpura
- rash
- restlessness
- seizures
- SIADH
- sinus tachycardia
- stroke
- suicidal ideation
- syncope
- tardive dyskinesia
- testicular swelling
- thrombocytopenia
- tinnitus
- tremor
- urinary retention
- urticaria
- vasculitis
- visual impairment
- vomiting
- weight gain
- weight loss
- xerostomia
Monitoring Parameters
- ECG
- LFTs
- serum amoxapine concentrations
- thyroid function tests (TFTs)
Contraindications
- abrupt discontinuation
- acute myocardial infarction
- agranulocytosis
- alcoholism
- anticholinergic medications
- asthma
- bipolar disorder
- breast-feeding
- carbamazepine hypersensitivity
- cardiac arrhythmias
- cardiac disease
- children
- closed-angle glaucoma
- diabetes mellitus
- driving or operating machinery
- electroconvulsive therapy (ECT)
- gastroesophageal reflux disease (GERD)
- geriatric
- GI disease
- hematological disease
- hepatic disease
- hyperthermia
- hyperthyroidism
- hypothyroidism
- ileus
- increased intraocular pressure
- MAOI therapy
- Parkinson’s disease
- pregnancy
- prostatic hypertrophy
- radiographic contrast administration
- respiratory depression
- schizophrenia
- seizure disorder
- seizures
- suicidal ideation
- sunlight (UV) exposure
- surgery
- tachycardia
- tardive dyskinesia
- thrombocytopenia
- tricyclic antidepressant hypersensitivity
- urinary retention
Interactions
- Abiraterone
- Acetaminophen; Butalbital
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Codeine
- Acetaminophen; Dextromethorphan; Doxylamine
- Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
- Acetaminophen; Dextromethorphan; Phenylephrine
- Acetaminophen; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Dichloralphenazone; Isometheptene
- Acetaminophen; Diphenhydramine
- Acetaminophen; Guaifenesin; Phenylephrine
- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Acetaminophen; Pentazocine
- Acetaminophen; Propoxyphene
- Acetaminophen; Pseudoephedrine
- Acetaminophen; Tramadol
- Acetazolamide
- Acrivastine; Pseudoephedrine
- Alfentanil
- Alosetron
- Alprazolam
- Amantadine
- Ambenonium Chloride
- Amitriptyline; Chlordiazepoxide
- Amlodipine; Celecoxib
- Amobarbital
- Amphetamine; Dextroamphetamine Salts
- Amprenavir
- Anticholinergics
- Anxiolytics; Sedatives; and Hypnotics
- Aripiprazole
- Artemether; Lumefantrine
- Articaine; Epinephrine
- Asenapine
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Oxycodone
- Atazanavir
- Atazanavir; Cobicistat
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Atropine; Difenoxin
- Atropine; Diphenoxylate
- Atropine; Edrophonium
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Azelastine
- Azelastine; Fluticasone
- Baclofen
- Barbiturates
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Belladonna; Opium
- Benzhydrocodone; Acetaminophen
- Benzodiazepines
- Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Benzphetamine
- Bismuth Subsalicylate
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Brexpiprazole
- Brompheniramine
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Dextromethorphan; Guaifenesin
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Brompheniramine; Pseudoephedrine
- Buprenorphine
- Buprenorphine; Naloxone
- Bupropion
- Bupropion; Naltrexone
- Buspirone
- Butabarbital
- Butorphanol
- Cannabidiol
- Capsaicin; Metaxalone
- Carbetapentane; Chlorpheniramine
- Carbetapentane; Chlorpheniramine; Phenylephrine
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbetapentane; Guaifenesin
- Carbetapentane; Guaifenesin; Phenylephrine
- Carbetapentane; Phenylephrine
- Carbetapentane; Phenylephrine; Pyrilamine
- Carbetapentane; Pseudoephedrine
- Carbetapentane; Pyrilamine
- Carbidopa; Levodopa
- Carbidopa; Levodopa; Entacapone
- Carbinoxamine
- Carbinoxamine; Dextromethorphan; Pseudoephedrine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbinoxamine; Phenylephrine
- Carbinoxamine; Pseudoephedrine
- Cariprazine
- Carisoprodol
- Celecoxib
- Cenobamate
- Cetirizine
- Cetirizine; Pseudoephedrine
- Chlophedianol; Dexbrompheniramine
- Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
- Chlophedianol; Guaifenesin; Phenylephrine
- Chloral Hydrate
- Chlorcyclizine
- Chlordiazepoxide
- Chlordiazepoxide; Clidinium
- Chlorpheniramine
- Chlorpheniramine; Codeine
- Chlorpheniramine; Dextromethorphan
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Phenylephrine
- Chlorpheniramine; Pseudoephedrine
- Chlorpromazine
- Chlorthalidone; Clonidine
- Chlorzoxazone
- Cholinergic agonists
- Cimetidine
- Cinacalcet
- Clemastine
- Clobazam
- Clonazepam
- Clonidine
- Clorazepate
- Clozapine
- Cocaine
- Codeine
- Codeine; Guaifenesin
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- COMT inhibitors
- Cyclizine
- Cyclobenzaprine
- Cyproheptadine
- Dacomitinib
- Dantrolene
- Darifenacin
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Delavirdine
- Desloratadine; Pseudoephedrine
- Deutetrabenazine
- Dexchlorpheniramine
- Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
- Dexmethylphenidate
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Guaifenesin; Phenylephrine
- Dextromethorphan; Guaifenesin; Pseudoephedrine
- Dextromethorphan; Promethazine
- Dextromethorphan; Quinidine
- Diazepam
- Diethylpropion
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Dimenhydrinate
- Diphenhydramine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Diphenhydramine; Phenylephrine
- Disopyramide
- Disulfiram
- Dobutamine
- Donepezil
- Donepezil; Memantine
- Dopamine
- Doxylamine
- Doxylamine; Pyridoxine
- Dronabinol
- Edrophonium
- Ephedrine
- Epinephrine
- Erythromycin
- Erythromycin; Sulfisoxazole
- Esketamine
- Estazolam
- Eszopiclone
- Ethanol
- Ethotoin
- Everolimus
- Fedratinib
- Felbamate
- Fentanyl
- Fexofenadine; Pseudoephedrine
- Flecainide
- Flumazenil
- Fluoxetine
- Fluoxetine; Olanzapine
- Fluphenazine
- Flurazepam
- Fosphenytoin
- Gabapentin
- Galantamine
- General anesthetics
- Givosiran
- Goserelin
- Guaifenesin; Hydrocodone
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Guaifenesin; Phenylephrine
- Guaifenesin; Pseudoephedrine
- Guanabenz
- Guanfacine
- Guselkumab
- Haloperidol
- Histrelin
- Homatropine; Hydrocodone
- Hydantoins
- Hydrochlorothiazide, HCTZ; Methyldopa
- Hydrocodone
- Hydrocodone; Ibuprofen
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydromorphone
- Hydroxyzine
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Iloperidone
- Imatinib
- Iohexol
- Iopamidol
- Iopromide
- Ioversol
- Isocarboxazid
- Isoproterenol
- Isosulfan Blue
- Labetalol
- Lasmiditan
- Lemborexant
- Leuprolide
- Leuprolide; Norethindrone
- Levocetirizine
- Levodopa
- Levorphanol
- Linezolid
- Lofexidine
- Loperamide
- Loperamide; Simethicone
- Lopinavir; Ritonavir
- Loratadine; Pseudoephedrine
- Lorazepam
- Loxapine
- Lumateperone
- Lurasidone
- Magnesium Salts
- Maprotiline
- Meclizine
- Meperidine
- Meperidine; Promethazine
- Mephobarbital
- Meprobamate
- Mesoridazine
- Metaxalone
- Methadone
- Methamphetamine
- Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
- Methohexital
- Methyldopa
- Methylene Blue
- Methylphenidate
- Metoclopramide
- Midazolam
- Midodrine
- Minocycline
- Mirabegron
- Mirtazapine
- Molindone
- Monoamine oxidase inhibitors
- Morphine
- Morphine; Naltrexone
- Nabilone
- Nalbuphine
- Naproxen; Pseudoephedrine
- Neostigmine
- Nitroglycerin
- Non-Ionic Contrast Media
- Norepinephrine
- Olanzapine
- Ombitasvir; Paritaprevir; Ritonavir
- Orphenadrine
- Osilodrostat
- Oxazepam
- Oxycodone
- Oxymorphone
- Ozanimod
- Paliperidone
- Paroxetine
- Pentazocine
- Pentazocine; Naloxone
- Pentobarbital
- Perampanel
- Perphenazine
- Perphenazine; Amitriptyline
- Phendimetrazine
- Phenelzine
- Phenobarbital
- Phentermine
- Phentermine; Topiramate
- Phenylephrine
- Phenylephrine; Promethazine
- Phenytoin
- Physostigmine
- Pimozide
- Pramipexole
- Pregabalin
- Prilocaine; Epinephrine
- Primidone
- Procarbazine
- Prochlorperazine
- Promethazine
- Propafenone
- Propoxyphene
- Pseudoephedrine
- Pyridostigmine
- Quazepam
- Quetiapine
- Quinidine
- Quinine
- Rasagiline
- Remifentanil
- Reserpine
- Risperidone
- Ritodrine
- Ritonavir
- Rivastigmine
- Ropinirole
- Safinamide
- Secobarbital
- Sedating H1-blockers
- Selegiline
- Sertraline
- Solifenacin
- St. John’s Wort, Hypericum perforatum
- Succinimides
- Sufentanil
- Tacrine
- Tapentadol
- Temazepam
- Terbinafine
- Thiethylperazine
- Thiopental
- Thioridazine
- Thiothixene
- Thyroid hormones
- Tipranavir
- Tolterodine
- Tramadol
- Tranylcypromine
- Trazodone
- Triazolam
- Tricyclic antidepressants
- Trifluoperazine
- Triprolidine
- Triptorelin
- Trospium
- Zaleplon
- Ziconotide
- Ziprasidone
- Zolpidem
