loxapine

Antipsychotic • Brands: Loxitane, Adasuve

Last reviewed: 2025-12-29

General information

Class: Antipsychotic
Common US brands: Loxitane, Adasuve
Typical dose range: Oral: start 10 mg BID; titrate to 60–100 mg/day divided (max 250 mg/day).
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-29

Dosing & forms

Forms/strengths: Oral capsules: 5–50 mg; oral concentrate 5 mg/mL.; Inhaled powder (Adasuve) 10 mg single-use device.
Frequency: Oral: start 10 mg BID; titrate to 60–100 mg/day divided (max 250 mg/day).
Typical range: Oral: start 10 mg BID; titrate to 60–100 mg/day divided (max 250 mg/day).

Mechanism (brief)

Mid-potency typical antipsychotic antagonizing dopamine D2 and serotonin 5-HT2A receptors with additional H1 and M1 blockade.

Metabolism & Half‑life

Metabolism: CYP1A2, CYP3A4, CYP2D6
Half‑life: Single-dose mean 6 h; Steady-state mean 8 h

Therapeutic Drug Monitoring (TDM)

Recommended: No

View labelExact

Monitoring highlights

Baseline airway screening (asthma/COPD history, active wheeze) before inhaled dosing; avoid Adasuve when bronchospasm risk is present.
Post-inhalation observation ≥1 hour with pulse oximetry and rescue bronchodilator immediately available; document respiratory symptoms and response.
EPS monitoring during titration and AIMS screening every 3–6 months for tardive dyskinesia, especially with long-term oral use.
Weight/BMI and metabolic labs at baseline and periodically, even if risk is lower than olanzapine; sedation and appetite changes still affect weight.
Orthostatic vitals and falls risk during initiation and after dose increases; adjust dose timing to bedtime when dizziness or sedation is problematic.
ECG monitoring when cardiac risk factors or QT-active co-medications are present.

Sources

Loxapine Hydrochloride Prescribing Information — DailyMed (2025)
Adasuve (loxapine inhalation powder) REMS — FDA (2019)
Triple advantages of injectable long acting second generation antipsychotics: relapse prevention, neuroprotection, and lower mortality — Schizophrenia Research (2018)
The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia — American Psychiatric Association (2020)

Monitoring highlights

Baseline airway screening (asthma/COPD history, active wheeze) before inhaled dosing; avoid Adasuve when bronchospasm risk is present.

Post-inhalation observation ≥1 hour with pulse oximetry and rescue bronchodilator immediately available; document respiratory symptoms and response.

EPS monitoring during titration and AIMS screening every 3–6 months for tardive dyskinesia, especially with long-term oral use.

Weight/BMI and metabolic labs at baseline and periodically, even if risk is lower than olanzapine; sedation and appetite changes still affect weight.

Orthostatic vitals and falls risk during initiation and after dose increases; adjust dose timing to bedtime when dizziness or sedation is problematic.

ECG monitoring when cardiac risk factors or QT-active co-medications are present.