|
amoxapine Classification |
| ROUTE | ONSET | PEAK | DURATION |
| PO | within 1–2 wk | 2–6 wk | days–wks |
Monitor mental status and affect. Assess for suicidal tendencies, especially during early therapy. Restrict amount of drug available to patient.Monitor blood pressure and pulse before and during initial therapy. Notify physician or other health care professional of decreases in blood pressure (10–20 mmHg) or sudden increase in pulse rate. Patients taking high doses or with a history of cardiovascular disease should have ECG monitored before and periodically during therapy.Observe for onset of extrapyramidal side effects (akathisia—restlessness; dystonia—muscle spasms and twisting motions; pseudoparkinsonism—mask facies, rigidity, tremors, drooling, shuffling gait, dysphagia, pill-rolling motions). Dose reduction or discontinuation may be necessary. Trihexyphenidyl or diphenhydramine may be used to control these symptoms.Monitor for tardive dyskinesia (lip smacking or puckering, puffing of cheeks, rhythmic chewing or worm-like movement of tongue and mouth, uncontrolled movements of extremities). Notify physician or other health care professional immediately if these symptoms occur; they may be irreversible. Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, convulsions, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control). Notify physician or other health care professional immediately if these symptoms occur.Lab Test Considerations:
May cause ↑ serum prolactin levels
Monitor CBC and differential during chronic therapy. May rarely cause bone marrow suppression.In chronic therapy, periodically monitor hepatic and renal function. Serum glucose may be ↑ or ↓.Dose increases should be made at bedtime because of sedation. Dosage titration is a slow process; may take weeks to months. May give entire dose (if <300 mg) at bedtime, when dose is stabilized.PO: Administer medication with or immediately after a meal to minimize gastric irritation.Instruct patient to take medication as directed. Abrupt discontinuation may cause nausea, headache, and malaise.Inform patient of the possibility of extrapyramidal symptoms and tardive dyskinesia. Instruct patient to report these symptoms immediately.May cause drowsiness and blurred vision. Caution patient to avoid driving and other activities requiring alertness until response to drug is known.Orthostatic hypotension, sedation, and confusion are common during early therapy, especially in geriatric patients. Protect patient from falls and advise patient to make position changes slowly.Advise patient to avoid alcohol or other CNS depressant drugs during and for 3–7 days after therapy.Instruct patient to notify health care professional if dry mouth or constipation persists or if urinary retention, uncontrolled movements, or rigidity occur. Sugarless candy or gum may diminish dry mouth, and an increase in fluid intake or bulk may prevent constipation. If these symptoms persist, dosage reduction or discontinuation may be necessary. Consult health care professional if dry mouth persists for more than 2 wk.Advise patient to inform health care professional if breast enlargement or sexual dysfunction occurs.Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.Inform patient to monitor dietary intake. Increased appetite may lead to undesired weight gain.Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.Advise patient to notify health care professional of medication regimen before treatment or surgery.Therapy for depression is usually prolonged. Emphasize the importance of follow-up exams to monitor effectiveness and side effects.Increased sense of well-being
Renewed interest in surroundings.Increased appetite.Improved energy level.Improved sleep.Decreased anxiety. Initial response may be noted in 4–7 days in some patients. Most patients respond within 2 wk.