TY - JOUR
T1 - The Role of Inhaled Loxapine in the Treatment of Acute Agitation in Patients with Psychiatric Disorders
T2 - A Clinical Review
AU - de Berardis, Domenico
AU - Fornaro, Michele
AU - Orsolini, Laura
AU - Iasevoli, Felice
AU - Tomasetti, Carmine
AU - de Bartolomeis, Andrea
AU - Serroni, Nicola
AU - Valchera, Alessandro
AU - Carano, Alessandro
AU - Vellante, Federica
AU - Marini, Stefano
AU - Piersanti, Monica
AU - Perna, Giampaolo
AU - Martinotti, Giovanni
AU - Di Giannantonio, Massimo
PY - 2017/2
Y1 - 2017/2
N2 - Loxapine is a first generation antipsychotic, belonging to the dibenzoxazepine class. Recently, loxapine has been reformulated at a lower dose, producing an inhaled powder that can be directly administered to the lungs to treat the agitation associated with psychiatric disorders, such as schizophrenia and bipolar disorder. Thus, the aim of this narrative and clinical mini-review was to evaluate the efficacy and tolerability of inhaled loxapine in the treatment of acute agitation in patients with psychiatric disorders. The efficacy of inhaled loxapine has been evaluated in one Phase II trial on patients with schizophrenia, and in two Phase III trials in patients with schizophrenia and bipolar disorder. Moreover, there are two published case series on patients with borderline personality disorder and dual diagnosis patients. Inhaled loxapine has proven to be effective and generally well tolerated when administered to agitated patients with schizophrenia and bipolar disorder. Two case series have suggested that inhaled loxapine may also be useful to treat agitation in patients with borderline personality disorder and with dual diagnosis, but further studies are needed to clarify this point. However, the administration of inhaled loxapine requires at least some kind of patient collaboration, and is not recommended in the treatment of severe agitation in totally uncooperative patients. Moreover, the drug-related risk of bronchospasm must always be kept in mind when planning to use inhaled loxapine, leading to a careful patient assessment prior to, and after, administration. Also, the higher costs of inhaled loxapine, when compared to oral and intramuscular medications, should be taken into account when selecting it for the treatment of agitation.
AB - Loxapine is a first generation antipsychotic, belonging to the dibenzoxazepine class. Recently, loxapine has been reformulated at a lower dose, producing an inhaled powder that can be directly administered to the lungs to treat the agitation associated with psychiatric disorders, such as schizophrenia and bipolar disorder. Thus, the aim of this narrative and clinical mini-review was to evaluate the efficacy and tolerability of inhaled loxapine in the treatment of acute agitation in patients with psychiatric disorders. The efficacy of inhaled loxapine has been evaluated in one Phase II trial on patients with schizophrenia, and in two Phase III trials in patients with schizophrenia and bipolar disorder. Moreover, there are two published case series on patients with borderline personality disorder and dual diagnosis patients. Inhaled loxapine has proven to be effective and generally well tolerated when administered to agitated patients with schizophrenia and bipolar disorder. Two case series have suggested that inhaled loxapine may also be useful to treat agitation in patients with borderline personality disorder and with dual diagnosis, but further studies are needed to clarify this point. However, the administration of inhaled loxapine requires at least some kind of patient collaboration, and is not recommended in the treatment of severe agitation in totally uncooperative patients. Moreover, the drug-related risk of bronchospasm must always be kept in mind when planning to use inhaled loxapine, leading to a careful patient assessment prior to, and after, administration. Also, the higher costs of inhaled loxapine, when compared to oral and intramuscular medications, should be taken into account when selecting it for the treatment of agitation.
KW - loxapine
KW - inhaled
KW - agitation
KW - schizophrenia
KW - bipolar disorder
KW - antipsychotics
KW - efficacy
KW - tolerability
KW - THERMALLY GENERATED AEROSOL
KW - TYPICAL ANTIPSYCHOTIC-DRUGS
KW - RAPID ACUTE TREATMENT
KW - BIPOLAR DISORDER
KW - PREFRONTAL CORTEX
KW - IN-VITRO
KW - HYDROXYLATED METABOLITES
KW - STACCATO(R) LOXAPINE
KW - HEALTHY-VOLUNTEERS
KW - INHALATION POWDER
U2 - 10.3390/ijms18020349
DO - 10.3390/ijms18020349
M3 - (Systematic) Review article
C2 - 28208695
SN - 1422-0067
VL - 18
JO - International journal of molecular sciences
JF - International journal of molecular sciences
IS - 2
M1 - 349
ER -