Amoxapine

INTRODUCTION

Indications

Treatment of various types of depression. Unlabeled Use: Anxiety, insomnia, neuropathic and chronic pain syndromes.

Action

Potentiates the effects of serotonin and norepinephrine in the CNS. Has significant anticholinergic properties. Also has antianxiety effect related to sedative properties. Therapeutic Effects: Antidepressant and antianxiety action.

Adverse Reactions/Side Effects

CNS: NEUROLEPTIC MALIGNANT SYNDROME, fatigue, sedation, extrapyramidal reactions, tardive dyskinesia. EENT: blurred vision, dry eyes, dry mouth. CV: ARRHYTHMIAS, hypotension, ECG changes. GI: constipation, increased appetite, weight gain, paralytic ileus. GU: testicular swelling, urinary retention. Derm: photosensitivity, rash. Endo: gynecomastia, sexual dysfunction. Hemat: blood dyscrasias. Misc: fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Watch for signs of neuroleptic malignant syndrome, including hyperthermia, diaphoresis, generalized muscle rigidity, altered mental status, tachycardia, changes in blood pressure (BP), and incontinence. Symptoms typically occur within 4–14 days after initiation of drug therapy, but can occur at any time during drug use. Report these signs to the physician immediately.

• Be alert for increased depression, especially in the initial period of drug therapy, and in children and teenagers. Notify physician immediately if patient exhibits signs of worsening depression or expresses thoughts of suicide.

• Assess motor function, and be alert for extrapyramidal symptoms. Report these symptoms immediately, especially tardive dyskinesia, because this problem may be irreversible. Common extrapyramidal symptoms include:

  • Tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities, lip smacking or puckering, puffing of cheeks, uncontrolled chewing, rapid or worm-like movements of tongue).

  • Pseudoparkinsonism (shuffling gait, rigidity, tremor, pill-rolling motion, loss of balance control, difficulty speaking or swallowing, mask-like face)

  • Akathisia (restlessness or desire to keep moving)

  • Other dystonias and dyskinesias (dystonic muscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs)

• If used to treat chronic pain, assess pain levels periodically to help determine drug efficacy.

• Measure blood pressure periodically, and compare to normal values (See Appendix F). Report low BP (hypotension), especially if patient experiences dizziness or syncope.

• Watch for signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, and bleeding gums), or unusual weakness and fatigue that might be due to anemia or other blood dyscrasias. Report these signs to the physician.

• Report excessive sedation and fatigue, especially in older adults. Determine if these side effects might impair gait, balance, and other functional activities.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight gain or increased body fat.

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