Alfentanil
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Drug reference
Loxapine
First-generation antipsychotic (tricyclic dibenzoxazepine) · Antipsychotic
START
Oral 10 mg PO twice daily; inhaled 10 mg single dose in clinic
TYPICAL MAX
250 mg/day oral; 10 mg per 24 h inhaled
STOP IF
Bronchospasm (inhaled), NMS, or significant QT/EPS
WATCH
Pulmonary status (inhaled), EPS/TD, ECG, prolactin
CDSCO approvedSchedule HATC N05AH01
KDIGO 2024 + manufacturer label
- ONSET
- 3min · inhaled onset
- PEAK
- 30min · inhaled Cmax
- t½
- 4h · t½
- DURATION
- 12h · BID dosing
EXCRETION
Renal metabolites and faecal
route + CYP
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
Use only if benefit outweighs risk; EPS/neonatal effects possible in 3rd trimester.
FDA category + note
Top interactionssee all 12 →
- AlfentanilSevereDatabaseDDInter
- BenzhydrocodoneSevereDatabaseDDInter
- BuprenorphineSevereDatabaseDDInter
- BupropionSevereDatabaseDDInter
Mechanism
D2/D1 dopamine and 5-HT2A serotonin receptor antagonist (with H1, alpha-1, muscarinic activity), reducing positive psychotic symptoms; inhaled loxapine acts rapidly via lung absorption.
Indications
Schizophrenia (oral)Acute agitation associated with schizophrenia / bipolar I disorder (inhaled)
Dosing
- Adult
- Oral: 10 mg PO twice daily; titrate to 20–60 mg/day (max 250 mg/day). Inhaled (agitation): 10 mg single dose by oral inhalation; one dose per 24 h, only in healthcare setting.
- Pediatric
- Not established (inhaled).
- Renal adjustment
- No specific adjustment.
- Hepatic adjustment
- Reduce dose in significant hepatic impairment.
- Geriatric
- Avoid (Beers — antipsychotic mortality in dementia).
- Max dose
- 250 mg/day (oral); 10 mg per 24 h (inhaled)
Pharmacokinetics
Onset
Oral 20–30 min; inhaled within 2 min
Peak effect
Oral ~2 h; inhaled ~2 min
Duration
~12 h (oral)
Half-life
~4 h (parent); active metabolites longer
Bioavailability
Inhaled ~91% systemic; oral ~30%
Protein binding
High
Metabolism
Hepatic CYP1A2/CYP2D6/CYP3A4
Excretion
Renal (metabolites) and faecal
Contraindications
- Comatose state / severe CNS depression
- Acute asthma / COPD (inhaled — bronchospasm risk)
- Hypersensitivity
- Caution: dementia-related psychosis (boxed mortality warning)
Side effects
Common
SedationExtrapyramidal symptomsDizzinessDry mouthThroat irritation (inhaled)
Serious
- Severe bronchospasm (inhaled — boxed)
- Neuroleptic malignant syndrome
- Tardive dyskinesia
- QT prolongation
- Increased mortality in elderly dementia (boxed)
- Hyperprolactinaemia
Pregnancy & lactation
Pregnancy
Use only if benefit outweighs risk; EPS/neonatal effects possible in 3rd trimester.
Lactation
Excreted in milk; caution (monitor infant).
Drug interactions
Benzhydrocodone
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Buprenorphine
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Bupropion
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Butorphanol
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Clozapine
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Codeine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Deutetrabenazine
Severe
Database
Clinical effect not specified
Source: DDInter
Dextropropoxyphene
Severe
Database
Clinical effect not specified
Source: DDInter
Dezocine
Severe
Database
Clinical effect not specified
Source: DDInter
Dihydrocodeine
Severe
Database
Clinical effect not specified
Source: DDInter
Fentanyl
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Related guidelines
Ask House about Loxapine
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung, BNF·Verified: 2026-05-20 · House clinical team·Cockpit curated: 2026-05-20