Effectiveness of Inhaled Loxapine in Dual-Diagnosis Patients: A Case Series

Roncero, Carlos; Ros-Cucurull, Elena; Grau-López, Lara; Fadeuilhe, Christian; Casas, Miguel

doi:10.1097/wnf.0000000000000153

Cited by 14 publications

(18 citation statements)

References 11 publications

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“…However, benzodiazepines use may lead to several side effects along with the strong sedation, hypotension, include respiratory depression, while typical antipsychotics cause dysphoria, acute dystonia, and akathisia. Recently, a few studies have reported that atypical antipsychotics such as Olanzapine, Ziprasidone, and Loxapine are more effective for treating acute crisis in BPD patients presenting to the ED ( 24 – 29 ). Intramuscular administration of single dose of olanzapine resulted in fast reduction of agitation in BPD patients and was tolerated well, with only 16% of patients requiring a second dose ( 25 ).…”

Section: Crisis Intervention In the Eds And Beyondmentioning

confidence: 99%

“…Roncero and colleagues have shown the effectiveness of lopaxine in managing agitation in the emergency. In their study, inhalation of a single dose of lopaxine (9.1 mg) was enough to calm the acutely agitated patients ( 29 ). Prescribing mood stabilizers for managing agitation in BPD patients is highly discouraged by many studies ( 27 , 30 ).…”

Section: Crisis Intervention In the Eds And Beyondmentioning

confidence: 99%

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Patients with Borderline Personality Disorder in Emergency Departments

et al. 2017

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Borderline personality disorder (BPD) patients, when in crisis, are frequent visitors of emergency departments (EDs). When these patients exhibit symptoms such as aggressiveness, impulsivity, intense anxiety, severe depression, self-harm, and suicidal attempts or gestures, diagnosis, and treatment of the BPD becomes challenging for ED doctors. This review will, therefore, outline advice to physicians and health-care providers who face this challenging patient population in the EDs. Crisis intervention should be the first objective of clinicians when dealing with BPD in the emergency. For the patients with agitation, symptom-specific pharmacotherapy is usually recommended, while for non-agitated patients, short but intensive psychotherapy especially dialectical behavior therapy (DBT) has a positive effect. Although various psychotherapies, either alone or integrated, are preferred modes of treatment for this group of patients, the effects of psychotherapies on BPD outcomes are small to medium. Proper risk management along with developing a positive attitude and empathy toward these patients will help them in normalizing in an emergency setting after which treatment course can be decided.

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Section: Crisis Intervention In the Eds And Beyondmentioning

confidence: 99%

Section: Crisis Intervention In the Eds And Beyondmentioning

confidence: 99%

Patients with Borderline Personality Disorder in Emergency Departments

et al. 2017

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“…Moreover, two open label case series, on five agitated patients with borderline personality disorder (BPD) [55] and 14 agitated patients with dual diagnosis [56], showed that inhaled loxapine 10 mg was rapid, effective, and well-accepted in both groups, without adverse effects (AEs).…”

Section: Overview Of Inhaled Loxapinementioning

confidence: 99%

“…Moreover, the delivery of inhaled loxapine directly into the lung has several potential advantages. These include a rapid onset of the anti-agitation effect (within a couple of minutes, generally 10), and a less invasive and needle-free systemic delivery of drugs [48,52,53,54,55,56]. Furthermore, the inhaled formulation of loxapine avoids transit through the gastrointestinal system and, therefore, the hepatic first-pass metabolism achieves a bioavailability of 9.1 mg of the 10 mg dose [25].…”

Section: A Clinical Perspective On the Role Of Inhaled Loxapine Inmentioning

confidence: 99%

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The Role of Inhaled Loxapine in the Treatment of Acute Agitation in Patients with Psychiatric Disorders: A Clinical Review

Berardis

Fornaro

Orsolini

et al. 2017

IJMS

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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.

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Schizophrenia and Related Psychoses

2021

The Maudsley Prescribing Guidelines in Psychiatry

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Despite disagreements about nomenclature, patients who develop schizophrenic or schizophrenialike symptoms in later life are often seen in clinical practice. Questions about the etiology of late-life psychotic disorders and about their similarities or differences from early-onset disorders remain unanswered. Neuroimaging techniques have been used to study patients with late onset of psychosis, and in substantial subgroups of patients (from 25% to 100% in various studies) compared with agematched control subjects, structural and functional abnormalities have been found. We review the literature on imaging in late-life schizophrenia and related psychotic disorders, and we present data from our own investigations of patients with these disorders. We discuss the potential usefulness of imaging evaluations in patients with late-onset disorders, and we offer suggestions for future investigations.

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Effectiveness of Inhaled Loxapine in Dual-Diagnosis Patients: A Case Series

Abstract: Inhaled loxapine was rapid, effective, and well accepted in all dual-pathology patients presenting with acute agitation in the emergency setting. Inhaled loxapine facilitated both patient cooperation and an adequate management of his or her disease.

Cited by 14 publications

References 11 publications

Patients with Borderline Personality Disorder in Emergency Departments

Patients with Borderline Personality Disorder in Emergency Departments

The Role of Inhaled Loxapine in the Treatment of Acute Agitation in Patients with Psychiatric Disorders: A Clinical Review

Schizophrenia and Related Psychoses

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