Inhaled Loxapine for Acute Treatment of Agitation in Patients With Borderline Personality Disorder

Kahl, Kai G.; Negt, Philip; Wollmer, Axel; Jung, Stefanie; Krüger, Tillmann H.C.

doi:10.1097/jcp.0000000000000402

Cited by 11 publications

(8 citation statements)

References 9 publications

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“…Thus, inhaled loxapine is a promising treatment for acute agitation secondary to schizophrenia and bipolar mania. Inhaled loxapine has also been utilized “off-label” in agitated patients with a borderline personality disorder, dual diagnosis (defined as concomitant psychiatric and substance use disorders), weaning from ventilation, electroconvulsive therapy pretreatment, and child and adolescent psychiatric conditions 45–49…”

Section: Discussionmentioning

confidence: 99%

<p>Examining the safety, efficacy, and patient acceptability of inhaled loxapine for the acute treatment of agitation associated with schizophrenia or bipolar I disorder in adults</p>

Faden¹,

Citrome²

2019

NDT

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Agitation is a common and serious symptom of bipolar mania and schizophrenia, and can be defined as excessive motor and verbal activity. If left unrecognized and untreated, agitation can evolve into aggression, resulting in potential patient and staff injury. An ideal treatment for agitation would have a rapid onset, cause calmness without sedation, and be tolerable, efficacious, and non-coercive, while managing the underlying condition. A novel approach for the treatment of agitation is inhaled loxapine. Inhaled loxapine is rapidly absorbed into the systemic circulation through the alveoli, resulting in a near immediate onset of action. The efficacy of inhaled loxapine was established in an extensive clinical development program that included persons with schizophrenia and bipolar mania. Additionally, inhaled loxapine has comparable efficacy to intramuscular ziprasidone, olanzapine, haloperidol, aripiprazole, and lorazepam, with the added benefit of being non-painful and non-traumatizing. Inhaled loxapine carries a bolded black box warning for bronchospasm, and as a result, in the US, requires enrollment in a Risk Evaluation and Mitigation Strategy program, and is contraindicated in those with pulmonary disease. Additionally, the use of inhaled loxapine can be associated with dysgeusia and throat irritation. Inhaled loxapine requires some degree of patient cooperation, and therefore may not be appropriate for all agitated patients.

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Section: Discussionmentioning

confidence: 99%

<p>Examining the safety, efficacy, and patient acceptability of inhaled loxapine for the acute treatment of agitation associated with schizophrenia or bipolar I disorder in adults</p>

Faden¹,

Citrome²

2019

NDT

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“…This article should be analyzed focusing in limitations, especially because it is a small case series and the use of inhaled loxapine as off-label in some cases. Nevertheless, the use of some medications as off-label in psychiatry and SUD is frequent 26 and inhaled loxapine has been administered as off-label in some reports, for example in borderline personality disorder 20 and in dual diagnoses patients. 21 Finally, effectiveness was not evaluated with a standard instrument but only with clinical assessment (considering tranquilization and use of additional medication or doses).…”

Section: Discussionmentioning

confidence: 99%

“… 19 Although, it is important to point out that inhaled loxapine was used as off-label in that report, as has been used in other diagnoses such as borderline personality disorder. 20 …”

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confidence: 99%

Inhaled Loxapine for Agitation in Intoxicated Patients: A Case Series

Roncero¹,

Ros-Cucurull²,

Palma-Álvarez³

et al. 2017

Clin Neuropharm

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ObjectivesEpisodes of agitation are frequent in intoxicated patients who have a substance use disorder, a psychiatric disorder or both (dual diagnosis). For managing the agitation, it is necessary to act promptly in a safe environment and addressing any underlying etiology. Inhaled loxapine improves symptoms of agitation in adults with psychiatric disorders (eg, schizophrenia) within 10 minutes of administration. Recently, some reports have documented the usefulness of loxapine in dual diagnoses patients with agitation. However, the efficacy of loxapine in intoxicated patients has not been deeply addressed.MethodsThis report describes a case series of 12 patients (with addiction or dual disorder) who received inhaled loxapine for symptoms of psychomotor agitation during intoxication with different substances (eg, alcohol, cannabis, or cocaine) at 1 center in Spain.ResultsData from 12 patients were reviewed, 5 patients were attended at the emergency room, 4 at the addiction and dual diagnosis unit, and 3 were treated during hospitalization for detoxification. All patients were under effects of substances. They had substance use disorder (including cannabis, cocaine, alcohol, hypnotics, and hallucinogens), and almost all (90%) presented 1 or more psychiatric disorders. One dose of inhaled loxapine was effective in 9 patients (75%), and in 3 patients, a second dose was required. Only mild dizziness was reported in 1 patient after the second dose.ConclusionsThe acute agitation was effectively and quickly managed with inhaled loxapine in all intoxicated patients and enabled the appropriate clinical evaluation of the agitated state and the patient's management.

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“… 5 , 10 , 13 , 17 , 18 In fact, we observed a rapid and effective response in eight of 10 patients, in some cases occurring well before 10 minutes had passed since administration, in agreement with what has been published in other case series. 19 , 20 …”

Section: Discussionmentioning

confidence: 99%

Inhaled Loxapine for the Treatment of Psychiatric Agitation in the Prehospital Setting: A Case Series

Cester-Martínez¹,

Cortés-Ramas²,

Borraz-Clares³

et al. 2017

CPC-EM

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Rapid and effective control of agitated patients is crucial for ensuring their safety and proper management. We present a case series of 12 agitated psychiatric patients who were suitable for treatment with inhaled loxapine in the prehospital emergency setting. Two refused its administration and two required additional treatment. Loxapine was effective within 2–10 minutes, with no adverse effects or sedation. In our experience the use of inhaled loxapine enabled rapid and non-coercive control of agitation in most psychiatric patients, allowing us to avoid mechanical restraint and injectable drugs, and facilitating the transportation and transfer of the patients.

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Inhaled Loxapine for Acute Treatment of Agitation in Patients With Borderline Personality Disorder

Cited by 11 publications

References 9 publications

<p>Examining the safety, efficacy, and patient acceptability of inhaled loxapine for the acute treatment of agitation associated with schizophrenia or bipolar I disorder in adults</p>

<p>Examining the safety, efficacy, and patient acceptability of inhaled loxapine for the acute treatment of agitation associated with schizophrenia or bipolar I disorder in adults</p>

Inhaled Loxapine for Agitation in Intoxicated Patients: A Case Series

Inhaled Loxapine for the Treatment of Psychiatric Agitation in the Prehospital Setting: A Case Series

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