Loxapine Treatment in an Autistic Child with Aggressive Behavior: Therapeutic Challenges

Reinblatt, Shauna P.; Abanilla, P. Karen; Jummani, Rahil; Coffey, Barbara J.

doi:10.1089/cap.2006.16.639

Cited by 11 publications

(11 citation statements)

References 12 publications

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“…Although data supports the use of haloperidol as an efficacious treatment of aggression in autistic disorder [ 51 - 54 ], the empirical data is less clear regarding the utility of the other typical antipsychotics in this patient population. Only anecdotic reports suggest anti-aggressive effects of loxapine [ 55 ] and amoxapine in autistic children [ 56 ], but there is a clear need for additional research in autistic and other psychiatric populations.…”

Section: Resultsmentioning

confidence: 99%

Revisiting loxapine: a systematic review

2015

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Loxapine is an antipsychotic used in psychiatry for over 40 years with a well-established profile. Loxapine is a dibenzoxazepine tricyclic antipsychotic agent, available for oral, intramuscular and inhalatory administration. In the light of the recent approval by the regulatory agencies of inhaled loxapine for use in the acute treatment of mild-to-moderate agitation in adults affected with schizophrenia or bipolar disorder, this article aims to critically review the available literature on loxapine, irrespective of its formulation.This review examines the efficacy and tolerability of the various formulations of loxapine in the treatment of agitation and aggression in patients affected with schizophrenia, bipolar disorder and other psychiatric conditions.A comprehensive and systematic literature search of PubMed/MEDLINE was conducted, and relevant pharmacodynamic and pharmacokinetic data was included. The findings from the literature were critically reviewed and synthesized.The available data suggests that the antipsychotic efficacy of loxapine is similar to the efficacy of other typical or atypical antipsychotics, with an adverse effects profile comparable to that of the typical antipsychotics at high doses for chronic treatment. As an acute treatment in agitation associated with schizophrenia or bipolar disorder, inhaled loxapine was developed as an innovative and rapid option which appears to be efficacious and tolerable.Electronic supplementary materialThe online version of this article (doi:10.1186/s12991-015-0053-3) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Revisiting loxapine: a systematic review

2015

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“…First, we did not search grey literature (e.g., dissertations, reports, newsletters) which can be a component of scoping reviews (Paez, (Mahood et al, 2014). Two of the extracted publications (Reinblatt et al, 2006;Wolfberg, 1993) are published conference proceedings and could be argued to represent grey literature. Mahood et al, (2014) suggest that peer-reviewed conference proceedings that appear in commercial publications can be considered peerreviewed literature.…”

Section: Limitations Of the Current Reviewmentioning

confidence: 99%

“…There were no direct relationships found across the interventions implemented in these studies. Moodley (1992) outlined Nandi!s diagnostic process for Rett syndrome and Reinblatt et al (2006) and Wolfberg (1993), featuring A and Teresa, respectively, focused on interventions.…”

Section: Relationships Across Publicationsmentioning

confidence: 99%

Missing from the Narrative: A Seven-Decade Scoping Review of the Inclusion of Black Autistic Women and Girls in Autism Research

Lovelace¹,

Comis²,

Tabb³

et al. 2021

Behav Analysis Practice

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The intersectional experiences of Black Autistic women and girls (BAWG) are missing from medical and educational research on autism spectrum disorder (ASD). Understanding the intersectional experiences of BAWG is important due to the rising prevalence of autism in Black children and girls (CDC, 2016) and the concurrent lack of availability of culturally relevant autism-related interventions (Maenner, 2020;West, 2016). Intersectionality is the study of the overlapping discrimination produced by systems of oppression (Collins, 2019;Crenshaw, 1989;1991) and allows the researcher to simultaneously address race and disability in special education (Artiles, 2013). In this scoping review, the authors used the PRISMA-ScR checklist (Tricco et al., 2018) and Arksey and O!Malley!s ( 2005) framework to investigate the degree to which autism-related research (ARR) has included the intersectional experiences of BAWG. Utilizing narrative synthesis, strengths and gaps across the current body of literature are identified in order to set new directions for intersectional ARR. Overall, the authors found that across a 77-year period, three studies foregrounded BAWG and none addressed intersectionality as measured through criteria advanced by García and Ortiz (2013). These results reveal the scholarly neglect BAWG face in ARR, discourse, policy, and practice. A future agenda including research, practice, and policy priorities is identified and discussed.

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“…Whereas extrapyramidal side effects and tardive dyskinesia are dose-related adverse events of typical antipsychotics including loxapine in conventional doses, the study doses were low in comparison, notably 5-15 mg/day. Only one published case report exists in the literature so far, describing successful loxapine treatment of a 10-year-old African American girl with autistic disorder and treatment-resistant aggression who showed response to a low dose of 15 mg/day (Reinblatt et al 2006). Mean subject BMI-Z decreased significantly between weeks 6 and 12 while all medication doses were held constant.…”

Section: Loxapine Add-on For Irritability In Autismmentioning

confidence: 99%

Loxapine Add-on for Adolescents and Adults with Autism Spectrum Disorders and Irritability

Hellings

Reed

Cain

et al. 2015

Journal of Child and Adolescent Psychopharmacology

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Objectives: Our clinical experience with low dose loxapine (5-15 mg/day) suggests promising efficacy and safety for irritability in autism spectrum disorders (ASD). We studied low dose loxapine prospectively in adolescents and adults with ASD and irritability. Additionally, we measured loxapine and metabolite concentrations, and brain-derived neurotrophic factor (BDNF) as a biomarker of neuromodulation. Methods: We performed a 12 week open trial of add-on loxapine in subjects, ages 13-65 years, diagnosed with ASD, and Aberrant Behavior Checklist-Irritability (ABC-I) subscale scores >14. Loxapine was dosed flexibly up to 15 mg daily, starting with 5 mg on alternate days. From weeks 1 to 6, other psychoactive medications were tapered if possible; from weeks 6 to 12, all medication doses were held stable. The primary outcome was the Clinical Global Impressions-Improvement subscale (CGI-I), ratings of Much Improved or Very Much Improved. Secondary outcomes were the ABC-I, Repetitive Behavior Scale-Revised, and Schalock Quality of Life scale. Serum BDNF and loxapine and metabolite concentrations were assayed. BDNF rs6265 was genotyped. Results: Sixteen subjects were enrolled; 12 completed all visits. Median age was 18 years (range 13-39). Median final loxapine dose was 7.5 mg/day (2.5-15). All 14 subjects (100%) with data at week 12 were rated as Much Improved on CGI-I at 12 weeks. Mean change on ABC-I at 12 weeks was -31%, p = 0.01. Mean body mass index (BMI)-Z decreased between weeks 6 and 12, p = 0.03. Side effects were minimal, and prolactin elevation occurred in only one subject. BDNF concentrations measured in 11 subjects increased significantly ( p = 0.04). Subjects with AG genotype for BDNF rs6265 required a lower dose of loxapine at study end, but had similar behavioral and BDNF concentration changes as the GG genotype.Conclusions: Low dose loxapine shows promise as a repurposed drug for irritability in ASD. Loxapine effects on BDNF warrant further study.

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Loxapine Treatment in an Autistic Child with Aggressive Behavior: Therapeutic Challenges

Cited by 11 publications

References 12 publications

Revisiting loxapine: a systematic review

Revisiting loxapine: a systematic review

Missing from the Narrative: A Seven-Decade Scoping Review of the Inclusion of Black Autistic Women and Girls in Autism Research

Loxapine Add-on for Adolescents and Adults with Autism Spectrum Disorders and Irritability

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