Loxapine

Key facts

• Loxapine (sold as Loxitane) is a first-generation (typical) antipsychotic taken by mouth, usually once or twice a day, for schizophrenia.
• Effects on hallucinations, delusions and agitation build over days to weeks; it is not a fast-acting sedative.
• It can trigger neuroleptic malignant syndrome (NMS), a rare but life-threatening reaction with high fever and severe muscle rigidity, and long-term use can cause tardive dyskinesia, a movement disorder that may be permanent.
• Seek urgent care for high fever with muscle stiffness, uncontrollable movements, or fainting.

What loxapine treats

Loxapine treats schizophrenia, a psychotic disorder involving hallucinations, delusions and disorganized thinking. It is sometimes used for agitation linked to other psychiatric conditions. It is not approved for dementia-related psychosis in older adults, and it does not calm everyday anxiety the way a short-acting sedative would.

How loxapine works

Loxapine blocks dopamine D2 receptors in the brain, reducing the overactive dopamine signaling that drives hallucinations and delusions in psychosis. It also blocks some serotonin and histamine receptors, which adds to its calming and sedating effects.

Before you take it

• Do not take loxapine if you have severe central nervous system depression or a known allergy to it.
• Tell your prescriber about heart rhythm problems, seizures, Parkinson's disease, low blood pressure, or a history of NMS.
• Older adults with dementia-related psychosis should generally avoid loxapine: antipsychotics as a class raise the risk of death in this group.
• Alcohol and other sedating drugs add to drowsiness and increase fall risk.

Side effects

Common effects include drowsiness, dizziness on standing, dry mouth, constipation and weight gain.

Stop and seek urgent medical care for:

• High fever, severe muscle stiffness, confusion or an irregular heartbeat, which can signal NMS.
• Uncontrollable movements of the face, tongue or limbs, which can signal tardive dyskinesia.
• Fainting, or a fast or irregular heartbeat.
• Signs of a serious allergic reaction: facial swelling, rash, or difficulty breathing.

Safety essentials

• Loxapine can cause NMS and movement disorders such as tremor, rigidity and tardive dyskinesia; report any new muscle stiffness or fever right away, since tardive dyskinesia can be permanent even after stopping.
• It is not approved for dementia-related psychosis in older adults, a group in which antipsychotics increase the risk of death.
• Stand up slowly from sitting or lying down to reduce dizziness from low blood pressure.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.