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A brief summary of loxapine inhalation for rapid tranquillisation: what is its place in practice?

Published online by Cambridge University Press:  22 October 2013

Caroline Parker
Caroline Parker*
Affiliation:
Consultant Pharmacist, Adult Mental Health, Central and North West London NHS Foundation Trust
*
Correspondence to: Dr Caroline Parker, CNWL NHS Foundation Trust, Pharmacy, St Charles Mental Health Unit, Exmoor St, London, W10 6DZ. E-mail: [email protected]
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Abstract

Loxapine has recently been licensed in the UK for the management of mild-to-moderate agitation in adults with schizophrenia or bipolar affective disorder.

Loxapine is a first generation antipsychotic, and although not previously available in the UK, it has been used orally and as an intramuscular injection in some countries for many years. It is now formulated in a single use inhalator.

This is the first newly licensed medicine in the UK for the management of agitation for over five years.

This brief article provides an overview of this new medicine in order to help readers consider its place in regular clinical practice prior to its UK launch.

Keywords

Rapid tranquillisationloxapinebuccalintramuscular
Type
Product Review
Information
Journal of Psychiatric Intensive Care , Volume 10 , Issue 2 , August 2014 , pp. 110 - 114
Copyright
Copyright © NAPICU 2013 

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References

European Medicines Agency (2013) Adasuve (loxapine). EMEA/H/C/002400Google Scholar
Alexander, J., Tharyan, P., Adams, C., John, T., Mol, C., Philip, J. (2004) Rapid tranquillisation of violent or agitated patients in psychiatric emergency setting: pragmatic randomised trial of intramuscular lorazepam versus haloperidol plus promethazine. British Journal of Psychiatry. 185: 63–69.CrossRefGoogle ScholarPubMed
Allen, M.H., Feifel, D., Lesem, M.D., Zimbroff, D.L., Ross, R., Munzar, P., Spyker, D.A., Cassella, J.V. (2011) Efficacy and safety of loxapine for inhalation in the treatment of agitation in patients with schizophrenia: a randomized, double-blind, placebo-controlled trial. Journal of Clinical Psychiatry. 72(10): 1313–1321.CrossRefGoogle ScholarPubMed
Chakrabarti, A., Bagnall, A.M., Chue, P., Fenton, M., Palaniswamy, V., Wong, W., Xia, J. (2007) Loxapine for schizophrenia. The Cochrane Database of Systematic Reviews. (4): CD001943. DOI:10.1002/14651858.CD001943.pub2 Google ScholarPubMed
Eli, Lilly and Co. Ltd. (2013) Zyprexa powder for solution for injection. Summary of product characteristics, last updated 13/06/2013. http://www.medicines.org.uk/emc/medicine/7284 Google Scholar
Huf, G., Coutinho, E.S.F., Adams, C.E., and TREC Collaborative Group (2007) Rapid tranquillisation in psychiatric emergency settings in Brazil: pragmatic randomized controlled trial of intramuscular haloperidol versus intramuscular haloperidol plus promethazine. British Medical Journal. 335(7625): 869–875.CrossRefGoogle ScholarPubMed
Innes, J., Iyeke, L. (2012) A review of the practice and position of monitoring in today's rapid tranquillisation protocols. Journal of Psychiatric Intensive Care. 8(1): 15–24.CrossRefGoogle Scholar
Innes, J., Sethi, F. (2013) Current rapid tranquillisation documents in the UK: a review of the drugs recommended, their routes of administration and clinical parameters influencing their use. Journal of Psychiatric Intensive Care. 8(2): 110–118.CrossRefGoogle Scholar
Janssen-Cilag Ltd. (2011) Haldol Injection. Summary of product characteristics, last updated 22/11/2011. http://www.medicines.org.uk/emc/medicine/7267/spc Google Scholar
Keating, G. (2013) Loxapine inhalation powder: a review of its use in the acute treatment of agitation in patients with bipolar disorder or schizophrenia. CNS Drugs. 27: 479–489.CrossRefGoogle ScholarPubMed
Kwentus, J., Riesenberg, R.A., Marandi, M., Manning, R.A., Allen, M.H., Fishman, R.S., Spyker, D.A., Kehne, J.H., Cassella, J.V. (2012) Rapid acute treatment of agitation in patients with bipolar I disorder: a multicenter, randomized, placebo-controlled clinical trial with inhaled loxapine. Bipolar Disorder. 14(1): 31–40.CrossRefGoogle ScholarPubMed
Lesem, M.D., Tran-Johnson, T.K., Riesenberg, R.A., Feifel, D., Allen, M.H., Fishman, R., Spyker, D.A., Kehne, J.H., Cassella, J.V. (2011) Rapid acute treatment of agitation in individuals with schizophrenia: multicentre, randomised, placebo-controlled study of inhaled loxapine. British Journal of Psychiatry. 198(1): 51–58.CrossRefGoogle ScholarPubMed
Loynes, B., Innes, J., Dye, S. (2013) Assessment of physical health monitoring following rapid tranquillisation: a national survey. Journal of Psychiatric Intensive Care. 9(2): 85–90.CrossRefGoogle Scholar
National Institute for Clinical Excellence (2005) Violence: The short term management of disturbed and violent behaviour in inpatient psychiatric settings and emergency departments. Clinical Guideline 25. NICE, 83pp. http://www.nice.org.uk/guidance/CG25 Google Scholar
National Institute for Health Care Excellence (2013) Loxapine inhalation for treating acute agitation and disturbed behaviours associated with schizophrenia and bipolar disorder (terminated appraisal). Technology Appraisal 286. NICE, 4 pp. http://guidance.nice.org.uk/TA286/Guidance/pdf/English Google Scholar
Pereira, S., Paton, C., Walkert, L.M., Shaw, S., Gray, R., Wildgust, H. (2005) Treatment of acute behavioural disturbance: a UK national survey of rapid transquillistaion. Journal of Psychiatric Intensive Care. 1(2): 84–88.CrossRefGoogle Scholar
Raveendran, N.S., Tharyan, P., Alexander, J., Adams, C.E. (2007) Rapid tranquillisation in psychiatric emergency settings in India: pragmatic randomised controlled trial of intramuscular olanzapine versus intramuscular haloperidol plus promethazine. British Medical Journal. 335(7625): 865–872.CrossRefGoogle ScholarPubMed
Taylor, D., Paton, C., Kapur, S. (2012) The Maudsley Prescribing Guidelines in Psychiatry, 11th edition. London: Wiley-Blackwell.Google Scholar
UKMi (2013) Inhaled loxapine (Adasuve®) for agitation associated with schizophrenia and bipolar disorder. London: New Drugs Group, APC/DTC Briefing document, February 2013. http://www.medicinesresources.nhs.uk/upload/Loxapine_Feb20132.pdf Google Scholar
Wright, P., Birkett, M., David, S.R., Meehan, K., Ferchland, I., Alaka, K.J., Saunders, J.C., Krueger, J., Bradley, P., San, L., Bernardo, M., Reinstein, M., Breier, A. (2001) Double-blind, placebo-controlled comparison of intramuscular olanzapine and intramuscular haloperidol in the treatment of acute agitation in schizophrenia. American Journal of Psychiatry. 158(7): 1149–1151.CrossRefGoogle ScholarPubMed