Posted by med_empowered on September 20, 2005, at 19:08:02
In reply to Starting new drug - Loxapine, posted by ICanFlyButterfly on September 19, 2005, at 22:10:20
hey! Loxapine is one of the older ("conventional") antipsychotics (the new ones are called "atypicals"). ALL antipsychotics can cause tardive dyskinesia, which is a syndrome of uncontrollable movements (usually in the face, but sometimes elsewhere in the body). Tardive Dyskinesia sometimes goes away after the drug is withdrawn, but that can sometimes take years, and the syndrome is often permanent. The new antipsychotics, like Zyprexa, can cause tardive dyskinesia, but they tend to do so less often than the older drugs. To put in perspective, a 1980 study found that, for patients taking antipsychotics (the old ones), about 3% would develop tardive dyskinesia a year; at the end of 5 years, this jumped to a total of 20% with the disorder, and after long-term treatment (25years+), the numbers for TD were above 50%. Keep in mind that tardive dyskinesia can vary in severity; some people don't even notice that they have it and its minimal; some have more pronounced symptoms, and some people are crippled by tardive dyskinesia or a related disorder, tardive dystonia (uncontrollable muscle movements; some people are confined to a wheel chair b/c of this). Some studies also show that tardive dyskinesia is associated with overall cognitive decline; patients with tardive dyskinesia are often shown to have much more cognitive impairment and overall decline in performance than those who are never given antipsychotics or those who are but do not develop tardive dyskinesia. Loxapine is one of the older drugs, and it has caused TD, and it would probably be wise to just apply the 3%/year statistic to it. Your risk of TD may be higher if you are: very young, elderly, female, have depression, bipolar, or another mood-disorder, and if you experience severe negative reactions to loxapine early on it treatment OR are sensitive to antipsychotics in general. Tardive dyskinesia also seems to be affected by dosage and duration of treatment; the higher the dosage, the longer the treatment, the higher the risk of developing tardive dyskinesia. Keep in mind also that there are other side-effects from antipsychotics to consider--akathisia, which is a sense of inner-restlesness and turmoil, often occurs, and is also characterized by uncontrolled movements (in some people, tardive akathisia may develop, which may not respond to any sort of treatment and become permanent). NMS, or neuroleptic malignancy syndrome, is relatively rare, but can be fatal. Basically, antipsychotics set up a blockade at your D2 (dopamine) receptors; this blockade can go haywire and result in muscle rigidity, fever, incontinence/loss of bowel control, and death (about 30% of NMS cases will result in death). The syndrome usually happens within the first 2 weeks of taking the antipsychotic, but can happen at any time during therapy, and is most commonly found in young men (especially those given other meds..the risk seems unusually high when Lithium is given in addition to antipyshotics.) The best estimate I've seen puts the total number of antipsychotic users worldwide since the 1950s in the tens of millions, while NMS has probably resulted in about 100,000 fatalities worldwide. In terms of other effects...loxapine is an old antipsychotic, and it seems to have many of the side effects of the old antipsychotics, but it does have some characteristics of the newer (atypical) antipsychotics...as a result, you might get some benefits associated with the newer antipsychotics (anxiety reduction, depression reduction, etc.). Then again...you might not. Neuroleptics can help with depression and anxiety, but they can also cause depression/anxiety, or make pre-existing depression/anxiety worse. There is a condition called "Neuroleptic Induced Dysphoria" in which the patient experiences extreme distress and unhappiness as a direct result of antipsychotic usage. I've experienced it with the newer antipsychotics (zyprexa, abilify, and seroquel), and it has been observed a good bit with the older antipsychotics. To give you an idea of what its like...when I experienced it at its worst, I burst into tears without knowing exactly what was wrong or what, if anything, I could do about it. I felt depressed but also separated from myself, as if my thoughts were somehow being slowed down and my self was being destroyed. It was *worse* for me than suicidal depression--I know it sounds like an exagerration, but for me, this was truly hell on earth. (I took atypicals for bipolar disorder). Anyway, loxapine is dosed anywhere from 20mgs (usually just a starting dose, but it works well for some people) up to a max of 250mgs (more common in institutions/mental hospitals where they need to shut people up). The higher the dose, the higher the risk of side effects, but the side effects can occur (or not occur) at any dosage and at any point during drug therapy. Both weight gain and weight loss can occur while on loxapine, so do keep that mind. Good luck!
poster:med_empowered
thread:557122
URL: http://www.dr-bob.org/babble/20050914/msgs/557400.html