Asendin

1 What is Asendin?

Brand: Asendin, Asendis, Defanyl, Demolox

Generic: Amoxapine

Amoxapine is a tetracyclic compound which is used to treat the symptoms of depression. It increases synaptic concentration of serotonin and/or norepinephrine in the central nervous system (CNS) by blocking the neuronal reuptake of norepinephrine and serotonin. 

It also blocks response of dopamine D2 receptors to dopamine. It is chemically related to the antipsychotic drug and has mixed antidepressant plus neuroleptic properties. 

As a result, it offers advantage for patients with psychotic depression. This medicine is available in tablet form and you can get this drug only with your doctor's prescription.

2 What to Know Before using

If you are about to start a drug therapy, the risk and benefit ratio of taking the drug should be considered. This is a decision that your doctor will make with your active participation. 

There are some important factors such as drug interaction, metabolic impairment, hypersensitivity reaction, pregnancy, lactation etc. which may alter the drug action.

Amoxapine is often used in the treatment of major depressive disorder. Compared to other antidepressants it is believed to have a faster onset of action, with therapeutic effects seen within four to seven days. 

Despite its apparent lack of extrapyramidal side effects in patients with schizophrenia it has been found to exacerbate motor symptoms in patients with Parkinson's disease psychosis.

Sometimes presence of other health disorders affects the beneficial effects of this medicine and even may cause serious complications. Make sure you mention your doctor if you have any other medical problems. 

The use of amoxapine is contraindicated in those with known hypersensitivity to dibenzoxazepine compounds, angle-closure glaucoma, recent myocardial infarction, cardiac arrhythmia, and heart failure

Moreover, this drug should be used cautiously in some critical conditions such as pre-existing cardiovascular disease, prostatic hyperplasia (increased susceptibility to urinary retention), history of seizures (threshold may be lowered) etc. 

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risk.

Certain drugs should not be used concurrently with such medications. It is always recommended to consult with your doctor if you are in need of some drugs for another health problem in order to avoid unwanted serious effects. 

You should know about the following drug interactions in order to get rid of unwanted complications: 

  • Amoxapine may potentiate directly acting sympathomimetic amines (in cold and asthma remedies). Adrenaline containing local anesthetic should be avoided. However, TCAs attenuate the actions of indirect sympathomimetics (ephedrine, tyramine).
  • It may abolish the antihypertensive action of guanethidine and clonidine by preventing their transport into adrenergic neurons.
  • It also potentiates all the CNS depressants, including hypnotics, anxiolytics, opioids, analgesics, anti-histaminics  and alcohol. 
  • Phenytoin, phenylbutazone, aspirin and CPZ can displace amoxapine from its protein binding sites and cause toxicity.
  • SSRIs inhibit metabolism of several drugs including amoxapine – dangerous toxicity may occur if the two are given concurrently.
  • By their anticholinergic property, amoxapine delays gastric emptying and retards its own as well as other drug’s absorption. However, digoxin and tetracyclines may be more completely absorbed. When used together, the anticholinergic action of neuroleptics and TCAs may add up.
  • MAO inhibitors –dangerous hypertensive crisis with excitement and hallucinations has occurred when given with amoxapine.
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3 Proper Usage

Medicines should be used following the directions given by a doctor. The dose of this medicine will vary according to patient’s condition or requirement. 

You should follow the doctor's directions and advices strictly. The amount of medicine that you take should not exceed the maximum therapeutic dose. 

Also, the frequency of your daily drug administration and the duration of drug therapy depend on the particular medical problem for which you are taking the medicine.

Relief of symptoms of depression in patients with neurotic or reactive depressive disorders as well as endogenous and psychotic depressions and for depression accompanied by anxiety or agitation can be achieved by initiating the drug therapy with 50 mg for 2-3 times in a day. 

The dose can be increased up to 600 mg per day that is given in divided doses.

  

You should take your medicine in time. If you miss any dose of this medicine, you should take it as soon as possible. 

But if it is time for your next dose, then you should skip the missed dose and go back to your regular treatment schedule. 

You should store the medicine in a closed container at room temperature away from heat, moisture, and direct light. 

All kinds of medicines should be kept out of the reach of children. Outdated medicine must be disposed by an appropriate way.

4 Precautions to Take

Regular visits are recommended to make sure this medicine is working properly or not while you are receiving a drug therapy. 

The use of amoxapine in patients with bipolar illness, cardiovascular disease, renal or liver impairment, epilepsy, thyroid dysfunction, and diabetes may be responsible for serious effects. 

Some important measures should be taken if you feel any discomfort following this drug therapy. As this drug may precipitate a mixed or manic episode in patients at risk for bipolar disorder, amoxapine has not been approved yet for treatment of bipolar depression. 

Monitoring is recommended for signs of clinical worsening, suicidality, unusual changes in behavior, mania, cardiovascular events, tardive dyskinesia, allergic reactions, fever, angle-closure glaucoma, and other adverse reactions while the patient is receiving amoxapine therapy. 

Recent use of MAO inhibitors (within the last 14 days), acute recovery phase post-myocardial infarction (MI), and concurrent usage with cisapride are not suitable for amoxapine therapy. 

You should avoid abrupt withdrawal of therapy to get rid of some unwanted complications like urinary retention, prostatic hyperplasia, chronic constipation, angle-closure glaucoma, and phaeochromocytoma.

5 Potential Side Effects

There are some unwanted side-effects associated with each drug that usually do not need medical attention. These side-effects usually go away during the treatment episode as your body adjusts to the medicine. 

Your healthcare professional may advise you about the ways how to prevent or reduce those unwanted side-effects. Sometimes you may need to consult with the doctor if you feel any of the following serious toxic effects:

  • Anticholinergic effects: dry mouth, bad taste, constipation, epigastric distress, urinary retention (especially in males with enlaged prostate), blurred vision, and palpitation.
  • Sedation, mental confusion and weakness.
  • Increased appetite and weight gain is noted with most TCAs and trazodone, but not with SSRIs and bupropion.
  • Some patients receiving any antidepressant may abruptly switch over to a dysphoric-agitated state or to mania. Most likely, these are cases of bipolar depression, the other pole being unmasked by the antidepressant. 
  • Sweating and fine tremors are relatively common.
  • Seizure threshold is lowered – fits may be precipitated, especially in children. Bupropion, clomipramine, amoxapine have greater propensity, while desipramine and SSRIs are safer in this regard.
  • Postural hypotension, especially in older patients; less severe with desipramine-like drugs and insignificant with SSRIs.
  • Cardiac arrhythmias, especially in patients with ischaemic heart disease-may be responsible for sudden death in these patients. 
  • Rashes and jaundice due to hypersensitivity are rare.
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