Amoxapine Dosage

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Usual Adult Dose for:

Usual Geriatric Dose for:

Additional dosage information:

Usual Adult Dose for Depression

For the relief of symptoms of depression in patients with neurotic or reactive depressive disorders as well as endogenous and psychotic depressions:

Initial dose: 50 mg 2 or 3 times daily. Depending on tolerance, the dosage may be increased to 100 mg 2 or 3 times daily by the end of the first week. An initial dosage of 300 mg daily may be given, but notable sedation may occur in some patients during the first few days of therapy at this level. Increases above 300 mg daily should be made only if 300 mg daily has been ineffective during a trial period of at least two weeks. When an effective dosage is established, the drug may be given in a single dose (not to exceed 300 mg) at bedtime.

Maintenance: 200 to 300 mg daily.
Three weeks is an adequate trial period providing the dosage has reached 300 mg daily (or the lower level of tolerance) for at least two weeks. If no response is seen at 300 mg, the dosage may be increased (depending on tolerance) up to 400 mg daily. Hospitalized patients who have been refractory to antidepressant therapy and who have no history of convulsive seizures may have their dosage cautiously raised up to 600 mg daily in divided doses.

Amoxapine may be given in a single daily dose up to 300 mg, preferably at bedtime. If the total daily dosage exceeds 300 mg, it should be given in divided doses.

Usual Geriatric Dose for Depression

For the relief of symptoms of depression in patients with neurotic or reactive depressive disorders as well as endogenous and psychotic depressions:

Initial dose: 25 mg 2 or 3 times daily. If no intolerance is observed, the dosage may be increased by the end of the first week to 50 mg 2 or 3 times daily. Although 100 to 150 mg daily may be adequate for many elderly patients, some may require a higher dosage. Careful increases up to 300 mg daily may be appropriate for such individuals.

Once an effective dose has been established, amoxapine may be given as a single bedtime dose, not to exceed 300 mg.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

The recommended maintenance dosage is the lowest dosage that will maintain remission. If symptoms reappear, the dosage should be increased to earlier level until symptoms are under control.

Precautions

Children, adolescents, and young adults (18 to 24 years of age) with major depressive disorder and other psychiatric disorders may be at an increased risk of suicidal thinking and suicidality with antidepressant use, particularly during the first few months of treatment. Medical evidence has not shown this increased risk to exist in adults older than 24 years of age, but adults 65 years of age and older taking antidepressants appear to have a decreased risk of suicidality. The results of a meta-analysis indicate an overall favorable risk-to-benefit profile for the use of antidepressants (i.e., selective serotonin and/or norepinephrine reuptake inhibitors) in the treatment of pediatric patients (less than 19- years- old) with major depressive disorders (MDD), obsessive-compulsive disorder (OCD), or non- OCD anxiety disorders. Although this study also reports an overall increased risk of suicidal ideation/suicide attempt associated with the use of antidepressants in pediatric patients, the risk may be less than originally estimated. Additional prospective studies are warranted in order to confirm these findings.

Worsening of depression and/or increased suicidal thinking or behavior may always be a possibility in patients treated with antidepressant medications, particularly those being treated for depression. Anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia (severe restlessness), hypomania, and mania have been reported in patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. It is unknown if these symptoms are a precursor to either worsening of depression or the emergence of suicidal impulses; however, there is concern that patients who experience one or more of these symptoms may be at increased risk for worsening depression or suicidality. Although the FDA has not concluded that antidepressant drugs cause worsening depression or suicidality, health care providers should be aware that worsening of symptoms could be due to the underlying disease or might be a result of drug therapy.

Health care providers should carefully monitor patients receiving antidepressants for possible and/or persistent worsening of depression or emergent suicidality, especially at the beginning of therapy or when the dose either increases or decreases. If symptoms are severe, abrupt in onset, or were not part of the patient's presenting symptoms, the health care provider will need to determine what intervention, including discontinuing or modifying the current drug therapy, is indicated. Prescriptions should be written for small quantities of drug to reduce the risk of an attempt to overdose. Health care providers should instruct patients, their families and their caregivers to be alert for the emergence of agitation, irritability, and the other symptoms described above, as well as the emergence of suicidality and worsening depression, and to report such symptoms immediately to their health care provider.

Because antidepressants are believed to have the potential for inducing manic episodes in patients with bipolar disorder, there is a concern about using antidepressants alone in this population. Therefore, patients should be adequately screened to determine if they are at risk for bipolar disorder before initiating antidepressant treatment so that they can be appropriately monitored during treatment. Such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.

The concomitant administration of monoamine oxidase inhibitors and tricyclic antidepressants is considered contraindicated.

Safety and effectiveness have not been established in pediatric patients less than 16 years of age.

Dialysis

Data not available

Other Comments

Amoxapine is indicated for depression accompanied by anxiety or agitation.

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