Asendin

amoxapine

Asendin

Indications

Action

Pharmacokinetics

Time/action profile (antidepressant effect)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• neuroleptic malignant syndrome (life-threatening)
• fatigue (most frequent)
• sedation (most frequent)
• extrapyramidal reactions
• tardive dyskinesia

Ear, Eye, Nose, Throat

• blurred vision (most frequent)
• dry eyes (most frequent)
• dry mouth (most frequent)

Cardiovascular

• arrhythmias (life-threatening)
• hypotension (most frequent)
• ECG changes

Gastrointestinal

• constipation (most frequent)
• increased appetite
• weight gain
• paralytic ileus

Genitourinary

• testicular swelling
• urinary retention

Dermatologic

• photosensitivity
• rash

Endocrinologic

• gynecomastia
• sexual dysfunction

Hematologic

• blood dyscrasias

Miscellaneous

• fever

Interactions

Drug-Drug interaction

Route/Dosage

Availability (generic available)

Nursing implications

Nursing assessment

• Monitor mental status (orientation, mood, behavior) frequently. Assess for suicidal tendencies, especially during early therapy. Restrict amount of drug available to patient.
• Monitor BP and pulse before and during initial therapy. Notify physician or other health care professional of decreases in BP (10–20 mmHg) or sudden increase in pulse rate. Patients taking high doses or with a history of cardiovascular disease should have ECG monitored before and periodically during therapy.
• Observe for onset of extrapyramidal side effects (akathisia—restlessness; dystonia—muscle spasms and twisting motions; pseudoparkinsonism—mask facies, rigidity, tremors, drooling, shuffling gait, dysphagia, pill-rolling motions of hands). Dose reduction or discontinuation may be necessary. Trihexyphenidyl or diphenhydramine may be used to control these symptoms.
• Monitor for tardive dyskinesia (lip smacking or puckering, puffing of cheeks, rhythmic chewing or worm-like movement of tongue and mouth, uncontrolled movements of extremities). Notify health care professional immediately if these symptoms occur; they may be irreversible.
• Monitor for development of neuroleptic malignant syndrome(fever, respiratory distress, tachycardia, convulsions, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control). Notify health care professional immediately if these symptoms occur.
• Assess for sexual dysfunction.
• Lab Test Considerations: May cause ↑ serum prolactin levels.
  • Monitor CBC and differential during chronic therapy. May rarely cause bone marrow suppression.
  • In chronic therapy, periodically monitor hepatic and renal function. Serum glucose may be ↑ or ↓.

Potential Nursing Diagnoses

Implementation

• Dose increases should be made at bedtime because of sedation. Dosage titration is a slow process; may take weeks to months. May give entire dose (if <300 mg) at bedtime, when dose is stabilized.
• Taper amoxapine to avoid withdrawal effects.
• Oral: Administer medication with or immediately after a meal to minimize gastric irritation.

Patient/Family Teaching

• Instruct patient to take medication as directed. Abrupt discontinuation may cause nausea, headache, and malaise.
• Inform patient of the possibility of extrapyramidal symptoms and tardive dyskinesia. Instruct patient to report these symptoms immediately.
• May cause drowsiness and blurred vision. Caution patient to avoid driving and other activities requiring alertness until response to drug is known.
• Orthostatic hypotension, sedation, and confusion are common during early therapy, especially in geriatric patients. Protect patient from falls and advise patient to make position changes slowly.
• Refer patient to nutritional or weight management program as appropriate.
• Advise patient to avoid alcohol or other CNS depressant drugs during and for 3–7 days after therapy.
• Instruct patient to notify health care professional if dry mouth or constipation persists or if urinary retention, uncontrolled movements, or rigidity occur. Sugarless candy or gum may diminish dry mouth, and an increase in fluid intake or bulk may prevent constipation. If these symptoms persist, dosage reduction or discontinuation may be necessary. Consult health care professional if dry mouth persists for more than 2 wk.
• Advise patient to inform health care professional if breast enlargement or sexual dysfunction occurs.
• Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
• Inform patient to monitor dietary intake. Increased appetite may lead to undesired weight gain.
• Advise patient to notify health care professional of medication regimen before treatment or surgery.
• Therapy for depression is usually prolonged. Emphasize the importance of follow-up exams to monitor effectiveness and side effects and to improve coping skills.
• Treatment is not a cure since symptoms can recur after discontinuation of medication.
• Refer to local support group.
• Pediatric: Caution parents/guardians of teenagers or children taking this medication about possible increase in suicide risk. Teach parents how to assess for suicidal thoughts and to report concerns immediately.
• Obstetric / Lactation: Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

• Increased sense of well-being.
  • Renewed interest in surroundings.
  • Increased appetite.
  • Improved energy level.
  • Improved sleep.
  • Decreased anxiety. Initial response may be noted in 4–7 days in some patients. Most patients respond within 2 wk.