Drug interactions
Amoxapine + Clozapine
Severity: Major
Amoxapine and Clozapine: major interaction.
Last updated Sources: Health Canada product monograph
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Amoxapine has antipsychotic-like dopamine-blocking activity, so combining it with clozapine increases the risk of extrapyramidal symptoms and neuroleptic malignant syndrome. Sedation, anticholinergic effects and QT prolongation may also be additive, and seizure threshold may be lowered.
What this interaction means in plain words
Amoxapine and Clozapine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Additive D2 antagonism, anticholinergic effects, QT prolongation and seizure threshold lowering.
What to do
Avoid the combination if possible and choose an antidepressant without dopamine-blocking activity. If used, monitor ECG, electrolytes, movement symptoms and seizure risk.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Clozapine
- Clozapine + Deferiprone Contraindicated
- Clozapine + Irinotecan Contraindicated
- Clozapine + Pimozide Contraindicated
- Clozapine + Thioridazine Contraindicated
- Acalabrutinib + Clozapine Major
- Adagrasib + Clozapine Major
Frequently asked questions
Can I take Amoxapine with Clozapine?
MediHelp rates the interaction as major. Amoxapine and Clozapine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Amoxapine has antipsychotic-like dopamine-blocking activity, so combining it with clozapine increases the risk of extrapyramidal symptoms and neuroleptic malignant syndrome. Sedation, anticholinergic effects and QT prolongation may also be additive, and seizure threshold may be lowered.
How serious is the interaction between Amoxapine and Clozapine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination if possible and choose an antidepressant without dopamine-blocking activity. If used, monitor ECG, electrolytes, movement symptoms and seizure risk.
What other medicines interact with Clozapine?
MediHelp also lists interactions of Clozapine with, for example, Deferiprone, Irinotecan, Pimozide. The full list is on the Clozapine page.
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