Drug interactions
Epinephrine + Loxapine
Severity: Major
Epinephrine and Loxapine: 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
Loxapine blocks alpha-1 adrenergic receptors, so the vasoconstrictor effect of epinephrine is blunted and its beta-mediated vasodilation can predominate. This can produce paradoxical hypotension and tachycardia when epinephrine is given for shock or anaphylaxis, and the pressor response may be reduced.
What this interaction means in plain words
Epinephrine and Loxapine 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.
Epinephrine belongs to Endocrine; Loxapine belongs to Central Nervous System.
Why it happens
Pharmacodynamic antagonism of alpha-adrenergic vasoconstriction by loxapine, leaving unopposed beta-2 vasodilation.
What to do
If a pressor is needed in a patient on loxapine, consider a pure alpha agonist such as norepinephrine or phenylephrine instead of epinephrine where appropriate. Monitor blood pressure and heart rate closely when epinephrine is essential, such as in anaphylaxis.
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 Loxapine
- Alfentanil + Loxapine Major
- Alprazolam + Loxapine Major
- Amisulpride + Loxapine Major
- Amoxapine + Loxapine Major
- Apomorphine + Loxapine Major
- Belladonna and opium + Loxapine Major
Other interactions of Epinephrine
- Epinephrine + Isocarboxazid Contraindicated
- Epinephrine + Phenelzine Contraindicated
- Epinephrine + Tranylcypromine Contraindicated
- Acebutolol + Epinephrine Major
- Amitriptyline + Epinephrine Major
- Amoxapine + Epinephrine Major
Frequently asked questions
Can I take Epinephrine with Loxapine?
MediHelp rates the interaction as major. Epinephrine and Loxapine 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. Loxapine blocks alpha-1 adrenergic receptors, so the vasoconstrictor effect of epinephrine is blunted and its beta-mediated vasodilation can predominate. This can produce paradoxical hypotension and tachycardia when epinephrine is given for shock or anaphylaxis, and the pressor response may be reduced.
How serious is the interaction between Epinephrine and Loxapine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: If a pressor is needed in a patient on loxapine, consider a pure alpha agonist such as norepinephrine or phenylephrine instead of epinephrine where appropriate. Monitor blood pressure and heart rate closely when epinephrine is essential, such as in anaphylaxis.
What other medicines interact with Loxapine?
MediHelp also lists interactions of Loxapine with, for example, Alfentanil, Alprazolam, Amisulpride. The full list is on the Loxapine page.
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