side effects, dosage, reviews, how to take & discontinue, uses, pros & cons, and more
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Brand & Generic Names; Drug Classes; Availability & Forms
|US brand name: Asendin|
|Generic name: amoxapine|
|Primary drug class: Antidepressants|
|Additional drug class(es): Antipsychotics, Tricyclic & Tetracyclic Antidepressants|
Generic and Overseas Availability
|Available as a generic? Yes|
Other Trade Names and Overseas Availability
- Defanyl (France)
- Demolox (Denmark; India; Portugal; Spain)
- アモキサピン (Japan)
Shapes & Sizes (How Supplied)Tablets
Approved & Off-Label Uses (Indications)
Asendin’s US FDA Approved Treatment(s)
Neurotic or reactive depressive disorders
Uses Approved Overseas but not in the US
Endogenous and psychotic depressions
Off-Label Uses of Asendin
Schizophrenia (One of numerous studies on this use)
When & If Asendin Will Work
Asendin’s Usual Onset of Action (when it starts working)
One to two weeks. Tetracyclics are fast. You’ll feel something within a couple of days.
Likelihood of Working
Taking and Discontinuing
How to Take Asendin
The initial dose is 50mg two to three times daily. After two to three weeks that may be increased to 100mg two to three times daily. Presuming this stuff works, the maintenance dose of 200–300mg may then be taken all at once at bedtime, but anything above 300mg a day needs to be split into two, or even three doses a day.
Inpatients may receive up to 600mg a day.
Given the incidence of AP-related side effects, you and your doctor should seriously discuss any increase above 200mg a day. You’d probably know by then if it’s going to be doing something positive for you.
How to Stop Taking Asendin (discontinuation / withdrawal)
Tri/tetracyclics don’t have much of a discontinuation syndrome. Depending on why you need to stop taking it, reducing your dosage by 50–100mg a day each week should be relatively painless.
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Asendin’s Pros and Cons
Amoxapine has been around since forever, so doctors are familiar with its uses and effects. Like most tetracyclics It starts to work very quickly. As it’s practically a combination antidepressant & antipsychotic it could be just the thing for anyone with treatment-resistant depression as well as psychotic, agitated and/or delusional depressions. And since it’s available only as a generic amoxapine is probably the cheapest antidepressant & antipsychotic on the market.
Amoxapine has been since forever, so younger doctors are less likely to prescribe it and other tri/tetracyclics, even if they might be a better first or second choice for you. The chances for movement- and prolactin-related side effects are less than Risperdal’s Risperdal’s but greater than a lot of other AAPs. It’s not really an antidepressant & antipsychotic cocktail so you can’t easily mix and match a replacement. Who knows how much longer it will be available in the US as it’s been pulled from the UK and New Zealand since I wrote the original article in 2004.
Interesting Stuff your Doctor Probably didn’t Tell You* If you overdose on amoxapine and aspirin at the same time they can extract the novel compound, N-acetylated amoxapine, from various parts of you. What it’s good for, if anything, has yet to be determined.
- They found out amoxapine is an antipsychotic of sorts because of so many people getting hit by the same side effects typical of APs. So crappy side effects aren’t always a bad thing. For other people.
Best Known for
Asendin’s Side Effects
Typical Side Effects
The anticholinergic and norepinephrine-reuptake inhibition side effects typical when starting TCAs - headache, nausea, sweating, dry mouth, sleepiness or insomnia, constipation, urinary hesitancy, and blurry vision. As amoxapine isn’t much of an anticholinergic and only a moderate antihistamine expect most of them to pass in a week or two. The constipation and urinary hesitancy are the most likely to stick around.
Uncommon Side Effects
Since amoxapine turns out to be a hybrid antipsychotic and antidepressant, you can get all the side effects related to antipsychotics that aren’t any good as anticholinergics, like Risperdal and Saphris: movement disorders (EPS, TD, and akathisia) and big tits that leak milk. The last two are especially fun if you’re a guy.
Freaky Rare Side Effects
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What You Really Need to be Careful About
C-Use with caution
Asendin’s Half-Life & How Long Until It Clears Your System
Plasma half-life: Amoxapine does a double metabolism. The drug itself has a half-life of around 8 hours. Its major metabolite has a half-life of 30 hours. Expect it to clear out of your system in 7–8 days.
Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream1, so there’s nothing swimming around to attach itself to your brain and start doing stuff. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what2, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood.
None is published that I could find. Based on the half-lives I’m presuming 7–8 days, if everything is nice and linear.
Steady state is the flipside of half-life. This is when you can expect to get over side effects caused by fluctuating amounts of a medication in your bloodstream. Often, but not always the same amount of time as the plasma clearance above.
How amoxapine Works
the current best guess at any rateFairly strong reuptake inhibition of norepinephrine, moderate reuptake inhibition of serotonin, potent binding to the 5HT2A serotonin receptors, strong binding to the D2 dopamine receptors and moderate binding to the alpha1 norepinephrine receptors makes amoxapine look almost like a cocktail of Cymbalta and Geodon.
The active ingredient is usually the same as the generic name, but more often than not it’s a chemical salt of the substance identified as the generic. E.g. Fluoxetine is the generic for Prozac, but the active ingredient is fluoxetine hydrochloride (or HCl). It usually doesn’t make much of a difference outside of the more esoteric aspects of a drug’s pharmacology, but not always.
Noted Drug-Drug & Drug-Food Interactions
Check for Other Drug-Drug & Drug-Food Interactions
It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on te Faecesbooks.
Comments, PI Sheet, Ratings, Reviews and More
CommentsGiven how strong amoxapine is at D2 I’m not surprised at the rate of side effects like leaking tits and tardive dyskinesia (TD). 300mg a day is sort of like taking 10mg a day of Risperdal as far as D2 dopamine is concerned, (not taking pharmacokinetics into account, keep reading) and just thinking of 10mg a day of Risperdal is almost enough for my TD symptoms to reappear.
On the plus side, amoxapine is probably misclassified as an antidepressant. Some people want it to be classified as an atypical antipsychotic. There’s more than enough evidence for it. Top studies:
- Amoxapine vs. Risperdal for schizophrenia. Equally effective. Bonus: the people taking amoxapine (average dosage ~225mg) had lower prolactin levels than those taking Risperdal (average dosage 4.5mg). Lower prolactin means that, although the leaking tits and TD can still happen and suck bad enough to make you stop taking it, it’s still less likely to happen and won’t be as bad with an equivalent dosage of Risperdal.
- Is amoxapine an atypical antipsychotic? Positron-emission tomography investigation of its dopamine2 and serotonin2 occupancy. * Amoxapine as an antipsychotic: comparative study versus haloperidol.
After looking at all the evidence, I agree with them Asendin (amoxapine) is more antipsychotic than antidepressant. It’s just never going to be approved to treat schizophrenia, because no one wants to spend the money getting a new approval for a generic, so I don’t know if and when I’ll move it. For now I’ll list it in both categories.
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If you’re still feeling judgmental as well as just mental3, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.
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Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) Third edition by Stephen M. Stahl © 2008 Published by Cambridge University Press.
Physicians’ Desk Reference Edition 53 © 1999. Published by Medical Economics Company.
Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007 An imprint of Elsevier. Also the 2004 edition, but only on pages that haven’t been fully updated yet.
Instant Psychopharmacology 2nd Edition Ronald J. Diamond M.D. © 2002. Published by W.W. Norton
The Complete Guide to Psychiatric Drugs Edward Drummond, M.D. © 2000. Published by John Wiley & Sons, Inc.
Healing Anxiety & Depression Daniel G. Amen, M.D., and Lisa C. Routh, M.D. © 2003. Published by G.P. Putnam’s Sons.
Handbook of Affective Disorders edited by Eugene S. Paykel, M.D. FRCPsych © 1992. Published by The Guilford Press.
2 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.
3 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!
I welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why I write these damn things. I’m frustrated enough as it is. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds.
|Last modified on Monday, 20 January, 2014 at 15:07:29 by SomeMedCritic||Page Author: JerodPoore||Date created Monday, 28 January 2013 at 15:05:38|
Asendin, and all other drug names on this page and use throughout the site, are a trademark of someone else. Look on the the PI sheet or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing.
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Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and the following disclaimer, I’m usually cool with it.
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All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazymeds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had a forerunner of QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]