Highlighting uses, dosage, reviews, how to take & discontinue, side effects, pros & cons, and more

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Brand & Generic Names; Drug Classes

US brand name: Asendin
Generic name: amoxapine

Drug Class(es)

Primary drug class: Antidepressants
Additional drug class(es): Antipsychotics, Tricyclic & Tetracyclic Antidepressants

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.

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Likelihood of Working

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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.

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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

Pros

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.
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Cons

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.
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Interesting Stuff your Doctor Probably didn’t Tell You about Asendin

  • 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.

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Best Known for


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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.
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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.
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Freaky Rare Side Effects

Testicular swelling, painful ejaculation and retrograde ejaculation. Amoxapine is the drug for guys in sex addicts anonymous.
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What You Really Need to be Careful About

Movement disorders (EPS, TD, and akathisia) and prolactin-related side effects (swollen breasts and unexpected lactation) normally associated with antipsychotics.

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Pregnancy Category

C-Use with caution
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Pharmacology

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.

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Steady State

Steady state is reached in: 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.

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How amoxapine Works

the current best guess at any rate
Fairly 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.

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Active Ingredient

amoxapine

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.


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Shelf Life


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Asendin’s Noted Drug-Drug, Drug-Food & Drug-Supplement Interactions

Check for Other Drug-Drug, Drug-Food & Drug-Supplement Interactions

Drugs.com’s drug-drug and drug-food interaction checker

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 teh Faecesbooks.
Learn more about drug-everything interactions on our page of tips about taking crazy meds.

Name, Address, Serial Number (Generic and Overseas Availability)

Available in the US as a generic? Yes

Other Trade Names and Overseas Availability

  • Amoxan(Japan)
  • Defanyl (France)
  • Demolox (Denmark; India; Portugal; Spain)
  • アモキサピン (Japan)


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Shapes & Sizes (How Supplied)

Tablets
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Comments, PI Sheet, Ratings, Reviews and More

Comments

Given 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:

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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Rate Asendin

Give your overall impression of Asendin on a scale of 0 to 5. Detailed ratings and reviews are available on the Asendin Ratings & Reviews Page.

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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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Full US PI sheet, Global SPCs & PILs, Other Consumer Review & Rating Sites, and Other Sites that may be of Interest

Discussion board

If you have any questions not answered here, please see the Crazymeds Asendin discussion board.
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References

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

Primer of Drug Action 12th edition by Robert M. Julien Ph.D., Claire D. Advokat, Joseph Comaty © 2011 Published by Worth Publishers.

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.


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1 Based on Julien's calculations from A Primer of Drug Action, the half-life multiplied by five is the generally accepted estimate of how long it takes a single dose of any given drug to be eliminated from the blood stream/plasma of someone with a normal metabolism. That's also the rough estimate for steady state if they can't get, or won't provide a number for that.

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!


If you have any questions not answered here, please see the Crazymeds Asendin discussion board. We 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 we write these damn things. 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. — Jerod Poore, CME, Publisher crazymeds.us


Last modified on Saturday, 22 March, 2014 at 12:31:51 by SomeMedCriticPage Author Date created Monday, 28 January 2013 at 15:05:38
“Asendin” by Jerod Poore is copyright © 2013 Jerod Poore Published online 2013/01/28
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will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. 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. It may of changed hands by the time you finished reading this article.




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