US Brand Name: Asendin

generic name: amoxapine

Class: Antidepressants Specifically Tetracyclic Antidepressant (TCAs). But maybe not. (See the comments section).

1.  Other brand names & branded generic names¹

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

2.  FDA Approved Uses of amoxapine

Break out the DSM-II or III:

• Neurotic or reactive depressive disorders
• endogenous and psychotic depressions
• depression accompanied by anxiety or agitation

3.  Off-Label Uses of amoxapine

• Schizophrenia (One of numerous studies on this use)

4.  Amoxapine’s pros and cons

4.1  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.

4.2  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.

5.  Side Effects

5.1  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.

5.2  Not So Common 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.

5.3  Freaky Rare Side Effects

Testicular swelling, painful ejaculation and retrograde ejaculation. Amoxapine is the drug for sex addicts anonymous.

6.  Interesting Stuff Your Doctor Probably Won’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.

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7.  Asendin’s (amoxapine) Dosage and How to Take Asendin (amoxapine)

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.

8.  How Long Asendin (amoxapine) Takes to Work

One to two weeks. Tetracyclics are fast. You’ll feel something within a couple of days.

9.  How to Stop Taking Asendin (amoxapine)

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.

10.  Asendin’s (amoxapine) Half-Life & Average Time to Clear Out of Your System

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.

11.  Days to Reach a Steady State

None is published. Based on the half-lives I’m presuming 7–8 days, if everything is nice and linear.

12.  How Asendin (amoxapine) Works

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.

13.  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:

• 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.

14.  Discussion board

Crazy Meds’ Asendin discussion board

15.  Your Comments About and Experiences with Asendin

Tell us what you think about Asendin

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Enter your own Comments & Experiences with Asendin here.
You must be a registered member of the Crazy Meds Talk forum to post a comment on this page.

16.  Full US PI sheet, Global SPCs & PILs, check for drug-drug interactions

Asendin Full US Prescribing Information / PI Sheet
Japanese Amoxan prescribing information

Canadian monograph

Check for drug-drug interactions

17.  Bibliography

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.

¹ The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin, and they are owned by Pfizer, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions.

Date created 26 Mar 2011 - 16:09 Page Creator: Last edited by:

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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 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 Crazy Meds. 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 the forerunner to 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]