serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).prochlorperazineMonitor Closely (2)loxapine inhaled and prochlorperazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. loxapine inhaled and prochlorperazine both increase sedation. Use Caution/Monitor.promethazineMonitor Closely (3)promethazine, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction). loxapine inhaled and promethazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. promethazine and loxapine inhaled both increase sedation. Use Caution/Monitor.propanthelineMonitor Closely (2)loxapine inhaled increases effects of propantheline by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. propantheline decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.propofolMonitor Closely (1)propofol and loxapine inhaled both increase sedation. Use Caution/Monitor.propylhexedrineMonitor Closely (1)loxapine inhaled increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.protriptylineMonitor Closely (1)loxapine inhaled and protriptyline both increase sedation. Use Caution/Monitor.quazepamMonitor Closely (1)quazepam and loxapine inhaled both increase sedation. Use Caution/Monitor.quetiapineMonitor Closely (2)loxapine inhaled and quetiapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. loxapine inhaled and quetiapine both increase sedation. Use Caution/Monitor.ramelteonMonitor Closely (1)loxapine inhaled and ramelteon both increase sedation. Use Caution/Monitor.rapacuroniumMonitor Closely (2)loxapine inhaled increases effects of rapacuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. rapacuronium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.remimazolamMonitor Closely (1)remimazolam, loxapine inhaled. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.rimabotulinumtoxinBMonitor Closely (1)loxapine inhaled, rimabotulinumtoxinB. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Anticholinergics may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.risperidoneMonitor Closely (2)loxapine inhaled and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. loxapine inhaled and risperidone both increase sedation. Use Caution/Monitor.rizatriptanMonitor Closely (1)rizatriptan, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).rocuroniumMonitor Closely (2)loxapine inhaled increases effects of rocuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. rocuronium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.ropiniroleSerious - Use Alternative (1)loxapine inhaled decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.rotigotineMonitor Closely (1)loxapine inhaled and rotigotine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)loxapine inhaled decreases effects of rotigotine by pharmacodynamic antagonism. Contraindicated.safinamideSerious - Use Alternative (1)loxapine inhaled decreases effects of safinamide by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Dopamine antagonists may decrease safinamide effects and exacerbate Parkinson disease symptoms.sageMinor (1)loxapine inhaled and sage both increase sedation. Minor/Significance Unknown.salmeterolMonitor Closely (1)loxapine inhaled increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.scopolamineMonitor Closely (2)loxapine inhaled increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. scopolamine decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.scullcapMonitor Closely (1)loxapine inhaled and scullcap both increase sedation. Use Caution/Monitor.secobarbitalMonitor Closely (1)secobarbital and loxapine inhaled both increase sedation. Use Caution/Monitor.selegilineMonitor Closely (1)selegiline, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).selinexorSerious - Use Alternative (1)selinexor, loxapine inhaled. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.sevofluraneMonitor Closely (1)sevoflurane and loxapine inhaled both increase sedation. Use Caution/Monitor.shepherd's purseMonitor Closely (1)loxapine inhaled and shepherd's purse both increase sedation. Use Caution/Monitor.smokingMinor (1)smoking decreases levels of loxapine inhaled by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.sodium oxybateSerious - Use Alternative (1)loxapine inhaled, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.sodium sulfate/?magnesium sulfate/potassium chlorideMonitor Closely (1)sodium sulfate/?magnesium sulfate/potassium chloride increases effects of loxapine inhaled by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant.sodium sulfate/potassium sulfate/magnesium sulfateMonitor Closely (1)sodium sulfate/potassium sulfate/magnesium sulfate increases effects of loxapine inhaled by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant.solifenacinMonitor Closely (2)loxapine inhaled increases effects of solifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. solifenacin decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.sufentanilMonitor Closely (1)sufentanil and loxapine inhaled both increase sedation. Use Caution/Monitor.sufentanil SLSerious - Use Alternative (1)sufentanil SL, loxapine inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.sumatriptanMonitor Closely (1)sumatriptan, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).sumatriptan intranasalMonitor Closely (1)sumatriptan intranasal, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).tapentadolMonitor Closely (1)tapentadol and loxapine inhaled both increase sedation. Use Caution/Monitor.temazepamMonitor Closely (1)temazepam and loxapine inhaled both increase sedation. Use Caution/Monitor.terbutalineMonitor Closely (1)loxapine inhaled increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.tetrabenazineMonitor Closely (1)loxapine inhaled and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.thioridazineMonitor Closely (2)loxapine inhaled and thioridazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. loxapine inhaled and thioridazine both increase sedation. Use Caution/Monitor.thiothixeneMonitor Closely (2)loxapine inhaled and thiothixene both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. loxapine inhaled and thiothixene both increase sedation. Use Caution/Monitor.tiotropiumMonitor Closely (2)loxapine inhaled increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. tiotropium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.tolterodineMonitor Closely (2)loxapine inhaled increases effects of tolterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. tolterodine decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.topiramateMonitor Closely (1)loxapine inhaled and topiramate both increase sedation. Modify Therapy/Monitor Closely.tramadolMonitor Closely (1)tramadol and loxapine inhaled both increase sedation. Use Caution/Monitor.tranylcypromineMonitor Closely (1)tranylcypromine, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).trazodoneMonitor Closely (1)loxapine inhaled and trazodone both increase sedation. Use Caution/Monitor.triazolamMonitor Closely (1)triazolam and loxapine inhaled both increase sedation. Use Caution/Monitor.triclofosMonitor Closely (1)triclofos and loxapine inhaled both increase sedation. Use Caution/Monitor.trifluoperazineMonitor Closely (2)loxapine inhaled and trifluoperazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. loxapine inhaled and trifluoperazine both increase sedation. Use Caution/Monitor.trihexyphenidylMonitor Closely (2)loxapine inhaled increases effects of trihexyphenidyl by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. trihexyphenidyl decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.trimipramineMonitor Closely (1)loxapine inhaled and trimipramine both increase sedation. Use Caution/Monitor.triprolidineMonitor Closely (1)triprolidine and loxapine inhaled both increase sedation. Use Caution/Monitor.trospium chlorideMonitor Closely (2)loxapine inhaled increases effects of trospium chloride by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. trospium chloride decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.vecuroniumMonitor Closely (2)loxapine inhaled increases effects of vecuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. vecuronium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.venlafaxineMonitor Closely (1)venlafaxine, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).vilazodoneMonitor Closely (1)vilazodone, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).xylometazolineMonitor Closely (1)loxapine inhaled increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.yohimbineMonitor Closely (1)loxapine inhaled increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ziconotideMonitor Closely (1)loxapine inhaled and ziconotide both increase sedation. Use Caution/Monitor.ziprasidoneMonitor Closely (2)loxapine inhaled and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. loxapine inhaled and ziprasidone both increase sedation. Use Caution/Monitor.zolmitriptanMonitor Closely (1)zolmitriptan, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).zotepineMonitor Closely (2)loxapine inhaled and zotepine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. loxapine inhaled and zotepine both increase sedation. Use Caution/Monitor. >10% Respiratory adverse effects in patients with COPD (19%) Dysgeusia (14%) Sedation (12%) 1-10% Throat irritation (3%) <1% Bronchospasm (0.8%) Akathisia (0.4%) Neck dystonia and oculogyration (0.4%) Black Box Warnings Bronchospasm Can cause bronchospasm that has the potential to lead to respiratory distress and respiratory arrest Administer only in an enrolled healthcare facility that has immediate access on-site to supplies and personnel and ready access to emergency response services; facilities must have a short-acting bronchodilator, including a nebulizer and inhalation solution, for immediate treatment of bronchospasm Prior to administering, screen patients regarding a current diagnosis, history, or symptoms of asthma, COPD and other lung diseases, and examine (including chest auscultation) patients for respiratory signs Monitor for signs and symptoms of bronchospasm following treatment Dementia-related psychosis Patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death as shown in short-term controlled trials The deaths appeared to be either cardiovascular (eg, heart failure, stroke, sudden death) or infectious (eg, pneumonia) in nature This drug is not approved for the treatment of patients with dementia-related psychosis Contraindications Current diagnosis or history of asthma, COPD, or other lung disease associated with bronchospasm Acute respiratory symptoms or signs (eg, wheezing) Current use of medications to treat airways disease, such as asthma or COPD History of bronchospasm following treatment Known hypersensitivity (including serious skin reactions) to loxapine or amoxapine Cautions Can cause bronchospasm (see Black Box Warnings) Monitor