Amoxapine, sold under the brand name Asendin among others, is a tricyclic antidepressant (TCA). It is the N-demethylated metabolite of loxapine. Amoxapine first received marketing approval in the United States in 1992, approximately 30 to 40 years after most of the other TCAs were introduced in the United States. Medical uses Amoxapine is used in the treatment of major depressive disorder. Compared to other antidepressants it is believed to have a faster onset of action, with therapeutic effects seen within four to seven days. In excess of 80% of patients that do respond to amoxapine are reported to respond within two weeks of the beginning of treatment. It also has properties similar to those of the atypical antipsychotics, and may behave as one and may be used in the treatment of schizophrenia off-label. Despite its apparent lack of extrapyramidal side effects in patients with schizophrenia it has been found to exacerbate motor symptoms in patients with Parkinson's disease and psychosis. Contraindications As with all FDA-approved antidepressants it carries a black-box warning about the potential of an increase in suicidal thoughts or behaviour in children, adolescents and young adults under the age of 25. Its use is also advised against in individuals with known hypersensitivities to either amoxapine or other ingredients in its oral formulations. Its use is also recommended against in the following disease states: Severe cardiovascular disorders (potential of cardiotoxic adverse effects such as QT interval prolongation) Uncorrected narrow angle glaucoma Acute recovery post-myocardial infarction Its use is also advised against in individuals concurrently on monoamine oxidase inhibitors or if they have been on one in the past 14 days and in individuals on drugs that are known to prolong the QT interval (e.g. ondansetron, citalopram, pimozide, sertindole, ziprasidone, haloperidol, chlorpromazine, thioridazine, etc.). Lactation Its use in breastfeeding mothers not recommended as it is excreted in breast milk and the concentration found in breast milk is approximately a quarter that of the maternal serum level. Side effects Adverse effects by incidence: Note: Serious (that is, those that can either result in permanent injury or are irreversible or are potentially life-threatening) are written in bold text. Very common (>10% incidence) adverse effects include: Constipation Dry mouth Sedation Common (1–10% incidence) adverse effects include: Anxiety Ataxia Blurred vision Confusion Dizziness Headache Fatigue Nausea Nervousness/restlessness Excessive appetite Rash Increased perspiration (sweating) Tremor Palpitations Nightmares Excitement Weakness ECG changes Oedema. An abnormal accumulation