Considering Loxapine Instead of Clozapine: A Case Series and Literature Review

This case series highlights the importance of loxapine in psychiatric disorders when clozapine is unable to control agitation and psychotic symptoms due to medication noncompliance, intolerable side effects, or inadequate clinical outcomes. Loxapine is classified as a first-generation typical antipsychotic but displays atypical antipsychotic-like characteristics with structural similarity to clozapine. However, since the inception of second-generation antipsychotic medications, the role of loxapine in modern psychiatric practice has become limited. Loxapine has been underutilized due to concerns of side effects and lack of in-depth research about its safety, tolerability, and efficacy. This report revisits loxapine’s clinical utility through two well-studied long-term inpatient cases, where it played a crucial role in controlling psychotic symptoms and achieving better medication compliance by eliminating significant barriers, including monitoring regular differential complete blood counts. We aim to add to the current evidence and literature about the advantage of using loxapine for specific clinical scenarios in psychiatric practice.