Like all tricyclic antidepressants, amoxapine should be used cautiously and with close physician supervision in people, especially the elderly, who have benign pro-static hypertrophy, urinary retention, and glaucoma, especially angle-closure glaucoma (the most severe form). Before starting treatment, people with these conditions should discuss the relative risks and benefits of treatment with their doctors to help determine if amoxap-ine is the right antidepressant for them.
A common problem with tricyclic antidepressants is sedation (drowsiness, lack of physical and mental alertness). This side effect is especially noticeable early in therapy. In most patients, sedation decreases or disappears entirely with time, but until then patients taking amoxap-ine should not perform hazardous activities requiring mental alertness or coordination. The sedative effect is increased when amoxapine is taken with other central nervous system depressants, such as alcoholic beverages, sleeping medications, other sedatives, or antihistamines. It may be dangerous to take amoxapine in combination with these substances. Amoxapine may increase the possibility of having seizures. Patients should tell their physician if they have a history of seizures, including seizures brought on by the abuse of drugs or alcohol. These people should use amoxapine only with caution and be closely monitored by their physician.
Amoxapine may increase heart rate and stress on the heart. It may be dangerous for people with cardiovascular disease, especially those who have recently had a heart attack, to take this drug or other antidepressants in the same pharmacological class. In rare cases in which patients with cardiovascular disease must receive amoxap-ine, they should be monitored closely for cardiac rhythm disturbances and signs of cardiac stress or damage.
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