Amoxapine neurotoxicity: a case report with long-term follow-up

At this time, because of the lack of knowledge and experience in the treatment of amoxapine toxicity, it is impossible to formulate any conclusions concerning this drug's true toxic potential and capabilities. In toxic situations, amoxapine appears to produce some of the expected sequelae associated with TCAs. Neurotoxicity appears to be amoxapine's greatest toxic liability; the drug seems to have the ability to produce unusual neurological alterations, as well as a tendency to induce severe seizure activity. Procedures generally utilized for treatment of TCA or neuroleptic overdoses may prove inappropriate for dibenzoxazepine overdoses. It appears that intervention should include combating initiation of seizure activity and maintaining functional acid-base status. It has yet to be determined whether amoxapine or other dibenzoxazepine derivatives have a greater potential than other TCAs for inducing metabolic acidosis in toxic situations. However, observations from cases presented here would indicate this to be a distinct possibility.