PARIS – The inhaled powder formulation of loxapine appears to be a safe and effective treatment for acute agitation in patients with personality disorders, Diego R. Mendez Mareque, MD, reported at the annual congress of the European College of Neuropsychopharmacology.
Inhaled loxapine is approved for the treatment of acute agitation associated with schizophrenia or bipolar I disorder. Its use in patients with borderline personality and other personality disorders is off label. But this inhaled typical antipsychotic shows promise in filling an unmet need for a rapid-acting, minimally invasive treatment for acute agitation in patients with personality disorders, a very common scenario in psychiatric wards and emergency departments, and one that can quickly escalate to aggression and violence, noted Dr. Mendez Mareque of the Galician Health Service in Ferrol, Spain.
He presented a prospective, longitudinal, observational pilot study of 14 patients with personality disorders treated with a single 10-mg dose of inhaled loxapine while experiencing acute agitation in a psychiatric emergency department or psychiatric ward. Their mean baseline score on the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC) was 20.8 out of a possible 35 points. The scale assesses five domains: excitement, tension, uncooperativeness, hostility, and poor impulse control.
Within 10 minutes after administration of inhaled loxapine by a health care professional, 11 patients showed a significant drop on the PANSS-EC. They were calm, nonsedated, and ready for assessment. Within 20 minutes, their PANSS-EC scores were reduced by roughly half, compared with baseline.
Three patients were nonresponders. They received rescue treatment with oral or injectable antipsychotics and benzodiazepines.
None of the 14 patients had a history of airway disease, and none experienced bronchospasm, a known possible side effect of inhaled loxapine, the psychiatrist noted.
The results of this Spanish observational study confirm the benefits of inhaled loxapine for treating agitation in patients with borderline personality disorder previously described in a German case series (J Clin Psychopharmacol. 2015 Dec;35[6]:741-3).
Dr. Mendez Mareque reported having no financial conflicts of interest regarding his study.