Case report: Effectiveness of inhalative loxapin in the treatment of therapy refractory agitation

Agitation is a common symptom occurring in different psychiatric disorders. As a state of severe excitement and tension, agitation may also be associated with aggressive behavior. Thus, there is a great need for treatment options, in particular drug therapies, that have a rapid short-term effect. We treated a 26-year-old patient with mixed personality disorder with antisocial and impulsive features (ICD-10:F61) who frequently presented himself with states of severe agitation and aggression and urgently demanded medication to calm down. In the course of treatment, high doses of several antipsychotics (i. e. quetiapine 1000 mg/d, haloperidole 40 mg/d, olanzapine 50 mg/d) and benzodiazepins (i. e. diazepam 40 mg/d) were given as acute medication, but didn’t show any significant effect on the described states. In the subsequent inpatient care, the patient received inhalative loxapine (Adasuve 9,1 mg) for the first time. Following the first drug administration, there was a rapid and strong improvement of agitation and aggression that lasted for more than 24 hours. In this period, no other medication was required. However, the patient also reported side effects in terms of a marked sedation and sleepiness. Also in subsequent administrations of inhalative loxapine, there was a reliable improvement of symptoms for at least four hours. After discharge from hospital, a comparable effect was obtained by an off-label pnr medication with oral loxapine (up to 3 × 25 mg/d). This case demonstrates that inhalative loxapine may be a beneficial treatment option for agitation in psychiatric patients also beyond the official approval for schizophrenia and bipolar disorder.