Asendin: Advanced Relief for Major Depressive Disorder
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Asendin (amoxapine) is a tetracyclic antidepressant indicated for the treatment of major depressive disorder. It functions primarily by inhibiting the reuptake of norepinephrine, thereby increasing its availability in the central nervous system. This mechanism offers a distinct neurochemical approach for patients who have not achieved satisfactory results with first-line SSRI therapies. Clinical evidence supports its efficacy in managing both emotional and somatic symptoms associated with moderate to severe depression.
Features
- Active ingredient: amoxapine
- Available in 25 mg, 50 mg, 100 mg, and 150 mg oral tablets
- Tetracyclic antidepressant (TeCA) class
- Dual mechanism: norepinephrine reuptake inhibition and moderate dopamine blockade
- Bioavailability of approximately 90% following oral administration
- Peak plasma concentration reached within 1–2 hours
- Half-life of approximately 8 hours in healthy adults
- Metabolized primarily via hepatic pathways (CYP2D6)
Benefits
- Provides rapid onset of antidepressant effect, often within 4–7 days
- Effective in reducing both psychological and physical symptoms of depression
- May improve energy levels and motivation in lethargic or anergic patients
- Demonstrates efficacy in treatment-resistant depression cases
- Lower incidence of sexual side effects compared to SSRIs
- May alleviate certain anxiety components often comorbid with depression
Common use
Asendin is primarily prescribed for the management of major depressive disorder (MDD) in adults. It is particularly considered in cases where patients exhibit symptoms such as psychomotor retardation, fatigue, and concentration difficulties. Off-label uses may include adjunctive treatment in certain anxiety disorders, though such applications require careful clinical justification and monitoring. It is not typically considered a first-line treatment but serves as a valuable option when other antidepressants prove ineffective or poorly tolerated.
Dosage and direction
Initial dosing for adults is typically 25 mg two to three times daily. Depending on patient tolerance and clinical response, the dosage may be gradually increased. The effective therapeutic dose usually ranges between 200 mg and 300 mg per day, though some patients may require up to 400 mg daily in divided doses. Dosage adjustments should occur at intervals of no less than three days. Elderly patients or those with hepatic impairment should initiate therapy at lower doses (e.g., 10–25 mg once daily). Tablets should be swallowed whole with water and may be taken with or without food, though consistent administration with meals may reduce gastrointestinal discomfort.
Precautions
Patients should be monitored for emerging suicidal ideation, particularly during the initial weeks of therapy or following dosage adjustments. Regular assessment of hepatic and renal function is advised during prolonged treatment. Caution is warranted in patients with cardiovascular disease, glaucoma, urinary retention, or seizure disorders. Asendin may impair cognitive or motor performance; patients should avoid operating machinery or driving until their response to the medication is established. Abrupt discontinuation should be avoided due to risk of withdrawal symptoms; tapering over at least two weeks is recommended.
Contraindications
Asendin is contraindicated in patients with known hypersensitivity to amoxapine or any component of the formulation. Concurrent use with monoamine oxidase inhibitors (MAOIs) is prohibited due to risk of serotonin syndrome; a minimum 14-day washout period must be observed when switching between these agents. Additional contraindications include recent myocardial infarction, uncompensated heart failure, and severe hepatic impairment. The medication is not approved for use in pediatric patients under 18 years of age.
Possible side effects
Common adverse reactions (≥5% incidence) include drowsiness, dry mouth, constipation, blurred vision, and dizziness. Less frequently (1–5%), patients may experience orthostatic hypotension, tachycardia, weight gain, or increased sweating. Rare but serious side effects (<1%) include neuroleptic malignant syndrome, tardive dyskinesia, seizures, and blood dyscrasias. Any emergence of extrapyramidal symptoms should prompt immediate clinical evaluation. Most side effects are dose-dependent and may diminish with continued therapy or dosage adjustment.
Drug interaction
Asendin demonstrates significant interaction potential through CYP2D6 inhibition. Concurrent use with other serotonergic agents (e.g., SSRIs, SNRIs, triptans) increases risk of serotonin syndrome. Potent CYP2D6 inhibitors (quinidine, fluoxetine) may increase amoxapine plasma concentrations. Anticholinergic effects may be amplified when used with other anticholinergic medications. Concurrent use with CNS depressants (alcohol, benzodiazepines, opioids) may produce additive sedation. Asendin may reduce the antihypertensive effect of guanethidine and similar agents.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed administration. Consistent timing is important to maintain stable plasma concentrations, though occasional minor variations (within 2–3 hours) are unlikely to significantly impact therapeutic efficacy.
Overdose
Amoxapine overdose represents a medical emergency with potentially fatal consequences. Symptoms may include severe cardiac arrhythmias, profound hypotension, seizures, coma, and respiratory depression. Mortality rates are significant in ingestions exceeding 1 gram. Treatment is supportive and symptomatic, with emphasis on cardiac monitoring for at least 72 hours. Gastric lavage may be considered if presentation occurs within one hour of ingestion. Activated charcoal may be administered. There is no specific antidote; forced diuresis and hemodialysis are not effective due to high protein binding and extensive tissue distribution.
Storage
Store at controlled room temperature (20–25°C or 68–77°F) in the original container. Protect from light and moisture. Keep tightly closed and out of reach of children and pets. Do not transfer tablets to alternative containers without proper labeling. Discard any medication that shows signs of deterioration (discoloration, unusual odor) or that has expired. Proper disposal should follow local regulations for pharmaceutical waste, preferably through medication take-back programs.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Prescription and use of Asendin must be under the supervision of a qualified healthcare professional. Individual response to medication may vary based on genetic factors, comorbidities, and concomitant therapies. The prescribing physician should be consulted for specific recommendations tailored to the patient’s clinical situation. Full prescribing information including boxed warnings should be reviewed before initiation of therapy.
Reviews
Clinical studies demonstrate response rates of approximately 65–70% in patients with major depressive disorder, with particular efficacy noted in cases featuring prominent fatigue and cognitive slowing. Many clinicians report satisfactory outcomes in treatment-resistant cases where multiple SSRIs have failed. Some patients note improved energy levels within the first week of therapy. However, side effect profile remains a consideration, with approximately 15–20% of patients discontinuing therapy due to adverse effects, primarily anticholinergic symptoms. Long-term maintenance data support sustained efficacy over 6–12 month periods with appropriate monitoring.