Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2007 Oct 17;2007(4):CD001943.
doi: 10.1002/14651858.CD001943.pub2.

Loxapine for schizophrenia

A Chakrabarti  1 , A Bagnall, P Chue, M Fenton, V Palaniswamy, W Wong, J Xia
Affiliations
Meta-Analysis

Loxapine for schizophrenia

A Chakrabarti et al. Cochrane Database Syst Rev. .

Abstract

Background: Some authors have suggested that loxapine is more effective than typical antipsychotics in reducing the negative symptoms of schizophrenia, that extrapyramidal adverse effects are not usually seen at clinically effective antipsychotic doses and that it should therefore be classed as atypical.

Objectives: To determine the effects of loxapine compared with placebo, typical and other atypical antipsychotic drugs for schizophrenia and related psychoses.

Search strategy: For this 2007 update, we searched the Cochrane Schizophrenia Group's Register (January 2007).

Selection criteria: We included all randomised controlled clinical trials relevant to the care of schizophrenia that compared loxapine to other treatments.

Data collection and analysis: We independently inspected abstracts ordered papers, re-inspected and quality assessed these. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a fixed effects model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated weighted mean differences (WMD) again based on a fixed effects model.

Main results: We were able to include 41 studies in this review. Compared with placebo, loxapine has an antipsychotic effect (Global effect - not improved at six weeks: n=78, 2 RCTs, RR 0.30 CI 0.1 to 0.6 NNT 3 CI 3 to 5). It is as effective as typical drugs in the short term (4 -12 weeks) (Global effect: n=580, 13 RCTs, RR 0.86 CI 0.7 to 1.1; mental state: n=915, 6 RCTs, RR 0.89 CI 0.8 to 1.1). Very limited heterogeneous data suggest that, given intramuscularly (IM), loxapine may be at least as sedating as IM haloperidol and thiothixene. Loxapine is also as effective as atypicals (risperidone, quetiapine) (n=468, 6 RCTs, RR mental state not improved 1.07 CI 0.8 to 1.5). Adverse effect profile is similar to typicals but loxapine may cause more extrapyramidal adverse effects when compared with atypicals (n=340, 4 RCTs, RR 2.18 CI 1.6 to 3.1).

Authors' conclusions: Loxapine is an antipsychotic which is not clearly distinct from typical or atypical drugs in terms of its effects on global or mental state. Loxapines profile of adverse effects is similar to that of the older generation of antipsychotic drugs.

PubMed Disclaimer

Conflict of interest statement

Mark Fenton has lead Janssen, Lilly and Zeneca sponsored workshops for clinicians.

Jo Wood is Medical Information Officer for Janssen Cilag UK, and worked on this review to increase her knowledge of the process of systematic reviewing.

The Cochrane Schizophrenia Group has received general support funding from Eli Lilly during the years 1996‐9 (see Group Module).

Figures

1
1
Loxapine ‐ structure
1.1
1.1. Analysis
Comparison 1 LOXAPINE versus PLACEBO, Outcome 1 Leaving the study early ‐ any reason.
1.2
1.2. Analysis
Comparison 1 LOXAPINE versus PLACEBO, Outcome 2 Removed from analysis.
1.3
1.3. Analysis
Comparison 1 LOXAPINE versus PLACEBO, Outcome 3 Global effect: 1. Not improved.
1.4
1.4. Analysis
Comparison 1 LOXAPINE versus PLACEBO, Outcome 4 Global effect: 2. Needing additional antipsychotic/sedative drugs.
1.5
1.5. Analysis
Comparison 1 LOXAPINE versus PLACEBO, Outcome 5 Mental state: Specific symptoms ‐ anxiety/tension.
1.6
1.6. Analysis
Comparison 1 LOXAPINE versus PLACEBO, Outcome 6 Adverse effects: 1. Any adverse event.
1.7
1.7. Analysis
Comparison 1 LOXAPINE versus PLACEBO, Outcome 7 Adverse effects: 2. Anticholinergic effects ‐ specific symptoms.
1.8
1.8. Analysis
Comparison 1 LOXAPINE versus PLACEBO, Outcome 8 Adverse effects: 3. Cardiovascular problems.
1.9
1.9. Analysis
Comparison 1 LOXAPINE versus PLACEBO, Outcome 9 Adverse effects: 4. Gastrointestinal problems.
1.10
1.10. Analysis
Comparison 1 LOXAPINE versus PLACEBO, Outcome 10 Adverse effects: 5. Movement disorders.
1.11
1.11. Analysis
Comparison 1 LOXAPINE versus PLACEBO, Outcome 11 Adverse effects: 6. Neurological.
1.12
1.12. Analysis
Comparison 1 LOXAPINE versus PLACEBO, Outcome 12 Adverse effects: 7. Sleep problems.
1.13
1.13. Analysis
Comparison 1 LOXAPINE versus PLACEBO, Outcome 13 Adverse effects: 8. Weight changes.
1.14
1.14. Analysis
Comparison 1 LOXAPINE versus PLACEBO, Outcome 14 Adverse effects: 9.Others.
2.1
2.1. Analysis
Comparison 2 LOXAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 1 Leaving the study early ‐ any reason.
2.2
2.2. Analysis
Comparison 2 LOXAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 2 Removed from analysis.
2.3
2.3. Analysis
Comparison 2 LOXAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 3 Global effect: 1. Not improved (CGI).
2.4
2.4. Analysis
Comparison 2 LOXAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 4 Global effect: 2. Not ready for discharge ‐ up to 4 weeks.
2.5
2.5. Analysis
Comparison 2 LOXAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 5 Global effect: 3. Needing additional antipsychotic/sedative drugs ‐ up to 6 weeks.
2.6
2.6. Analysis
Comparison 2 LOXAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 6 Global effect: 4. Participant rating of illness.
2.7
2.7. Analysis
Comparison 2 LOXAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 7 Mental state: 1a. General ‐ not improved, by 8 weeks (BPRS/PANSS).
2.8
2.8. Analysis
Comparison 2 LOXAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 8 Mental state: 1b. General ‐ average endpoint score, by 8 weeks (BPRS, high score=worse).
2.9
2.9. Analysis
Comparison 2 LOXAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 9 Mental state: 1c. General ‐ average endpoint score, by 8 weeks (PANSS, high score=worse).
2.10
2.10. Analysis
Comparison 2 LOXAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 10 Mental state: 1d. General ‐ average change score (BPRS, high score=worse).
2.11
2.11. Analysis
Comparison 2 LOXAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 11 Mental state: 2. Specific.
2.12
2.12. Analysis
Comparison 2 LOXAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 12 Adverse effects: 1. Average change score, by 8 weeks (TESS, high score=worse).
2.13
2.13. Analysis
Comparison 2 LOXAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 13 Adverse effects: 2. Any adverse event.
2.14
2.14. Analysis
Comparison 2 LOXAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 14 Adverse effects: 3. Anticholinergic effects ‐ specific symptoms.
2.15
2.15. Analysis
Comparison 2 LOXAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 15 Adverse effects: 4. Cardiovascular problems.
2.16
2.16. Analysis
Comparison 2 LOXAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 16 Adverse effects: 5. Gastrointestinal problems.
2.17
2.17. Analysis
Comparison 2 LOXAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 17 Adverse effects: 6. Movement disorders.
2.18
2.18. Analysis
Comparison 2 LOXAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 18 Adverse effects: 7. Neurological problems.
2.19
2.19. Analysis
Comparison 2 LOXAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 19 Adverse effects: 8. Sleep problems.
2.20
2.20. Analysis
Comparison 2 LOXAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 20 Adverse effects: 9. Weight changes.
2.21
2.21. Analysis
Comparison 2 LOXAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 21 Adverse effects: 10. Others.
3.1
3.1. Analysis
Comparison 3 LOXAPINE IM versus TYPICAL ANTIPSYCHOTIC IM FOR RAPID TRANQUILISATION, Outcome 1 Withdrawn from or leaving the study early ‐ by 72 hours.
3.2
3.2. Analysis
Comparison 3 LOXAPINE IM versus TYPICAL ANTIPSYCHOTIC IM FOR RAPID TRANQUILISATION, Outcome 2 General effect: Not tranquilised.
3.3
3.3. Analysis
Comparison 3 LOXAPINE IM versus TYPICAL ANTIPSYCHOTIC IM FOR RAPID TRANQUILISATION, Outcome 3 Mental state: Average endpoint score ‐ at 72 hours (BPRS, high score=worse).
3.4
3.4. Analysis
Comparison 3 LOXAPINE IM versus TYPICAL ANTIPSYCHOTIC IM FOR RAPID TRANQUILISATION, Outcome 4 Adverse effects: 1. Any event ‐ 72 hours.
3.5
3.5. Analysis
Comparison 3 LOXAPINE IM versus TYPICAL ANTIPSYCHOTIC IM FOR RAPID TRANQUILISATION, Outcome 5 Adverse effects: 2. Movement ‐ specific symptoms.
3.6
3.6. Analysis
Comparison 3 LOXAPINE IM versus TYPICAL ANTIPSYCHOTIC IM FOR RAPID TRANQUILISATION, Outcome 6 Adverse effects: 3. Other.
4.1
4.1. Analysis
Comparison 4 LOXAPINE HIGH DOSE versus LOXAPINE LOW DOSE, Outcome 1 Leaving the study early ‐ any reason ‐ 12 weeks.
4.2
4.2. Analysis
Comparison 4 LOXAPINE HIGH DOSE versus LOXAPINE LOW DOSE, Outcome 2 Global effect: 1. Not improved ‐ 12 weeks.
4.3
4.3. Analysis
Comparison 4 LOXAPINE HIGH DOSE versus LOXAPINE LOW DOSE, Outcome 3 Global effect: 2. Needing additional antipsychotic/sedative drugs ‐ 12 weeks.
4.4
4.4. Analysis
Comparison 4 LOXAPINE HIGH DOSE versus LOXAPINE LOW DOSE, Outcome 4 Adverse effects: 1. Any event ‐ 12 weeks.
4.5
4.5. Analysis
Comparison 4 LOXAPINE HIGH DOSE versus LOXAPINE LOW DOSE, Outcome 5 Adverse effects: 2. Anticholinergic effects ‐ specific symptoms.
4.6
4.6. Analysis
Comparison 4 LOXAPINE HIGH DOSE versus LOXAPINE LOW DOSE, Outcome 6 Adverse effects: 3. Cardiovascular problems.
4.7
4.7. Analysis
Comparison 4 LOXAPINE HIGH DOSE versus LOXAPINE LOW DOSE, Outcome 7 Adverse effects: 4. Movement disorders.
4.8
4.8. Analysis
Comparison 4 LOXAPINE HIGH DOSE versus LOXAPINE LOW DOSE, Outcome 8 Adverse effects: 5. Sleep problems.
4.9
4.9. Analysis
Comparison 4 LOXAPINE HIGH DOSE versus LOXAPINE LOW DOSE, Outcome 9 Adverse effects: 6. Weight changes.
4.10
4.10. Analysis
Comparison 4 LOXAPINE HIGH DOSE versus LOXAPINE LOW DOSE, Outcome 10 Adverse effects: 7. Others ‐ abnormal blood results ‐ 12 weeks.
5.1
5.1. Analysis
Comparison 5 LOXAPINE versus ATYPICAL ANTIPSYCHOTICS, Outcome 1 Leaving the study early‐any reason ‐ 8 weeks.
5.2
5.2. Analysis
Comparison 5 LOXAPINE versus ATYPICAL ANTIPSYCHOTICS, Outcome 2 Removed from analysis ‐ 8 weeks.
5.3
5.3. Analysis
Comparison 5 LOXAPINE versus ATYPICAL ANTIPSYCHOTICS, Outcome 3 Mental state: 1. Not Improved, up to 8 weeks (PANSS).
5.4
5.4. Analysis
Comparison 5 LOXAPINE versus ATYPICAL ANTIPSYCHOTICS, Outcome 4 Mental state: 2a. Average endpoint score, by 8 weeks (BPRS, high score=worse).
5.5
5.5. Analysis
Comparison 5 LOXAPINE versus ATYPICAL ANTIPSYCHOTICS, Outcome 5 Mental state: 2b. Average endpoint score, by 8 weeks (PANSS, high score=worse).
5.6
5.6. Analysis
Comparison 5 LOXAPINE versus ATYPICAL ANTIPSYCHOTICS, Outcome 6 Adverse effects: 1. Average change score, by 8 weeks (TESS, high score=worse).
5.7
5.7. Analysis
Comparison 5 LOXAPINE versus ATYPICAL ANTIPSYCHOTICS, Outcome 7 Adverse effects: 2. Movement disorders ‐ 8 weeks.
5.8
5.8. Analysis
Comparison 5 LOXAPINE versus ATYPICAL ANTIPSYCHOTICS, Outcome 8 Adverse effects: 3. Cardiovascular ‐ 8 weeks.
5.9
5.9. Analysis
Comparison 5 LOXAPINE versus ATYPICAL ANTIPSYCHOTICS, Outcome 9 Adverse effects: 4. Sleep problems ‐ 8 weeks.
5.10
5.10. Analysis
Comparison 5 LOXAPINE versus ATYPICAL ANTIPSYCHOTICS, Outcome 10 Adverse effects: 5. Others ‐ 8 weeks.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Bagadia 1980 {published data only}
    1. Bagadia VN, Shah LP, Abhyankar RR. A double‐blind controlled trial of loxapine and trifluoperazine in adolescent schizophrenia. Current Therapeutic Research, Clinical and Experimental 1980;27(6):886‐96. [MEDLINE: ; PMID 361345] - PubMed
Bishop 1970 {published data only}
    1. Bishop MP, Gallant DM. Loxapine: a controlled evaluation in chronic schizophrenic patients. Current Therapeutic Research ‐ Clinical and Experimental 1970;12(9):594‐7. - PubMed
Charalampous 1974 {published data only}
    1. Charalampous KD, Freemesser GF, Malev J, Ford K. Loxapine succinate: A controlled double blind study in schizophrenia. Current Therapeutic Research 1974;6(8):829‐37. - PubMed
Clark 1972 {published data only}
    1. Clark ML, Huber WK, Sullivan J, Wood F, Costiloe JP. Evaluation of loxapine succinate in chronic schizophrenia. Diseases of the Nervous System 1972;33:783‐91. - PubMed
Clark 1975 {published data only}
    1. Clark ML, Paredes A, Costiloe JP, Wood F, Barrett A. Loxapine in newly admitted chronic schizophrenic patients. Journal of Clinical Pharmacology 1975;15(4):286‐94. - PubMed
Clark 1977 {published data only}
    1. Clark ML, Paredes A, Costiloe JP, Fulkerson FG, Wood F. Evaluation of two dose levels of loxapine succinate in chronic schizophrenia. Diseases of the Nervous System 1977;38(1):7‐10. - PubMed
Du 2003 {published data only}
    1. Du B‐G, Fang R‐L. Control studies on curative effects of loxapine succinate and risperidone in schizophrenics. Journal of Clinical Psychosomatic Diseases 2003;9(1):16‐9. [CAJ]
Dube 1976 {published data only}
    1. Dube KC, Kumar N. Loxapine succinate: a comparative study with chlorpromazine. Current Therapeutic Research ‐ Clinical and Experimental 1976;19(6):653‐60. - PubMed
Dubin 1996 {published data only}
    1. Dubin WR, Weiss KJ. Rapid tranquilization: a comparison of thiothixene with loxapine. Journal of Clinical Psychiatry 1986;47(6):294‐7. - PubMed
Fruensgaard 1977 {published data only}
    1. Fruensgaard K, Korsgaard S, Jorgensen H, Jensen K. Loxapine versus haloperidol parenterally in acute psychosis with agitation. A double‐blind study. Acta Psychiatrica Scandinavica 1977;56(4):256‐64. - PubMed
Fruensgaard 1978 {published data only}
    1. Fruensgaard K, Wollenberg J, Hansen KM, Fensbo C, Sihm F. Loxapine versus perphenazine in psychotic patients. A double‐blind, randomized, multicentre trial. Current Medical Research and Opinion 1978;5(8):601‐7. [MEDLINE: ; PMID 361345] - PubMed
Gallant 1971 {published data only}
    1. Gallant, Bishop. Oxilapine versus Trifluoperazine. Psychopharmacology Bulletin 1971;7(1):40‐3. [08024]
Huang 1997 {published data only}
    1. Huang S, Qin Y, Wang L. Study on the efficacy of loxapine in treatment of schizo phrenia in comparison with chlorpromazine. Chinese New Drugs Journal 1997;6(3):161‐4. [MEDI9706]
Kiloh 1976 {published data only}
    1. Kiloh LG, Williams SE, Grant DA, Whetton PS. A double‐blind comparative trial of loxapine and trifluoperazine in acute and chronic schizophrenic patients. Journal of International Medical Research 1976;4(6):441‐8. [MEDLINE: ; PMID 800384] - PubMed
Kramer 1978 {published data only}
    1. Kramer MR, Thomas SPJ, Zorick FJ, Blackwell B. Relative efficacy and safety of loxapine succinate (Loxitane) and thioridazine hydrochloride (Mellaril) in the treatment of acute schizophrenia. Current Therapeutic Research 1978;23(5):619‐31.
Li 2004 {published data only}
    1. Li Y, Shang J, Li C. Control study of loxapine succinate and clozapine on curative effects in treatment of schizophrenics. Heath Psychology Journal 2004;12(3):202. [115139]
Li 2005a {published data only}
    1. Li L‐X, Li C‐Y. A comparative study of loxapine succinate and risperidone in the treatment of schizophrenia. Shandong Archives of Psychiatry 2005;18(4):246‐7. [CAJ MEDI0510]
Li 2005b {published data only}
    1. Li Zhong‐yi, HE Rui‐fang. Comparative study between loxapine and risperedone in treatment of schizophrenia. Journal of clinical psychological medicine 2005;15(1):11‐12. [MEDLINE: ]
Liu 2005 {published data only}
    1. Liu. Control study of loxapine and chlorpromazine in the treatment of schizophrenia. Medical Journal of Chinese People's Health 2005;17(9):503‐4.
Lu 2003 {published data only}
    1. Lu X‐Q, Zhu G‐L. Control studies of loxapine succinate and clozapine in treatment of schizophrenia. Journal of Clinical Psychosomatic Diseases 2003;9(3):157‐8. [115139]
Malik 1980 {published data only}
    1. Malik SC, Kumar K. Loxapine in adolescent schizophrenia ‐ a comparative study with trifluoperazine. Current Therapeutic Research ‐ Clinical and Experimental 1980;28(3):432‐46.
Moore 1975 {published data only}
    1. Moore DF. Treatment of acute schizophrenia with loxapine succinate (Loxitane) in a controlled study with chlorpromazine. Current Therapeutic Research 1975;18(1):172‐80. - PubMed
Moyano 1975 {published data only}
    1. Moyano CZ. A double‐blind comparison of loxitane‐‐loxapine succinate and trifluoperazine hydrochloride in chronic schizophrenic patients. Diseases of the Nervous System 1975;36(6):301‐4. - PubMed
Pool 1976 {published data only}
    1. Pool D, et al. A controlled evaluation of loxitane in seventy‐five adolescent schizophrenic patients. Current Therapeutic Research 1976;19(1):99‐104. [PsycINFO 1976‐10411‐001] - PubMed
Rifkin 1984 {published data only}
    1. Rifkin A, Rieder E, Sarantakos S, Saraf K, Kane J. Is loxapine more effective than chlorpromazine in paranoid schizophrenia?. American Journal of Psychiatry 1984;141(11):1411‐3. - PubMed
Schiele 1975 {published data only}
    1. Schiele BC. Loxapine succinate: a controlled double‐blind study in chronic schizophrenia. Diseases of the Nervous System 1975;36(7):361‐4. - PubMed
Selman 1976 {published data only}
    1. Selman FB, McClure RF, Helwig DH. Loxapine succinate ‐ A double‐blind comparison with haloperidol and placebo in acute schizophrenics [Loxapine succinate ‐ essai comparatif en double aveugle avec l'haloperidol et un placebo dans les psychoses aigues]. Psychologie Medicale 1979;11(7):1533‐40.
    1. Selman FB, McClure RF, Helwig H. Loxapine succinate: A double‐blind comparison with haloperidol and placebo in acute schizophrenics. Current Therapeutic Research 1976;19(6):645‐52. - PubMed
Seth 1979 {published data only}
    1. Seth S, Mahal AS, Kumar KA. A double‐blind comparative trial of loxapine and trifluperazine in chronic schizophrenic patients. Current Therapeutic Research 1979;25(2):320‐9.
Shopsin 1972 {published data only}
    1. Gershon S. Loxapine vs chlorpromazine. Early clinical drug evaluation units report 1972;9:67‐70.
    1. Shopsin B, Pearson E, Gershon S, Collins P. A controlled double‐blind comparison between loxapine succinate and chlorpromazine in acute newly hospitalized schizophrenic patients. Current Therapeutic Research ‐ Clinical and Experimental 1972;14(11):739‐48. - PubMed
Simpson 1976 {published data only}
    1. Simpson GM, Cuculic Z. A double‐blind comparison of loxapine succinate and trifluoperazine in newly admitted schizophrenic patients. Journal of Clinical Pharmacology 1976;16(1):60‐5. - PubMed
Steinbook 1973 {published data only}
    1. Steinbook R, Goldstein BJ, Brauzer B, Moreno SS, Jacobson AF. Loxapine: A double blind comparison with chlorpromazine in acute schizophrenic patients. Current Therapeutic Research ‐ Clinical and Experimental 1973;15(1):1‐7. - PubMed
Tu 2004 {published data only}
    1. Tu Z‐M, Gao S‐R, Ye S‐N. Controlled study of loxapine and chlorpromazine in the treatment of schizophrenia. Medical Journal of Chinese People Health 2004;16(7):415‐7. [MED10505]
Tuason 1984 {published data only}
    1. Tuason VB, Escobar JI, Garvey M, Schiele B. Loxapine versus chlorpromazine in paranoid schizophrenia: A double blind study. Journal of Clinical Psychiatry 1984;45(4):158‐63. - PubMed
Tuason 1986 {published data only}
    1. Tuason VB. A comparison of parenteral loxapine and haloperidol in hostile and aggressive acutely schizophrenic patients. Journal of Clinical Psychiatry 1986;47(3):126‐9. - PubMed
Van Der Velde 1975 {published data only}
    1. Velde CD, Kiltie H. Effectiveness of loxapine succinate in acute schizophrenia: A comparative study with thiothixene. Current Therapeutic Research 1975;17(1):1‐12. - PubMed
Vyas 1980 {published data only}
    1. Vyas BK, Kalla V. A six‐month double‐blind comparison of loxapine succinate and chlorpromazine in chronic schizophrenic patients. Current Therapeutic Research ‐ Clinical and Experimental 1980;28(1):16‐30.
Wang 1996 {published data only}
    1. Wang L, Wang Z, Wang Y. Using loxapine succinate and chlorpromazine for treating schizophrenia. Tianjing Medical Journal 1996;24(11):672‐5. [115139]
Wang 2005a {published data only}
    1. Wang. Control study of Loxapine and Quetiapine treating first onset schizophrenia. Chinese journal of behavioural medical science 2005;14(8):752.
Wang 2005b {published data only}
    1. Wang H‐Y, Wang G‐P, Pei G‐X. A comparative study of loxapine and risperidone in the treatment of schizophrenic patients. Shandong Archives of Psychiatry 2005;18(1):28‐9. [CAJ]
Xue 2004 {published data only}
    1. Xue S‐J, Huang J‐M, Yang M‐Z. A comparison study on loxapine and chlorpromazine in the treatment of schizophrenia. Medical Journal of Chinese People Health 2004;16(10):593‐4. [115139]
Zhang 2005 {published data only}
    1. Zhang. Control study of Loxapine treatment in schizophrenia. Sichuan Mental Health 2005;18(4):222‐4.

References to studies excluded from this review

Ananth 1980 {published data only}
    1. Ananth, JV, Steen N. The place of loxapine ‐ a new neuroleptic drug. Psychiatric Journal of the University of Ottawa 1980;5(4):279‐82.
Bishop 1977 {published data only}
    1. Bishop MP, Simpson GM, Dunnett CW, Kiltie H. Efficacy of loxapine in the treatment of paranoid schizophrenia. Psychopharmacology 1977;51:107‐15. - PubMed
Branchey 1981 {published data only}
    1. Branchey MH, Branchey LB, Richardson MA. Effects of neuroleptic adjustment on clinical condition and tardive dyskinesia in schizophrenic patients. American Journal of Psychiatry 1981;138(5):608‐12. [MEDLINE: ; PMID 7015884] - PubMed
    1. Branchey MH, Branehey LB, Richardson MA. Effects of gradual decrease and discontinuation of neuroleptics on clinical condition and tardive dyskinesia. Psychopharmacology Bulletin 1981;17(1):118‐20. [MEDLINE: ; PMID 7232639] - PubMed
Brown 2003 {published data only}
    1. Brown ES, Nejtek VA, Perantie DC, Thomas NR, Rush AJ. Cocaine and amphetamine use in patients with psychiatric: Illness a randomized trial of typical antipsychotic continuation or discontinuation. Journal of Clinical Psychopharmacology 2003;23(4):384‐8. [EMBASE 2003319642] - PubMed
Bueno 1979 {published data only}
    1. Bueno JR. A double‐blind comparative clinical trial with loxapine succinate and haloperidol in the treatment of Schizophrenia [Ensaio clinico comparativo e duplo‐cego com succina de loxapina e haloperidol no tratamento da esquizofrenia]. Folha Medica 1979;78(1):47‐52. [CENTRAL 79169917; CENTRAL CN‐00316048]
Burdock 1974 {published data only}
    1. Burdock EI, Gershon S, Hardesty AS, Linden KJ. Problems and profits of cross‐national collaborative studies. Diseases of the Nervous System 1974;35(7, Sect 2):31‐2. - PubMed
Cottereau 1979 {published data only}
    1. Cottereau MJ, Poirier MF, Loo H, Deniker P. The loxapine succinate: A new major tranquillizer [Le succinate de loxapine: un nouveau neuroleptique]. Encephale 1979;5:251‐67. - PubMed
Delteil 1980 {published data only}
    1. Delteil P. Clinical trial of a new neuroleptic, loxapine [Essai clinique d'un nouveau neuroleptique la loxapine]. Psychiatrique 1980;56:915‐6.
Jones 2006 {published data only}
    1. Jones PB, Barnes TRE, Davies L, Dunn G, Lloyd H, Hayhurst KP, Murray RM, Markwick A, Lewis SW. Randomized controlled trial of the effect on quality of life of second‐ vs first‐generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1). Archives of General Psychiatry 2006;63(10):1079‐87. [MEDLINE: ; EMBASE 2006486244] - PubMed
Leone 1982 {published data only}
    1. Leone NF. Response of borderline patients to loxapine and chlorpromazine. Journal of Clinical Psychiatry 1982;43(4):148‐50. - PubMed
Lewis 2006 {published data only}
    1. Lewis SW, Davies L, Jones PB, Barnes TRE, Murray RM, Kerwin R, Taylor D, Hayhurst KP, Markwick A, Lloyd H, Dunn G. Randomised controlled trials of conventional antipsychotic versus new atypical drugs, and new atypical drugs versus clozapine, in people with schizophrenia responding poorly to, or intolerant of, current drug treatment. Health Technology Assessment 2006;10(17):iii‐xi, 1‐182. [MEDLINE: ; EMBASE 2006300640; CINAHL 2009206784] - PubMed
Lourido 1979 {published data only}
    1. Lourido E, Santa Cruz A. Comparative treatment of chronic psychoses with loxapine and thioridazine: a double‐blind clinical study. Current Therapeutic Research 1979;25(5):681‐9.
Maes 1996 {published data only}
    1. Maes M, Bosmans E, Ranjan R, Vandoolaeghe E, et al. Lower plasma CC16, a natural anti‐inflammatory protein, and increased plasma interleukin‐l receptor antagonist in schizophrenia: Effects of antipsychotic drugs. Schizophrenia Research 1996;21(1):39‐50. - PubMed
Mahmoud 2004 {published data only}
    1. Mahmoud RA, Engelhart LM, Janagap CC, Oster G, Ollendorf D. Risperidone versus conventional antipsychotics for schizophrenia and schizoaffective disorder. Clinical Drug Investigation 2004;24(5):275‐86. - PubMed
Martin 1982 {published data only}
    1. Martin A. A multi‐center study of the effect of loxapine on 403 hospitalized, chronically psychotic patients [Efficacite et tolerance de la loxapine a propos d'un essai multicentrique sur 403 psychotiques hospitalises]. Psychologie Medicale 1982;14(9):1439‐52.
Mattke 1975 {published data only}
    1. Mattke DJ, Mombour W, Glotzner FL. The assesment of neuroleptogenic extrapyramidial syndroms in psychopharmalogical research [Erfassung neuroleptisch bedingter extrapymidaler syndrome in einem psychopharmakologischen forschungsprojekt]. Pharmakopsychiat 1975;1:36‐44. - PubMed
Nair 1976 {published data only}
    1. Nair NP, Decker BL, Schwartz G. Loxapine succinate in the treatment of chronic schizophrenia. Current Therapeutic Research 1976;20(6):802‐9. - PubMed
Paprocki 1976 {published data only}
    1. Paprocki J, Barcala Peixoto MP, Andrade NM. A controlled double‐blind comparison between loxapine and haloperidol in acute newly hospitalized schizophrenic patients. Psychopharmacoly Bulletin 1976;12(2):32‐4. - PubMed
Paprocki 1977 {published data only}
    1. Paprocki J, Versiani M. A double‐blind comparison between loxapine and haloperidol by parenteral route in acute schizophrenia. Current Therapeutic Research 1977;21(1):80‐100. - PubMed
Rainaut 1975 {published data only}
    1. Rainaut J. Statistical analysis of the activity of loxapine and thioridazine in a double‐blind study [Analyse statistique de l'etude comparative double insu de l'activite de la loxapine et de la thioridazine]. Encephale 1975;1(2):147‐60. [MEDLINE: ; PMID 1100361] - PubMed
Serafetinides 1971 {published data only}
    1. Serafetinides EA, Willis D, Clark ML. The EEG effects of dibenzoxazepines (loxapine succinate) as compared to CPZ: EEG changes as drug side effects. International Pharmacopsychiatry 1971;6(1):38‐44. - PubMed
Serafetinides 1973 {published data only}
    1. Serafetinides EA. Consistency and similarity of drug EEG responses in chronic schizophrenic patients. International Pharmacopsychiatry 1973;8(4):214‐6. [MEDLINE: ; PsycINFO 52‐05954; PMID 4589640] - PubMed
Simpson 1976b {published data only}
    1. Branchey MH, Branchey LB, Richardson MA. Effects of neuroleptic adjustment on clinical condition and tardive dyskinesia in schizophrenic patients. American Journal of Psychiatry 1981;138(5):608‐12. - PubMed
    1. Simpson GM, Branchey MH, Lee JH, Varga E. Two year trial of loxapine succinate in chronic psychotic patients. Diseases of the Nervour System 1976;37(5):305‐7. - PubMed
Simpson 1978 {published data only}
    1. Simpson GM, Cooper TB, Lee JH, Young MA. Clinical and plasma level characteristics of intramuscular and oral loxapine. Psychopharmacology 1978;56(2):225‐32. [MEDLINE: ; PMID 417377] - PubMed
Ucer 1979 {published data only}
    1. Ucer E, Casey P. Effect of loxapine succinate in acutely ill schizophrenic outpatients. Current Therapeutic Research 1979;25(1):144‐9.
Versiani 1978 {published data only}
    1. Versiani M, Silva JA, Frota LH, Mundim FD. Double‐blind comparison between loxapine and haloperidol in the treatment of adolescent schizophrenic patients. Current Therapeutic Research 1978;24(5):559‐66.
Versiani 1980 {published data only}
    1. Versiani M, Silva JAR, Mundim FD. Loxapine versus thioridazine in the treatment of organic psychosis. Journal of International Medical Research 1980;8(1):22‐30. - PubMed
Vianna Filho 1975 {published data only}
    1. Vianna Filho U, Versiani Caldeira MV, Bueno J. Preliminary report on a double blind study comparing loxapine succinate with thiothixene in chronic schizophrenic patients. Jornal Brasileiro de Psiquiatria 1975;24(1):5‐27.
    1. Vianna‐Filho U, Versiani Caldeira V, Romildo Bueno J. The efficacy and safety of loxapine succinate in the treatment of schizophrenia: a comparative study with thiothixene. Current Therapeutic Research ‐ Clinical and Experimental 1975;18(3):476‐90. - PubMed
Yu 2004 {published data only}
    1. Yu H, Luo J‐Y, Xia S‐Y. Treatment of 44 cases of refractory schizophrenia with loxapine. Herald of Medicine 2004;23(10):723‐5. [MEDLINE: ]

Additional references

Adams 1999
    1. Adams CE, Gray R, Daniels J, Thornley B, Philpott H, Wahlbeck K. A survey of UK consultant psychiatrists first and second choice drug treatments for schizophrenia. Schizophrenia Trials Meeting, Stratford‐upon‐Avon. 5‐9th May, 1999.
Altman 1996
    1. Altman DG, Bland JM. Detecting skewness from summary information. BMJ 1996;313:1200. [LOX020600] - PMC - PubMed
APA 1994
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV). 4th Edition. Washington DC: American Psychiatric Association, 1994.
Begg 1996
    1. Begg C, Cho M, Eastwood S, Horton R, Moher D, Olkin I, Pitkin R, Rennie D, Schulz KF, Simel D, Stroup DF. Improving the quality of randomized controlled trials. The CONSORT statement. JAMA 1996;276:637‐9. - PubMed
Bland 1997
    1. Bland JM. Statistics notes. Trials randomised in clusters. BMJ 1997;315:600. - PMC - PubMed
Boissel 1999
    1. Boissel JP, Cucherat M, Li W, Chatellier G, Gueyffier F, Buyse M, Boutitie F, Nony P, Haugh M, Mignot G. The problem of therapeutic efficacy indices. 3. Comparison of the indices and their use. Therapie 1999;54(4):405‐11. - PubMed
Buckley 1997
    1. Buckley PF. New dimensions in the pharmacologic treatment of schizophrenia and related psychoses. Journal of Clinical Pharmacology 1997;37:363‐78. - PubMed
Carpenter 1994
    1. Carpenter WT Jr, Buchanan RW. Schizophrenia. New England Journal of Medicine 1994;330:681‐90. - PubMed
Casey 1997
    1. Casey DE. The relationship of pharmacology to side effects. Journal of Clinical Psychiatry 1997;58(10):55‐62. - PubMed
Chalmers 1983
    1. Chalmers TC, Celano P, Sacks HS, Smith H Jr. Bias in treatment assignment in controlled clinical trials. New England Journal of Medicine 1983;309:1358‐61. - PubMed
CWG 1998
    1. Collaborative Working Group on Clinical Trial Evaluations. Adverse effects of the atypical antipsychotics. Journal of Clinical Psychiatry 1998;59:17‐22. - PubMed
Deeks 2000
    1. Deeks J. Issues in the selection for meta‐analyses of binary data. Abstracts of 8th International Cochrane Colloquium; 2000 Oct 25‐28th; Cape Town, South Africa. 2000.
Divine 1992
    1. Divine GW, Brown JT, Frazier LM. The unit of analysis error in studies about physicians' patient care behavior. Journal of General Internal Medicine 1992;7(6):623‐9. - PubMed
Donner 2002
    1. Donner A, Klar N. Issues in the meta‐analysis of cluster randomized trials. Statistics in Medicine 2002;21:2971‐80. - PubMed
Egger 1997
    1. Egger M, Davey‐Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple graphical test. BMJ 1997;315:629‐34. - PMC - PubMed
Elwood 1982
    1. Elwood PC. Randomised controlled trials: sampling. British Journal of Clinical Pharmacology 1982;13:631‐6. - PMC - PubMed
Glazer 1997
    1. Glazer WM, Johnstone BM. Pharmacoeconomic evaluation of antipsychotic therapy for schizophrenia. Journal of Clinical Psychiatry 1997;58(10):50‐4. - PubMed
Gulliford 1999
    1. Gulliford MC. Components of variance and intraclass correlations for the design of community‐based surveys and intervention studies: data from the Health Survey for England 1994. American Journal of Epidemiology 1999;149:876‐83 876‐83. - PubMed
Guy 1976
    1. Guy W. Early clinical drug evaluation (ECDEU) assessment manual for psychopharmacology: National Institute of Mental Health Publication No.76‐338. Washington DC. National Institute of Mental Health Publication 1976; Vol. 76‐338:217‐22.
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327:557‐60. - PMC - PubMed
Higgins 2005
    1. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions 4.2.5 [updated May 2005]. The Cochrane Library. Chichester, UK: John Wiley & Sons, Ltd., 2005.
Hollis 1999
    1. Hollis S, Campbell F. What is meant by intention to treat analysis? Survey of published randomised controlled trials. BMJ 1999;319:670‐4. - PMC - PubMed
Kane 1996
    1. Kane JM. Factors which can make patients difficult to treat. British Journal of Psychiatry 1996;169(31):10‐4. - PubMed
Kay 1986
    1. Kay SR. Positive and negative symptom (PANNS) scale manual. Schizophrenia Bulletin 1987;13:261‐78. - PubMed
Kerwin 1994
    1. Kerwin RW. The new atypical antipsychotics. A lack of extrapyramidal side‐effects and new routes in schizophrenia research. British Journal of Psychiatry 1994;164:141‐8. - PubMed
Kerwin 1996
    1. Kerwin R, Taylor D. New antipsychotics. A review of their current status and clinical potential. CNS Drugs 1996;6:71‐82.
Leucht 2005a
    1. Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel R. Clinical implications of Brief Psychiatric Rating Scale Scores. British Journal of Psychiatry 2005;187:366‐71. - PubMed
Leucht 2005b
    1. Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel R. What does the PANSS mean?. Schizophrenia Research 2005;79:231‐8. - PubMed
Marshall 2000
    1. Marshall M, Lockwood A, Bradley C, Adams C, Joy C, Fenton M. Unpublished rating scales: a major source of bias in randomised controlled trials of treatments for schizophrenia. British Journal of Psychiatry 2000;176:249‐52. - PubMed
Moher 1998
    1. Moher D, Pham B, Jones A, Cook DJ, Jadad AR, Moher M, Tugwell P, Klassen TP. Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta‐analyses?. Lancet 1998;352:609‐13. - PubMed
Overall 1962
    1. Overall JE, Gorham DR. The Brief Psychiatric Rating Scale. Psychological Reports 1962;10:799‐812.
Schulz 1995
    1. Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273:408‐12. - PubMed
Silverstone 1995
    1. Silverstone T, Turner P. Drug treatment in psychiatry.. TJ Press, 1995.
Thomas 1998
    1. Thomas CS, Lewis C. Which atypical antipsychotic?. British Journal of Psychiatry 1998;172:106‐9. - PubMed
Ukoumunne 1999
    1. Ukoumunne OC, Gulliford MC, Chinn S, Sterne JAC, Burney PGJ. Methods for evaluating area‐wide and organistation‐based intervention in health and health care: a systematic review. Health Technology Assessment 1999;3(5):1‐75. - PubMed
Vanelle 1994
    1. Vanelle JM, Olie JP, Levy‐Soussan P. New antipsychotics in schizophrenia: the French Experience. Acta Psychiatrica Scandinavica, Supplementum 1994;380:59‐63. - PubMed
Wood MacKenzie 1998
    1. Wood MacKenzie. Review of the Global Schizophrenia Market. PharmaForum 1998;39:9.

References to other published versions of this review

Murphy 2000
    1. Murphy BE, Bagnall A, Chue P, Fenton M, Leitner M, Wood J. Loxapine for schizophrenia. Cochrane Database of Systematic Reviews 2000, Issue 2. [DOI: 10.1002/14651858.CD001943] - DOI - PubMed

MeSH terms