JoAnn Filipov, Mercer University College of Pharmacy
Limited options of antipsychotic drug administration exist in the current standard of care for the acute treatment of agitation.  According to the Expert Consensus Guidelines for Treatment of Behavioral Emergencies, speed of onset is key in choosing medication administration route.  Since intravenous administration of antipsychotics necessitates established intravenous access, oral and intramuscular administrations are more prominently used. However, oral and intramuscular formulations have a more gradual onset of action, unlike intravenous pharmacokinetics, thus allowing for symptoms to escalate before they begin to resolve.  It is reported that patients with an episode of acute agitation often resist intramuscular administration, further escalating the risk of intensifying symptoms. Therefore, there is a need for anti-agitation medications with rapid onset of action and acceptable safety profile that are easy to administer. 
Loxapine, an antipsychotic indicated for the treatment of schizophrenia.  Loxapine is available as a capsule and intramuscular injection formulations, that have demonstrated efficacy in the treatment of agitation.  Due to the unmet need, a new formulation of loxapine, AdasuveÒ, was developed that can be inhaled via Staccato inhalation system. The system is shown to distribute loxapine with intravenous-like pharmacokinetics.  Below article summarized the efficacy and safety of Adasuve®.