Atomoxetine

Aka: Atomoxetine, Strattera

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II. Indications

  1. Attention Deficit Hyperactivity Disorder (ADHD)

III. Contraindications

  1. Narrow-angle Glaucoma
  2. Concurrent MAO Inhibitor use

IV. Precautions

  1. Increased Suicidality in children and teens (FDA black box warning)

V. Mechanism

  1. Selective Norepinephrine reuptake inhibitor
  2. Non-stimulant (not a controlled substance)

VI. Pharmacokinetics

  1. Peak serum concentration
    1. Without food: 1 hour
    2. With food: 3 hours
  2. Metabolized by CYP2D6
  3. Half-Life
    1. Most patients: 5 hours
    2. CYP2D6 defect (5-10%): 24 hours
  4. Adjust dose to 50% if Hepatic dysfunction

VII. Dosing: Indicated for ADHD in Age 6 years and older

  1. Timing
    1. Once daily dosing or
    2. Split daily dose to bid (morning and late afternoon)
  2. Weight <70 kg
    1. Initial: 0.5 mg/kg/day
    2. Increase after 3 days to 1.2 mg/kg/day
      1. Delay increasing dose if on CYP2D6 Inhibitor
      2. See Drug Interactions below
    3. Maximum: 1.4 mg/kg/day up to 100 mg
  3. Weight >70 kg
    1. Initial: 40 mg/day
    2. Increase after 3 days to 80 mg/day
      1. Delay increasing dose if on CYP2D6 Inhibitor
      2. See Drug Interactions below
    3. Maximum: 100 mg/day or 1.4 mg/kg

VIII. Efficacy: Not considered a first line agent

  1. Superior to Placebo
  2. As effective as Methylphenidate
    1. Anecdotally does not show immediate effect as Ritalin
  3. References
    1. Kratochvil (2002) J Am Acad Child Adolesc Psychiatry [PubMed]
    2. Michelson (2001) Pediatrics 108:83 [PubMed]
    3. Spencer (2002) J Clin Psychiatry 63:1140 [PubMed]

IX. Adverse Effects

  1. Severe liver injury
    1. Serious reactions, but case reports only as of 2005
    2. Observe clinically, but no routine LFT monitoring
    3. (February 2005) Prescriber's Letter, p. 8
  2. Abdominal Pain
  3. Gastrointestinal upset
    1. Nausea
    2. Vomiting (more than with Methylphenidate)
  4. Diminished appetite
  5. Dizziness
  6. Somnolence (more than with Methylphenidate)
  7. Weight loss (3.5% weight loss in 20% of patients)
  8. Anticholinergic effects in adults
    1. Dry Mouth
    2. Constipation
    3. Urinary Retention
    4. Sexual Dysfunction

X. Drug Interactions

  1. MAO Inhibitor
  2. Concurrent use of potent CYP2D6 Inhibitors
    1. Paroxetine (Paxil)
    2. Fluoxetine (Prozac)
    3. Quinidine

XI. Safety

  1. Pregnancy Category C
  2. Unknown safety in Lactation

XII. Preparations

  1. Capsules: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg

XIII. References

  1. (2003) Lexi-Comp Drug Database for Pocket PC (7/9/03)
  2. (2003) Med Lett Drugs Ther 45(1149):11-2 [PubMed]

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Related Studies

Cost: Medications

atomoxetine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
ATOMOXETINE HCL 10 MG CAPSULE Generic $0.79 each
ATOMOXETINE HCL 100 MG CAPSULE Generic $0.99 each
ATOMOXETINE HCL 18 MG CAPSULE Generic $0.88 each
ATOMOXETINE HCL 25 MG CAPSULE Generic $0.78 each
ATOMOXETINE HCL 40 MG CAPSULE Generic $0.90 each
ATOMOXETINE HCL 60 MG CAPSULE Generic $0.84 each
ATOMOXETINE HCL 80 MG CAPSULE Generic $0.77 each
strattera (on 10/18/2023 at Medicaid.Gov Survey of pharmacy drug pricing)
STRATTERA 40 MG CAPSULE Generic $0.69 each
STRATTERA 60 MG CAPSULE Generic $0.75 each
STRATTERA 80 MG CAPSULE Generic $0.77 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Related Topics in Pharmacology

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