II. Indications
III. Background
- Released in 2021 in U.S.
IV. Contraindications
-
Bipolar Disorder
- Risk of provoking a manic episode
- Concurrent use of Monoamine Oxidase Inhibitor
- Pregnancy
- Animal studies suggest fetal and maternal toxicity
V. Mechanism
- Selective Norepinephrine Reuptake Inhibitor (SNRI)
- Morpholine Derivative
VI. Efficacy: Attention Deficit Disorder
- Marginal efficacy at best (that may not be detected clinically)
VII. Dosing
- Start: 100 mg orally daily
VIII. Advantages
- Once daily dosing
- No abuse potential (similar in this regard to the lower cost Atomoxetine)
IX. Disadvantages
- Low efficacy
- Expensive: $300/month (3x the cost of generic Atomoxetine)
X. Adverse Effects
- Suicidal Ideation
- Increased Heart Rate or Sinus Tachycardia (20-30% of patients)
-
Sleep and Constitutional Effects
- Insomnia (23% of patients)
- Somnolence (16% of children)
- Fatigue (6% of children)
- Gastrointestinal Effects
- Decreased Appetite (7% of children, 10% of adults)
- Nausea or Vomiting (4-5% of children, 12% of adults)
- Dry Mouth (10% of adults)
- Constipation (6% of adults)
- Neurologic Effects
- Headache (17% of adults)
XI. Resources
XII. References
- (2021) Presc Lett 28(9): 54
- Goodell (2023) Am Fam Physician 107(3): 309-10 [PubMed]
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