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Atomoxetine
Aka: Atomoxetine, Strattera
- See Also
- Attention Deficit Disorder in Children
- School Problem Evaluation
- Attention Deficit Disorder in Adults
- ADHD Diagnosis
- ADHD Differential Diagnosis
- ADHD Comorbid Conditions
- ADHD Non-Pharmacologic Management
- ADHD Medications
- Dextroamphetamine (Dexedrine, Dextrostat, Adderall) or Lisdexamfetamine (Vyvanse)
- Methylphenidate (Ritalin, Methylin, Concerta)
- Indications
- Attention Deficit Hyperactivity Disorder (ADHD)
- Contraindications
- Narrow-angle Glaucoma
- Concurrent MAO inhibitor use
- Precautions
- Increased Suicidality in children and teens (FDA black box warning)
- Mechanism
- Selective Norepinephrine reuptake inhibitor
- Non-stimulant (not a controlled substance)
- Pharmacokinetics
- Peak serum concentration
- Without food: 1 hour
- With food: 3 hours
- Metabolized by CYP2D6
- Half-life
- Most patients: 5 hours
- CYP2D6 defect (5-10%): 24 hours
- Adjust dose to 50% if Hepatic dysfunction
- Dosing: Indicated for ADHD in Age 6 years and older
- Timing
- Once daily dosing or
- Split daily dose to bid (morning and late afternoon)
- Weight <70 kg
- Initial: 0.5 mg/kg/day
- Increase after 3 days to 1.2 mg/kg/day
- Delay increasing dose if on CYP2D6 Inhibitor
- See Drug Interactions below
- Maximum: 1.4 mg/kg/day up to 100 mg
- Weight >70 kg
- Initial: 40 mg/day
- Increase after 3 days to 80 mg/day
- Delay increasing dose if on CYP2D6 Inhibitor
- See Drug Interactions below
- Maximum: 100 mg/day or 1.4 mg/kg
- Efficacy: Not considered a first line agent
- Superior to Placebo
- As effective as Methylphenidate
- Anecdotally does not show immediate effect as Ritalin
- References
- Kratochvil (2002) J Am Acad Child Adolesc Psychiatry [PubMed]
- Michelson (2001) Pediatrics 108:83 [PubMed]
- Spencer (2002) J Clin Psychiatry 63:1140 [PubMed]
- Adverse Effects
- Severe liver injury
- Serious reactions, but case reports only as of 2005
- Observe clinically, but no routine LFT monitoring
- (February 2005) Prescriber's Letter, p. 8
- Abdominal Pain
- Gastrointestinal upset
- Nausea
- Vomiting (more than with Methylphenidate)
- Diminished appetite
- Dizziness
- Somnolence (more than with Methylphenidate)
- Weight loss (3.5% weight loss in 20% of patients)
- Anticholinergic effects in adults
- Dry Mouth
- Constipation
- Urinary Retention
- Sexual Dysfunction
-
Drug Interactions
- MAO inhibitor
- Concurrent use of potent CYP2D6 Inhibitors
- Paroxetine (Paxil)
- Fluoxetine (Prozac)
- Quinidine
- Preparations
- Capsules: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg
- References
- (2003) Lexi-Comp Drug Database for Pocket PC (7/9/03)
- (2003) Med Lett Drugs Ther 45(1149):11-2 [PubMed]