1. Introduction
Atomoxetine is a non-stimulant selective norepinephrine reuptake inhibitor (NRI) used for the treatment of attention deficit hyperactivity disorder (ADHD). It enhances norepinephrine levels in the brain, improving focus, impulse control, and attention.
2. Indications
- Attention Deficit Hyperactivity Disorder (ADHD) (First-line for non-stimulant therapy)
- Off-Label Uses:
- Oppositional Defiant Disorder (ODD)
- Executive Dysfunction in Autism
- Treatment-Resistant Depression (Adjunctive therapy)
3. Dosage
Adults (ADHD):
- Initial dose: 40 mg once daily
- Target dose: 80 mg/day after 3 days
- Max dose: 100 mg/day
Children & Adolescents (≥6 years, Weight-Based Dosing):
- <70 kg:
- Start with 0.5 mg/kg/day, increase to 1.2 mg/kg/day after 3 days.
- Max dose: 1.4 mg/kg/day (not exceeding 100 mg).
- ≥70 kg:
- Start with 40 mg/day, increase to 80 mg/day after 3 days.
- Max dose: 100 mg/day.
Elderly (>65 years):
- Use lower doses initially—start with 25 mg/day and titrate slowly.
Renal Impairment:
- No dose adjustment required, but monitor response and side effects.
Hepatic Impairment:
- Mild impairment: Reduce dose to 50% of the normal dose.
- Moderate-severe impairment: Reduce dose to 25% of the normal dose.
4. Administration
- Take with or without food.
- Swallow capsules whole—do not crush, chew, or open (may cause throat irritation).
- Best taken in the morning to avoid insomnia.
5. Forms Available
- Capsules: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg
6. Side Effects
6.1 Common Side Effects:
- Loss of appetite
- Insomnia
- Nausea
- Dry mouth
- Dizziness
6.2 Less Common Side Effects:
- Increased blood pressure
- Fatigue
- Sweating
6.3 Rare but Serious Side Effects:
- Suicidal thoughts (especially in children & adolescents)
- Severe liver injury (jaundice, dark urine, abdominal pain)
- Increased heart rate (tachycardia)
- Urinary retention
7. Warnings
- Suicidal Ideation Risk:
- Monitor for mood changes, aggression, suicidal thoughts—especially in children.
- Cardiovascular Effects:
- Can cause increased blood pressure & heart rate—monitor in patients with hypertension or arrhythmias.
- Liver Toxicity:
- Monitor for signs of liver dysfunction (dark urine, jaundice, nausea).
- Psychiatric Effects:
- May cause irritability, aggression, or mood swings.
8. Precautions
- Avoid in severe liver disease—risk of hepatotoxicity.
- Not recommended in patients with glaucoma—may worsen intraocular pressure.
- Use with caution in seizure disorders—may lower seizure threshold.
9. Interactions
- MAOIs (e.g., phenelzine, selegiline): Contraindicated—risk of hypertensive crisis.
- SSRIs (e.g., fluoxetine, paroxetine): Increase atomoxetine levels—dose adjustment may be needed.
- Beta-Blockers (e.g., propranolol): Increased heart rate and blood pressure risk.
- CYP2D6 Inhibitors (e.g., quinidine, fluoxetine): May increase atomoxetine toxicity.
10. Monitoring Parameters
- Heart rate and blood pressure: Baseline, then every 3–6 months.
- Liver function tests: If symptoms of liver damage develop.
- Suicidal ideation and mood changes: Regular monitoring, especially in young patients.
- Growth monitoring in children: Check height & weight every 6 months.
11. Use in Children
- Approved for ADHD in children ≥6 years.
- Monitor for suicidal thoughts and growth suppression.
12. Use in Pregnancy
- Category C:
- Not recommended unless benefits outweigh risks.
- Alternative ADHD treatments (e.g., behavioural therapy) preferred during pregnancy.
13. Use in Elderly
- Start with a lower dose (25 mg/day), titrate cautiously due to increased sensitivity to side effects.
14. Use in Kidney Disease
- No dose adjustment required.
15. Use in Liver Disease
- Mild impairment: Reduce dose to 50% of normal dose.
- Moderate-severe impairment: Reduce dose to 25% of normal dose.
16. Patient Counselling Points
- Take at the same time each day for consistent effects.
- Monitor mood changes, aggression, or suicidal thoughts.
- Expect side effects like nausea and sleep disturbances—they usually improve over time.
- Do not open or crush the capsules—may cause irritation.
- Monitor growth in children—may cause slight growth suppression.
17. Table of Brand Names, Manufacturer, and Prices in USD
Brand Name | Manufacturer | Strength/Dosage Form | Price (USD) |
---|---|---|---|
Strattera | Eli Lilly | 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg Capsules | $350 (30 caps) |
Generic Atomoxetine | Various | 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg Capsules | $150 (30 caps) |
18. 15 FAQs (Frequently Asked Questions)
1. What is Atomoxetine used for?
It is used for ADHD in children, adolescents, and adults.
2. How does Atomoxetine work?
It increases norepinephrine levels, improving attention and impulse control.
3. How long does Atomoxetine take to work?
It takes 1–2 weeks for initial effects and 4–6 weeks for full benefits.
4. Can I stop Atomoxetine suddenly?
Yes, but do not stop without medical advice—withdrawal is less severe than with stimulants.
5. Can Atomoxetine cause weight loss?
Yes, it may reduce appetite, leading to weight loss in some patients.
6. Does Atomoxetine cause insomnia?
Yes, take it in the morning to reduce sleep disturbances.
7. Can Atomoxetine be used for depression?
It is not an antidepressant, but may be used off-label as an adjunct therapy.
8. Can I drink alcohol while taking Atomoxetine?
Limit alcohol, as it may increase side effects like drowsiness.
9. Does Atomoxetine cause addiction?
No, it is non-addictive and has no abuse potential.
10. Can Atomoxetine cause heart problems?
Yes, it may increase heart rate and blood pressure—monitor regularly.
11. Can Atomoxetine cause mood swings?
Yes, monitor for irritability, aggression, or suicidal thoughts.
12. Can I take Atomoxetine with caffeine?
Yes, but excess caffeine may increase side effects like nervousness.
13. Is Atomoxetine better than stimulants (e.g., Adderall, Ritalin)?
It is less effective but preferred in patients at risk of addiction.
14. Does Atomoxetine affect sexual function?
Yes, it may cause erectile dysfunction or reduced libido.
15. Can I take Atomoxetine long-term?
Yes, but regular monitoring is required for side effects.