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Uses of Atomoxetine

Atomoxetine is used primarily for treating Attention-Deficit/ Hyperactivity Disorder (ADHD).

Although it is sometimes tried for treatment-resistant Depression, it is likely not very effective for that purpose [ref].

How Atomoxetine Works

Atomoxetine is a selective norepinephrine reuptake inhibitor (NRI). It blocks norepinephrine reuptake in the central nervous system and thus increases norepinephrine neurotransmission. It also increases dopamine neurotransmission in the frontal cortex indirectly, as dopamine is inactivated by norepinephrine reuptake in the frontal cortex.

Cautions when Using Atomoxetine

In people with cardiovascular disease, cerebrovascular disease, hypertension, arrhythmias, seizure disorder, or glaucoma, advice from the appropriate medical specialist should be obtained before starting Atomoxetine.

Atomoxetine can worsen states of anxiety and agitation. It may worsen or induce psychosis in people with Psychotic Disorders, and can worsen or induce Manic or Mixed Episodes in people with Bipolar Disorder.

Atomoxetine should not be used during or within 14 days following the administration of an MAOI, because a hypertensive crisis may result.

Dosing of Atomoxetine

In children weighing up to 40kg (88lbs), start with a dose of 0.5mg/kg/day, either once in the morning or divided twice a day. After 7 days dose can be increased to 1.2mg/kg/day. Maximum dose is 1.4mg/kg/day, or 60mg/day, whichever is less.

In adults and children weighing over 40kg (88lbs), start with a dose of 0.5mg/kg/day, or 40mg/day, whichever is less, either once in the morning or divided twice a day. After 7 days dose can be increased to 80mg/day. After an additional 2-4 weeks, can increase to a maximum of 100mg/day.

When wanting to stop this medication, the dose should be reduced gradually over a period of a few weeks.

Onset of action

Therapeutic effect in ADHD can be seen as soon as the first day of use. Can take several weeks to attain maximum therapeutic effect. If no significant effects are seen after 6 weeks then it likely will not work at all.

Kidney impairment

Dose adjustment not necessary.

Liver impairment

In patients with moderate hepatic impairment (Child-Pugh class B), reduce normal doses by 50%. In patients with severe hepatic function impairment (Child-Pugh class C), reduce normal doses by 25%.

Side-effects of Atomoxetine

Below is a list of most of the reported side-effects of Atomoxetine. Most of these side-effects occur in only a minority of individuals, and many also resolve with time while the medication is continued.

Cardiovascular: tachycardia (rapid heart rate); palpitations; increased blood pressure; QT prolongation; syncope (fainting).

Central Nervous System: headache; insomnia; somnolence; dizziness; tremor; seizures (rare).

Dermatologic: rash; excessive perspiration.

Endocrine: does not significantly affect growth in children [ref]; dysmenorrhea (abnormal menstruations).

Eyes, Ears, Nose and Throat: blurred vision; dry mouth.

Gastrointestinal: nausea; constipation; vomiting; abdominal pain; dyspepsia; decreased appetite.

Genitourinary: decreased libido; erectile disturbance; impotence; ejaculatory problems; abnormal orgasm; priapism (painful or nonpainful penile erection lasting a few hours); urinary hesistancy; urinary retention (mainly in older men).

Psychiatric: anxiety; irritability; restlessness; agitation; psychosis (more likely in people with Psychotic Disorders or Bipolar Disorder); mania and mixed states (more likely in people with Bipolar Disorder); suicidal thoughts.

Common side-effects of Atomoxetine

Headache, decreased appetite, insomnia, somnolence, fatigue, dry mouth, nausea, abdominal pain, vomiting, constipation, erectile dysfunction.

Rare but serious side-effects of Atomoxetine

  • heart attack and stroke, more likely in people with pre-existing cardiovascular disease
  • sudden death has been reported in a few individuals with pre-existing cardiac structural abnormalities.
  • liver damage
  • suicidal thoughts

Atomoxetine overdose

Restlessness, panic states, agitation, psychosis, tremor, fever, rapid respiration, nausea, vomiting, diarrhea, abdominal cramps, arrhythmias, hypertension or hypotension, circulatory collapse, seizures. No fatalities have been reported when used alone.

Atomoxetine and pregnancy

Category C: some animal studies show adverse effects at very high doses, but no controlled human studies have been done; can be used in pregnancy if benefits outweigh potential risks.

Medical Monitoring for Atomoxetine

Measure blood pressure and pulse a few weeks after starting the medication and after ever dose increase.

Drug Interactions with Atomoxetine

  • Blood concentrations of Atomoxetine may be increased by Paroxetine, Fluoxetine and Bupropion.
  • Atomoxetine should not be used during or within 14 days following the administration of an MAOI, because a hypertensive crisis may result.