Atomoxetine, sold under the brand name Strattera among others, is a medication used to treat attention deficit hyperactivity disorder(ADHD).[6] Use is only recommended in those who are at least six years old.[6] It is taken by mouth.[6]
Common side effects include abdominal pain, loss of appetite, nausea, feeling tired, and dizziness.[6] Serious side effects may include angioedema, liver problems, stroke, psychosis, heart problems, suicide, and aggression.[6][7] Safety in pregnancy and breastfeeding is not clear.[8] Atomoxetine is a norepinephrine reuptake inhibitor which is how it is believed to work.[6]
Atomoxetine was approved for medical use in the United States in 2002.[6] A month's supply in the United Kingdom costs the NHS about 53 £ as of 2019.[7] In the United States, the wholesale cost of this amount is about 77 USD.[9] In 2016, it was the 245th most prescribed medication in the United States, with more than 2 million prescriptions.[10]
Medical uses
Attention deficit hyperactivity disorder
Atomoxetine is approved for use in children, adolescents, and adults.[11] However, its efficacy has not been studied in children under six years old.[2] Its primary advantage over the standard stimulant treatments for ADHD is that it has little known abuse potential.[2] While it has been shown to significantly reduce inattentive and hyperactive symptoms, the responses were lower than the response to stimulants. Additionally, 40% of participants who were treated with atomoxetine experienced residual ADHD symptoms.[12]
The initial therapeutic effects of atomoxetine usually take 2–4 weeks to become apparent.[1]A further 2–4 weeks may be required for the full therapeutic effects to be seen.[13] Its efficacy may be less than that of stimulant medications.[14]
Unlike α2 adrenoceptor agonists such as guanfacine and clonidine, atomoxetine's use can be abruptly stopped without significant discontinuation effects being seen.[2]
Contraindications
Contraindications include:[2]
§ Hypersensitivity to atomoxetine or any of the excipients in the product
§ Symptomatic cardiovascular disease including:
-moderate to severe hypertension
-atrial fibrillation
-atrial flutter
-ventricular tachycardia
-ventricular fibrillation
-ventricular flutter
-advanced arteriosclerosis
§ Severe cardiovascular disorders
§ Pheochromocytoma
§ Concomitant treatment with monoamine oxidase inhibitors
§ Narrow angle glaucoma
§ Poor metabolizers (due to the metabolism of atomoxetine by CYP2D6)
Adverse effects
Very common (>10% incidence) adverse effects include:
§ Nausea (26%)
§ Xerostomia (Dry mouth) (20%)
§ Appetite loss (16%)
§ Insomnia (15%)
§ Fatigue (10%)
§ Headache
§ Cough
§ Vomiting (in children and adolescents)
Common (1–10% incidence) adverse effects include:
§ Constipation (8%)
§ Dizziness (8%)
§ Erectile dysfunction (8%)
§ Somnolence (sleepiness) (8%)
§ Abdominal pain (7%)
§ Urinary hesitation (6%)
§ Tachycardia (high heart rate) (5–10%)
§ Hypertension (high blood pressure) (5–10%)
§ Irritability (5%)
§ Abnormal dreams (4%)
§ Dyspepsia (4%)
§ Ejaculation disorder (4%)
§ Hyperhidrosis (abnormally increased sweating) (4%)
§ Vomiting (4%)
§ Hot flashes (3%)
§ Paraesthesia (sensation of tingling, tickling, etc.) (3%)
§ Menstrual disorder (3%)
§ Weight loss (2%)
§ Depression
§ Sinus headache
§ Dermatitis
§ Mood swings
Uncommon (0.1–1% incidence) adverse effects include:
§ Suicide-related events
§ Hostility
§ Emotional lability
§ Aggression
§ Psychosis
§ Syncope (fainting)
§ Tremor
§ Migraine
§ Hypoaesthesia
§ Seizure
§ Palpitations
§ Sinus tachycardia
§ QT interval prolongation
§ Increased blood bilirubin
§ Allergic reactions
Rare (0.01–0.1% incidence) adverse effects including:
§ Raynaud's phenomenon
§ Abnormal/increased liver function tests
§ Jaundice
§ Hepatitis
§ Liver injury
§ Acute liver failure
§ Urinary retention
§ Priapism[17]
§ Male genital pain
The FDA of the US has issued a black box warning for suicidal behaviour/ideation.[3] Similar warnings have been issued in Australia.[2][18] Unlike stimulant medications, atomoxetine does not have abuse liability or the potential to cause withdrawal effects on abrupt discontinuation.[2]
Overdose
Atomoxetine is relatively non-toxic in overdose. Single-drug overdoses involving over 1500 mg of atomoxetine have not resulted in death.[2] The most common symptoms of overdose include:[2]
§ Gastrointestinal symptoms
§ Somnolence
§ Dizziness
§ Tremor
§ Abnormal behaviour
§ Hyperactivity
§ Agitation
§ Dry mouth
§ Tachycardia
§ Hypertension
§ Mydriasis
Less common symptoms:[2]
§ Seizures
§ QTc interval prolongation
The recommended treatment for atomoxetine overdose includes use of activated charcoal to prevent further absorption of the drug.[2]
