Medication and Treatment Reviews

Atomoxetine Hydrochloride

Brand Name: Strattera

Uses

Atomoxetine — more commonly known by the brand name Strattera — is an effective and safe alternative to the stimulant medications most commonly used to treat attention deficit hyperactivity disorder (ADHD) in children ages 6-12, adolescents, and adults. It is a selective norepinephrine reuptake inhibitor (SNRI) medicine. Atomoxetine is not considered a controlled substance by the Drug Enforcement Agency (DEA). It has not been studied in children under the age of 6.

Atomoxetine was the first non-stimulant approved for treatment of ADHD in the United States by the Food and Drug Administration (FDA). Stimulant medications are often the first-recommended treatment, but atomoxetine is a good alternative for people who cannot tolerate, or don’t experience the desired effects of, stimulant medication.

The American Academy of Pediatrics recommends treatment with behavioral therapy before medication for children under the age of 6. For children ages 6 to 11, the AAP says “The primary care clinician should prescribe US Food and Drug Administration–approved medications for ADHD and/or evidence-based parent- and/or teacher-administered behavior therapy as treatment for ADHD, preferably both.” Likewise, the National Institute of Mental Health finds the most successful treatment plans use a combination of ADHD medication, like atomoxetine, and behavior therapies.

How to Use Atomoxetine

Before starting or refilling an atomoxetine prescription, read the medication guide included with your pills, as it may be updated with new information.

This guide should not replace a conversation with your doctor, who has a holistic view of your or your child’s medical history, other diagnoses, and other prescriptions. If you have questions, ask your doctor or pharmacist before you begin taking the medication.

Dosage

As with all medications, follow your atomoxetine prescription instructions exactly.  Atomoxetine is taken orally, with or without food, once or twice daily. The first dose is typically taken first thing in the morning. If a second dose is prescribed, it is typically taken in the late afternoon or early evening. It should be taken at the same time each day for the best results.

Capsules should be swallowed whole with water or other liquids. Capsules should never be opened, crushed, or chewed. If your child is unable to swallow the capsule, discuss a different medication with your doctor.

Capsules are available in 10mg, 18mg, 25mg, 40mg, 80mg, and 100mg dosages. The time-release formulation is designed to maintain a steady level of medication in your body throughout the day.

The optimal dosage varies patient by patient. Your doctor may adjust your daily dosage after 3 days until you or your child experiences the best response — that is, the lowest dosage at which you experience the greatest improvement in symptoms without side effects. The maximum recommended dosage is 100mg/day.

During treatment, your doctor may periodically ask you to stop taking your atomoxetine so that he or she can monitor ADHD symptoms; check vital statistics including blood, heart, and blood pressure; or evaluate height and weight. If any problems are found, your doctor may recommend discontinuing treatment.

Side Effects

The most common side effects of Atomoxetine are as follows:

Children and adolescents (ages 6 – 17): upset stomach, decreased appetite, nausea, and vomiting.

Adults: constipation, dry mouth, nausea, decreased appetite, dizziness, sexual side effects, and problems passing urine.

Other serious side effects include the following: severe allergic reaction, slowed growth in children, priapism, and difficulty urinating including trouble starting and emptying the bladder. Seek immediate medical attention if you have trouble breathing, see swelling or hives, or experience any other signs of an allergic reaction.

Taking atomoxetine may impair your or your teenager’s ability to drive, operate machinery, or perform other potentially dangerous tasks. This side effect usually wears off with time. If side effects are bothersome, or do not go away, talk to your doctor. Most people taking this medication do not experience any of these side effects.

Disclose to your physician all mental health issues including any family history of suicide, bipolar illness, or depression. The FDA recommends evaluating patients for bipolar disorder prior to administration of atomoxetine to avoid inducing a manic episode. Atomoxetine may create new or exacerbate existing behavior problems, bipolar disorder, or suicidal ideation. It can cause psychotic or manic symptoms in children and teenagers. Call your doctor immediately if you or your child experiences new or worsening mental health symptoms including anxiety, hearing voices, agitation, panic attacks, trouble sleeping, irritability, hostility, aggressiveness, or depression.

Discuss any existing liver problems with your doctor. Atomoxetine can cause severe liver injury for some patients. Contact your doctor immediately if you or your child experiences these signs of liver problems: itching, right upper belly pain, dark urine, yellow skin or eyes, or inexplicable flu-like symptoms.

Report to your doctor any heart-related problems or a family history of heart and blood pressure problems. Patients with structural cardiac abnormalities and other serious heart problems have experienced sudden death, stroke, heart attack, and increased blood pressure while taking atomoxetine. Physicians should monitor these vital signs closely during treatment. Call your doctor immediately if you or your child experiences warning signs such as chest pain, shortness of breath, or fainting while taking atomoxetine.

The above is not a complete list of potential side effects. If you notice any health changes not listed above, discuss them with your doctor or pharmacist.

Precautions and Safety

Store atomoxetine in a secure place out of the reach of children, and at room temperature. Do not share your atomoxetine prescription with anyone, even another person with ADHD. Sharing prescription medication is illegal, and can cause harm.

You should not take atomoxetine if you have:

  • taken, or plan to take an antidepressant monoamine oxidase inhibitor or MAOI within 14 days
  • narrow angle glaucoma
  • an allergy to any ingredients
  • a rare tumor called pheochromocytoma

If you’re thinking of becoming pregnant, discuss the use of atomoxetine with your doctor. Animal studies indicate a potential risk of fetal harm; infants may be born prematurely, with low birth weight, with spinal abnormalities, or experience withdrawal. Atomoxetine is passed through breastmilk, so it is recommended that mothers do not nurse while taking it.

The effects of atomoxetine on children under 6 and on the elderly have not been studied.

Interactions

Before taking atomoxetine, discuss all other active prescription medications with your doctor. Atomoxetine can have a dangerous interaction with antidepressants including MAOIs, asthma medicines, blood pressure medicines, and cold or allergy medicines that contain decongestants.

Share a list of all vitamin or herbal supplements, and prescription and non-prescription medications you take with the pharmacist when you fill your prescription, and let all doctors and physicians know you are taking Atomoxetine before having any surgery or laboratory tests. The above is not a complete list of all possible drug interactions.

Sources:

http://pi.lilly.com/us/strattera-ppi.pdf
http://www.fda.gov/downloads/drugs/drugsafety/ucm089138.pdf
http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/021411s035lbl.pdf

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