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AtomoxetineAka: Strattera

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

atomoxetine (C0076823)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHC041930
Englishatomoxetine, ATOMOXETINE PREPARATION, tomoxetine
Spanishatomoxetina
Parent Concepts[CN900] CNS MEDICATIONS, OTHER (C0973511), Unclassified Ingredients (C1372954), Selective norepinephrine re-uptake inhibitor (C1319272), Norepinephrine uptake inhibitor (C1319313), Drug allergen (C1320237), Non-amphetamines (C1579270)
SourcesLNC, MSH, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Strattera (C1176420)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHC041930
EnglishLilly brand of atomoxetine hydrochloride, Strattera
Parent ConceptsMoved elsewhere (C1274021)
SourcesMSH, MTH, NCI, PDQ, RXNORM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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