Pediatrics Book

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Atomoxetine

Aka: Atomoxetine, Strattera
  1. See Also
    1. Attention Deficit Disorder in Children
    2. School Problem Evaluation
    3. Attention Deficit Disorder in Adults
    4. ADHD Diagnosis
    5. ADHD Differential Diagnosis
    6. ADHD Comorbid Conditions
    7. ADHD Non-Pharmacologic Management
    8. ADHD Medications
    9. Dextroamphetamine (Dexedrine, Dextrostat, Adderall) or Lisdexamfetamine (Vyvanse)
    10. Methylphenidate (Ritalin, Methylin, Concerta)
  2. Indications
    1. Attention Deficit Hyperactivity Disorder (ADHD)
  3. Contraindications
    1. Narrow-angle Glaucoma
    2. Concurrent MAO inhibitor use
  4. Precautions
    1. Increased Suicidality in children and teens (FDA black box warning)
  5. Mechanism
    1. Selective Norepinephrine reuptake inhibitor
    2. Non-stimulant (not a controlled substance)
  6. 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
  7. 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 or 1.4 mg/kg
  8. 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) J Am Acad Child Adolesc Psychiatry [PubMed]
      2. Michelson (2001) Pediatrics 108:83 [PubMed]
      3. Spencer (2002) J Clin Psychiatry 63:1140 [PubMed]
  9. 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
  10. Drug Interactions
    1. MAO inhibitor
    2. Concurrent use of potent CYP2D6 inhibitors
      1. Paroxetine (Paxil)
      2. Fluoxetine (Prozac)
      3. Quinidine
  11. Preparations
    1. Capsules: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg
  12. References
    1. (2003) Lexi-Comp Drug Database for Pocket PC (7/9/03)
    2. (2003) Med Lett Drugs Ther 45(1149):11-2 [PubMed]
Medication Costs
strattera (on 1/18/2017 at Medicaid.Gov Pharmacy Drug pricing)
STRATTERA 10 MG CAPSULE $12.68 each
STRATTERA 100 MG CAPSULE $14.81 each
STRATTERA 18 MG CAPSULE $12.64 each
STRATTERA 25 MG CAPSULE $12.64 each
STRATTERA 40 MG CAPSULE $13.74 each
STRATTERA 60 MG CAPSULE $13.75 each
STRATTERA 80 MG CAPSULE $14.88 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

atomoxetine (C0076823)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C041930
SnomedCT 407038000, 407037005
LNC LP33297-0, MTHU016626
English Tomoxetine, atomoxetine [Chemical/Ingredient], ATOMOXETINE, Atomoxetine (product), Atomoxetine (substance), Atomoxetine, tomoxetine, atomoxetine
Spanish atomoxetina (producto), atomoxetina (sustancia), atomoxetina
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Strattera (C1176420)

Definition (CHV) a drug used to treat attention deficit hyperactivity disorder (ADHD)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C041930
SnomedCT 407039008
English strattera, Strattera (product), Strattera, Lilly brand of atomoxetine hydrochloride
Spanish Strattera, Strattera (producto)
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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