atomoxetine hydrochloride

atomoxetine hydrochloride

Strattera

Pharmacologic class: Selective norepinephrine reuptake inhibitor

Therapeutic class: Central nervous system agent

Pregnancy risk category C

FDA Boxed Warning

• Drug may increase risk of suicidal ideation in children or adolescents with attention deficit hyperactivity disorder (ADHD). Risk must be balanced with clinical need. Observe patient closely for clinical worsening, suicidality, and unusual behavior changes when therapy begins. Advise family to observe patient closely and communicate with prescriber as needed.
• Drug is approved for ADHD in pediatric and adult patients. It's not approved for major depressive disorder.

Action

Unclear. May block norepinephrine reuptake at neuronal synapse.

Availability

Capsules: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg

⊘Indications and dosages

➣ ADHD

Adults and children weighing more than 70 kg (154 lb): Initially, 40 mg P.O. daily. After 3 days, may increase to target total daily dosage of 80 mg P.O., given either as a single dose in morning or in evenly divided doses in morning and late afternoon or early evening. If desired response doesn't occur, may increase dosage after 2 to 4 more weeks to a maximum dosage of 100 mg P.O. daily.

Adults and children weighing 70 kg (154 lb) or less: Initially, 0.5 mg/kg/day P.O. Increase after at least 3 days to target daily dosage of 1.2 mg/kg, given either as single daily dose in morning or as evenly divided doses in morning and late afternoon or early evening.

Dosage adjustment

• Hepatic impairment
• Concurrent use of potent CYP2D6 inhibitors (such as fluoxetine, paroxetine, quinidine) in children weighing less than 70 kg (154 lb)

Contraindications

• Hypersensitivity to drug
• Closed-angle glaucoma
• MAO inhibitor use within past 14 days

Precautions

Use cautiously in:
• hypotension; impaired renal, cardiac, cerebrovascular, hepatic, or endocrine function
• pregnant or breastfeeding patients
• children younger than age 6.

Administration

• Give as a single dose in morning, or give half of total daily dose in morning and other half in late afternoon or early evening.
☞ Don't give to patient who has taken MAO inhibitors within past 14 days.

Route	Onset	Peak	Duration
P.O.	Rapid	1-2 hr	Unknown

Adverse reactions

CNS: aggression, insomnia, dizziness, drowsiness, headache, irritability, crying, mood swings, fatigue, rigors

CV: orthostatic hypotension, palpitations, tachycardia

EENT: rhinorrhea, sinusitis

GI: nausea, vomiting, constipation, upper abdominal pain, flatulence, dyspepsia, dry mouth

GU: urinary retention, urinary hesitancy, dysmenorrhea, erectile problems, ejaculation failure, impotence, prostatitis

Musculoskeletal: muscle pain

Respiratory: cough

Skin: dermatitis, sweating

Other: fever, hot flashes, growth retardation (in children), decreased appetite, weight loss

Interactions

Drug-drug. Albuterol: increased cardiovascular effects

MAO inhibitors: hyperthermia, myoclonus, rapid changes in vital signs

Potent CYP2D6 inhibitors: increased atomoxetine effects in children weighing less than 70 kg (154 lb)

Vasopressors: hypertensive crisis

Patient monitoring

• Monitor growth in children.
• Assess for weight loss.
• Check blood pressure and pulse, especially after dosage changes.
• Monitor for changes in mood, sleep patterns, and behavior.
• Evaluate for urinary hesitancy or urinary retention and sexual dysfunction.
• Provide dietary counseling. Refer patient to dietitian if adverse GI effects significantly limit food intake.

Patient teaching

• To minimize insomnia, advise patient to establish effective bedtime routine and to take drug in single morning dose or in divided half-doses in morning and late afternoon or early evening.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs mentioned above.