From the Guidelines
For adults with ADHD and a history of stimulant abuse, atomoxetine is the recommended first-line treatment, typically started at 40mg daily and gradually increased to an effective dose of 80-100mg daily. This recommendation is based on the most recent and highest quality study available, which highlights the efficacy and safety of non-stimulant medications in treating ADHD, particularly in patients with substance use disorders 1. The study notes that non-stimulants, such as atomoxetine, have a lower abuse potential compared to stimulants, making them a safer option for individuals with a history of substance abuse.
Some key points to consider when prescribing atomoxetine include:
- The medication can take several weeks to show its full effects, typically 6-12 weeks 1
- Atomoxetine has been shown to improve functional impairment and quality of life in patients with ADHD 1
- The daily dose of atomoxetine can be split into two equal doses administered in the morning and evening to reduce adverse effects 1
- Atomoxetine has a more favorable side effect profile compared to other non-stimulants, such as clonidine and guanfacine, with fewer reports of somnolence and fatigue 1
Other non-stimulant medications, such as guanfacine and clonidine, may also be considered as alternative treatment options. However, atomoxetine is generally preferred due to its efficacy, safety, and relatively low abuse potential. As with any medication, regular monitoring and dose adjustments are necessary to ensure optimal treatment outcomes and minimize side effects. Additionally, treatment should be part of a comprehensive approach that includes therapy and lifestyle modifications to address the underlying symptoms of ADHD and substance abuse.
From the FDA Drug Label
Atomoxetine hydrochloride is not approved for major depressive disorder The efficacy of atomoxetine capsules was established in seven clinical trials in outpatients with ADHD: four 6 to 9-week trials in pediatric patients (ages 6 to 18), two 10-week trial in adults, and one maintenance trial in pediatrics (ages 6 to 15)
The recommended medication to treat ADHD in an adult with stimulant abuse is atomoxetine 2, as it is a non-stimulant medication that has been shown to be effective in treating ADHD in adults.
- Key points:
- Atomoxetine is a non-stimulant medication
- Effective in treating ADHD in adults
- Recommended for adults with stimulant abuse due to its non-stimulant properties However, it is essential to note that the provided drug labels do not directly address the treatment of ADHD in adults with stimulant abuse. Therefore, this answer is based on the available information and should be considered with caution.
From the Research
Medication Options for Adult ADHD with Stimulant Abuse
- Atomoxetine is a recommended medication for treating ADHD in adults with stimulant abuse, as it is a non-stimulant and has a low risk of abuse or diversion 3, 4.
- Atomoxetine has been shown to be effective in reducing ADHD symptoms in adults, with improvements in attention, hyperactivity, and impulsivity 3, 4.
- The use of stimulants in adults with ADHD and comorbid substance abuse may be problematic, and atomoxetine may be a safer alternative 5, 6.
- Atomoxetine can be administered once or twice daily, and its side effect profile is generally benign, with common adverse events including dry mouth, insomnia, and nausea 3, 4.
Considerations for Treatment
- A hierarchical approach to treatment may be desirable, with mood stabilization preceding the treatment of ADHD symptoms in patients with comorbid bipolar disorder 5.
- Stimulant optimization should be considered before using alternative pharmacological strategies for ADHD, including non-stimulants like atomoxetine 7.
- The choice of medication for ADHD should be based on individual patient characteristics, including comorbidity profiles, cardiovascular risks, and risk of abuse of prescription medications 6.