From the Guidelines
Atomoxetine should be considered as a second-line treatment option for ADHD, particularly in cases where stimulants are not tolerated or are contraindicated, due to its non-stimulant mechanism of action and potential benefits in patients with comorbidities such as anxiety, tics, or substance use disorders 1. When initiating atomoxetine, the typical starting dose is 40mg daily for adults, gradually increasing to a target dose of 80-100mg daily, while children's dosing is based on weight (usually starting at 0.5mg/kg/day and increasing to 1.2-1.4mg/kg/day) 1. Key considerations for atomoxetine treatment include:
- Monitoring for potential adverse effects such as decreased appetite, headaches, stomach pain, and increased blood pressure or pulse 1
- Regular assessment of medication adherence and open discussion of potential issues to improve treatment outcomes 1
- Evaluation of patient and family attitudes towards pharmacological treatment, as well as factors such as trustful physician-patient relationship, family support, and knowledge about the disorder and intended medication to enhance adherence 1
- Preference for once-daily dosing to simplify the treatment regimen and improve adherence 1 Overall, atomoxetine offers a valuable alternative for patients who require a non-stimulant treatment option for ADHD, and its use should be guided by careful consideration of individual patient needs and circumstances 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Atomoxetine Overview
- Atomoxetine is a nonstimulant drug approved by the United States Food and Drug Administration (FDA) for the treatment of attention-deficit-hyperactivity disorder (ADHD) 2.
- It is a norepinephrine transport inhibitor that acts almost exclusively on the noradrenergic pathway, with a mechanism of action thought to be through the highly specific presynaptic inhibition of norepinephrine 2.
Efficacy and Safety
- Clinical trials have shown that atomoxetine is effective in maintaining control of ADHD symptoms in children and adults, with similar safety and efficacy to methylphenidate 2, 3.
- Atomoxetine has a favorable safety profile, with common adverse events including headache, abdominal pain, decreased appetite, vomiting, somnolence, and nausea 3.
- It has a negligible risk of abuse or misuse and is not a controlled substance in the US, making it a useful option for patients at risk of substance abuse or with co-morbid anxiety or tics 3.
Dosage and Administration
- Atomoxetine can be administered either as a single daily dose or split into two evenly divided doses, with a recommended clinical dose selection based on both CYP2D6 genotype and peak concentration 4.
- The dosage regimen may need to be adjusted based on individual patient response and tolerability, with a higher percentage of discontinuation at dosages greater than 1.5 mg/kg/day 2.
Comparison to Other Treatments
- Atomoxetine has been compared to methylphenidate and other stimulant medications, with similar efficacy and safety profiles 2, 3, 5.
- Combined therapy with methylphenidate and atomoxetine has been shown to be effective and well-tolerated in some patients, with enhanced effectiveness compared to monotherapy 5.