From the Guidelines
Atomoxetine is primarily used for treating attention-deficit/hyperactivity disorder (ADHD) in both children and adults, as it has been shown to improve functional impairment and quality of life 1. The medication works by increasing levels of norepinephrine in the brain, which helps improve attention, reduce impulsivity, and decrease hyperactivity. Unlike stimulant medications for ADHD, atomoxetine is not a controlled substance and has a lower potential for abuse. The medication is typically taken once or twice daily, with starting doses often lower (such as 40mg daily for adults or 0.5mg/kg daily for children) and then gradually increased as needed and tolerated, with a maximum recommended dosage of 1.4 mg/kg/day or 100 mg/day, whichever is lower 1. Some key points to consider when prescribing atomoxetine include:
- The full therapeutic effect may take several weeks to develop, unlike the immediate effects seen with stimulants 1.
- Atomoxetine can also be used off-label for conditions like depression, anxiety disorders, and binge eating disorder, although evidence for its efficacy in these areas is limited 1.
- Common side effects include decreased appetite, nausea, fatigue, mood swings, and increased heart rate or blood pressure 1.
- Patients should be monitored for rare but serious side effects including liver problems and suicidal thoughts, particularly when first starting treatment 1. It is essential to note that atomoxetine does not seem to be associated with major congenital malformations, including cardiac malformations, or other significant adverse obstetrical or developmental outcomes, although data are limited 1. Overall, atomoxetine is a viable treatment option for ADHD, particularly for patients who cannot tolerate stimulant medications or have certain comorbidities, and its use should be carefully considered and monitored by a healthcare professional.
From the FDA Drug Label
Atomoxetine hydrochloride is a selective norepinephrine reuptake inhibitor indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD). (1.1)
- Main use: Atomoxetine is used for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) 2.
From the Research
Atomoxetine Usage
- Atomoxetine is used for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children, adolescents, and adults 3, 4, 5, 6, 7.
- It is a selective norepinephrine reuptake inhibitor and nonstimulant, which acts almost exclusively on the noradrenergic pathway 3.
- Atomoxetine is effective in maintaining control of ADHD symptoms and preventing relapse of ADHD symptoms without an increase in adverse effects 3.
Administration and Dosage
- Atomoxetine can be administered either as a single daily dose or split into two evenly divided doses 4, 5, 6.
- The clinical dose selection of atomoxetine is recommended based on both CYP2D6 genotype and the peak concentration 6.
Efficacy and Safety
- Atomoxetine is effective and generally well tolerated in children and adolescents with ADHD 5, 6, 7.
- Common adverse events include headache, abdominal pain, decreased appetite, vomiting, somnolence, and nausea 5.
- Atomoxetine has a negligible risk of abuse or misuse and is not a controlled substance in the US 4, 5, 6.
- Rare cases of severe liver injury and suicidal ideation have been reported, and atomoxetine may affect the cardiovascular system, but these effects are not clinically significant in most patients 7.