What is the primary use and dosage of atomoxetine (Strattera) for treating Attention Deficit Hyperactivity Disorder (ADHD)?

From the Guidelines

Atomoxetine (Strattera) is a non-stimulant medication that primarily works by selectively inhibiting the reuptake of norepinephrine in the brain, which helps improve attention and reduce impulsivity and hyperactivity in patients with Attention Deficit Hyperactivity Disorder (ADHD). The medication is orally administered and primarily metabolized through the cytochrome P450 2D6 (CYP2D6) pathway 1.

Key Points to Consider

• The typical starting dose for children and adolescents weighing less than 70 kg is 0.5 mg/kg/day, gradually increasing to a target dose of 1.2 mg/kg/day, while for adults and children weighing more than 70 kg, treatment usually begins with 40 mg daily, with gradual increases to a maximum recommended daily dose of 100 mg 1.
• Atomoxetine can be taken with or without food, though taking it with food may help reduce stomach upset, and it may take 2-4 weeks to see the full therapeutic effects 1.
• Common side effects include decreased appetite, nausea, fatigue, and mood changes, and it's essential to monitor for rare but serious side effects such as liver problems or suicidal thoughts, particularly when first starting the medication or changing doses 1.
• Atomoxetine has been shown to be efficacious in treating ADHD, with a medium effect size compared to placebo, and it may be considered as a first-line treatment option in certain cases, such as disruptive behavior disorders, tic disorder, Tourette's syndrome, and substance use disorders 1.

Important Considerations

• The medication should be used with caution in patients with preexisting cardiovascular diseases or significant cardiac abnormalities, and warnings exist for emergent psychotic or manic symptoms, bipolar disorder, aggressive behavior or hostility, possible allergic reactions, effects on urine outflow and growth, and priapism in children, adolescents, and adults 1.
• Atomoxetine may have a lower risk of decreased appetite and growth problems compared to other non-stimulant medications, and it may be considered as an adjunctive therapy to stimulant medications to increase treatment effects or decrease adverse effects 1.

From the FDA Drug Label

Atomoxetine hydrochloride is a selective norepinephrine reuptake inhibitor indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD). Initial, Target and Maximum Daily Dose (Acute and Maintenance/Extended Treatment) Body Weight Initial Daily Dose Target Total Daily Dose Maximum Daily Dose Total Children and adolescents up to 70 kg 0.5 mg/kg 1.2 mg/kg 1.4 mg/kg Children and adolescents over 70 kg and adults 40 mg 80 mg 100 mg

The primary use of atomoxetine (Strattera) is for the treatment of Attention Deficit Hyperactivity Disorder (ADHD).

• The recommended dosage for children and adolescents up to 70 kg is:
  • Initial daily dose: 0.5 mg/kg
  • Target total daily dose: 1.2 mg/kg
  • Maximum daily dose: 1.4 mg/kg
• For children and adolescents over 70 kg and adults:
  • Initial daily dose: 40 mg
  • Target total daily dose: 80 mg
  • Maximum daily dose: 100 mg 2

From the Research

Atomoxetine Mechanism and Use

• Atomoxetine, a selective norepinephrine reuptake inhibitor, is approved for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children, adolescents, and adults 3, 4, 5, 6.
• It works by inhibiting the presynaptic norepinephrine transporter, preventing the reuptake of norepinephrine throughout the brain and inhibiting the reuptake of dopamine in specific brain regions such as the prefrontal cortex (PFC) 3.

Dosage and Administration

• Atomoxetine can be administered either as a single daily dose or split into two evenly divided doses 3, 5, 6.
• The clinical dose selection of atomoxetine is recommended based on both CYP2D6 genotype and the peak concentration 3.
• The dosage of atomoxetine varies, but common dosages include 60,90, or 120 mg/day for adults 6.

Efficacy and Safety

• Atomoxetine is effective in maintaining control of ADHD symptoms and preventing relapse of ADHD symptoms without an increase in adverse effects 4.
• It is generally well tolerated, with common adverse events including headache, abdominal pain, decreased appetite, vomiting, somnolence, and nausea 5, 6.
• Atomoxetine has a negligible risk of abuse or misuse and is not a controlled substance in the US 4, 5, 6.

Use in Specific Populations

• Atomoxetine may be effective in improving hyperactivity and inattention in children with autism spectrum disorder and ADHD, but the magnitude of effects is uncertain 7.
• It is also effective in adults with ADHD, with improvements in ADHD symptoms and a favorable safety profile 6.