Does atomoxetine (Strattera) have the same cardiovascular risks as Adderall (amphetamine and dextroamphetamine)?

From the Guidelines

Atomoxetine (Strattera) generally has a lower cardiovascular risk profile than Adderall (amphetamine and dextroamphetamine). While both medications can cause increases in blood pressure and heart rate, Adderall typically poses greater cardiovascular concerns because it is a stimulant that directly affects the sympathetic nervous system. Atomoxetine, as a norepinephrine reuptake inhibitor, has a more modest effect on cardiovascular parameters, as noted in a study published in 2019 1. However, atomoxetine still carries cardiovascular risks and can cause small increases in blood pressure and heart rate.

Both medications require cardiovascular monitoring, especially at treatment initiation and during dose adjustments. Patients with pre-existing heart conditions, hypertension, or cardiovascular disease should be evaluated carefully before starting either medication. The FDA has issued warnings for both medications regarding potential cardiovascular risks, though the warnings for stimulants like Adderall have generally been more prominent, as discussed in a study from 2022 1. For patients with significant cardiovascular concerns, atomoxetine may be considered a safer alternative to Adderall, but this should always be determined through individual clinical assessment by a healthcare provider.

Some key points to consider when evaluating the cardiovascular risks of these medications include:

• The potential for increased heart rate and blood pressure with both medications
• The need for careful evaluation of patients with pre-existing cardiovascular conditions
• The importance of monitoring cardiovascular parameters during treatment initiation and dose adjustments
• The relatively lower cardiovascular risk profile of atomoxetine compared to Adderall, as supported by recent studies 1.

Overall, while both medications carry some level of cardiovascular risk, atomoxetine may be a safer option for patients with significant cardiovascular concerns, due to its more modest effects on cardiovascular parameters.

From the FDA Drug Label

Severe Cardiovascular Disorders that might deteriorate with clinically important increases in HR and BP. (4.5) Serious Cardiovascular Events- Sudden death, stroke and myocardial infarction have been reported in association with atomoxetine treatment. Effects on Blood Pressure and Heart Rate- Increase in blood pressure and heart rate; orthostasis and syncope may occur.

The cardiovascular risks of atomoxetine are not directly compared to those of Adderall in the provided drug label. However, atomoxetine is known to have serious cardiovascular events associated with its treatment, including sudden death, stroke, and myocardial infarction. Additionally, it can cause increases in blood pressure and heart rate, which may lead to orthostasis and syncope.

• Key points about atomoxetine's cardiovascular risks include:
  • Increased risk of sudden death, stroke, and myocardial infarction
  • Increases in blood pressure and heart rate
  • Risk of orthostasis and syncope Since the label for Adderall is not provided, no direct comparison can be made between the two medications regarding their cardiovascular risks 2.

From the Research

Comparison of Cardiovascular Risks

• Atomoxetine (Strattera) and Adderall (amphetamine and dextroamphetamine) are both used to treat Attention-Deficit/Hyperactivity Disorder (ADHD), but they have different mechanisms of action and side effect profiles.
• Studies have shown that atomoxetine is associated with small but statistically significant increases in blood pressure and heart rate, similar to stimulant medications like Adderall 3, 4, 5.
• However, the increases in blood pressure and heart rate with atomoxetine are generally considered to be of little clinical significance and are often temporary 3, 4.
• Adderall, on the other hand, has been shown to have a higher risk of cardiovascular side effects, including palpitations, arrhythmias, and increased blood pressure 4, 5.
• A systematic review and meta-analysis found that both atomoxetine and amphetamines (including Adderall) were associated with small but statistically significant increases in systolic blood pressure, diastolic blood pressure, and heart rate in children and adolescents with ADHD 5.
• Another study found that the risk of serious cardiovascular adverse events, including heart failure and cardiomyopathy, was low with both atomoxetine and stimulant medications, including Adderall 6.

Key Differences

• Atomoxetine is a non-stimulant medication, while Adderall is a stimulant medication.
• Atomoxetine has a more selective mechanism of action, targeting the norepinephrine transporter, while Adderall has a broader mechanism of action, affecting multiple neurotransmitters 3, 7.
• The side effect profiles of the two medications differ, with atomoxetine being associated with fewer cardiovascular side effects than Adderall 3, 4, 5.

Clinical Implications

• Both atomoxetine and Adderall can be effective treatments for ADHD, but the choice of medication should be based on individual patient needs and medical history 4, 5.
• Patients with a history of cardiovascular disease or risk factors for cardiovascular disease should be monitored closely when taking either medication 4, 6.
• The benefits of treating ADHD with either atomoxetine or Adderall generally outweigh the risks, but patients should be informed of the potential cardiovascular side effects and monitored regularly 4, 5, 6.