What is the interaction between atomoxetine (Strattera) and alcohol consumption?

Atomoxetine and Alcohol Interaction

Atomoxetine (Strattera) should not be combined with alcohol as this combination may increase the risk of adverse effects, though the interaction is not as severe as with some other ADHD medications.

Mechanism of Interaction

Atomoxetine is a selective norepinephrine reuptake inhibitor primarily metabolized through the CYP2D6 pathway 1. When considering its interaction with alcohol:

• Atomoxetine does not change the intoxicating effects of alcohol, as specifically noted in the FDA drug label 1
• However, alcohol consumption while taking atomoxetine may potentially:
  • Exacerbate common side effects like dizziness, somnolence, and fatigue
  • Increase risk of cardiovascular effects (both substances can affect heart rate and blood pressure)

Safety Considerations

Cardiovascular Effects

• Atomoxetine can cause small but statistically significant increases in blood pressure and heart rate 2
• Alcohol can also affect cardiovascular parameters, potentially compounding these effects
• Patients with pre-existing cardiovascular conditions should be particularly cautious about this combination

Hepatic Considerations

• Both atomoxetine and alcohol are metabolized by the liver
• Atomoxetine has been rarely associated with serious liver injury 3
• Alcohol is known to affect liver function, which could theoretically impact atomoxetine metabolism

Neurological Effects

• Both substances can affect the central nervous system
• Combined use may increase risk of:
  • Sedation
  • Dizziness
  • Impaired coordination
  • Impaired judgment

Evidence from Clinical Research

A post-hoc safety analysis specifically examining atomoxetine in adults with ADHD and comorbid alcohol abuse/dependence found:

• Study completion rates for patients receiving atomoxetine were comparable between heavy drinkers (60.9%) and patients with no alcohol-use disorder (71.0%) 4
• Discontinuation rates due to adverse events were not significantly different among drinking status groups 4
• However, patients with alcohol-use disorders, especially heavy drinkers, generally experienced the greatest frequency of treatment-emergent adverse events in both atomoxetine and placebo groups 4
• Vital signs and measures of hepatic function were not significantly different among the drinking status groups taking atomoxetine 4

Practical Recommendations

1. Patient Education:

   • Advise patients about potential additive effects on sedation and cognitive impairment
   • Warn about possible increased risk of cardiovascular effects

2. Monitoring:

   • For patients who do consume alcohol while on atomoxetine:
     • Monitor blood pressure and heart rate more frequently
     • Watch for signs of excessive sedation or cognitive impairment
     • Monitor liver function tests if heavy alcohol use is present

3. Risk Stratification:

   • Higher risk patients include those with:
     • Pre-existing cardiovascular disease
     • Hepatic impairment
     • History of substance use disorders
     • Concurrent use of other CNS depressants

Special Considerations

• Atomoxetine may be particularly useful for patients at risk of substance abuse, as it has negligible abuse potential and is not a controlled substance 5
• For patients with known alcohol use problems who require ADHD treatment, atomoxetine might be preferred over stimulants, but the combination still requires careful monitoring 4

While the interaction between atomoxetine and alcohol is not as concerning as with some other medications, caution is still advised, and patients should be educated about potential risks of combining these substances.