Is Strattera (atomoxetine) safe for patients after open heart surgery?

Safety of Strattera (Atomoxetine) in Post-Open Heart Surgery Patients

Strattera (atomoxetine) is generally safe for patients after open heart surgery, but should be used with caution due to its mild cardiovascular effects including small increases in heart rate and blood pressure.

Cardiovascular Considerations for Post-Cardiac Surgery Patients

Cardiovascular Effects of Atomoxetine

• Atomoxetine is associated with statistically but not clinically significant increases in heart rate and blood pressure in most patients 1
• Clinical studies show that cardiovascular effects of atomoxetine are typically minimal:
  • Small increases in systolic blood pressure in adults
  • Small increases in diastolic blood pressure in children and adolescents
  • Mild increases in pulse rate across all age groups 2
• These changes tend to occur early in therapy, stabilize over time, and return toward baseline upon discontinuation 2

Post-Cardiac Surgery Cardiovascular Management

• Post-cardiac surgery patients require careful cardiovascular monitoring, particularly for:
  • Heart rate control (target <110 bpm for hemodynamic stability) 3
  • Blood pressure management
  • Rhythm abnormalities, especially post-operative atrial fibrillation (POAF) which occurs in 25-50% of patients after open heart surgery 4

Safety Recommendations

Pre-Prescription Assessment

• Evaluate baseline cardiovascular status:
  • Current heart rate and blood pressure
  • Presence of arrhythmias
  • Left ventricular function
  • Concomitant medications (particularly those affecting heart rate or blood pressure)

Monitoring Requirements

• Regular monitoring of vital signs, especially during medication initiation and dose adjustments
• Monitor for:
  • Excessive increases in heart rate (>10-15 bpm above baseline)
  • Significant blood pressure elevations (>10-15 mmHg above baseline)
  • New-onset arrhythmias
  • Symptoms of cardiovascular distress (palpitations, dizziness, syncope)

Dosing Considerations

• Consider starting at a lower dose and titrating slowly
• FDA drug labeling indicates atomoxetine should generally not be used in patients with:
  • Severe cardiovascular disorders that might deteriorate with clinically important increases in heart rate and blood pressure 5
  • Serious structural cardiac abnormalities
  • Cardiomyopathy
  • Serious heart rhythm abnormalities 5

Special Considerations

Medication Interactions

• Be cautious with concomitant medications commonly used after cardiac surgery:
  • Beta-blockers (recommended for post-cardiac surgery patients to prevent POAF) 4
  • Antihypertensive medications (atomoxetine may affect blood pressure) 5
  • Albuterol or other beta-2 agonists (atomoxetine may potentiate cardiovascular effects) 5

Timing of Initiation

• Consider delaying initiation of atomoxetine until the patient is hemodynamically stable after surgery
• Most cardiovascular complications occur within the first week after cardiac surgery

Conclusion

While atomoxetine has mild cardiovascular effects, these are generally not clinically significant in most patients with stable cardiovascular function. For post-open heart surgery patients who have recovered and achieved cardiovascular stability, atomoxetine can be used with appropriate monitoring. However, it should be avoided in patients with severe cardiovascular disorders or significant cardiac abnormalities as specified in the FDA labeling.