How to safely stop Atomoxetine due to side effects?

How to Safely Discontinue Atomoxetine Due to Side Effects

Atomoxetine should be tapered off rather than suddenly discontinued to avoid potential adverse effects. 1

Discontinuation Protocol for Atomoxetine

Assessment and Preparation

• Confirm that side effects are related to atomoxetine and warrant discontinuation 1
• Common side effects of atomoxetine include somnolence, gastrointestinal symptoms, decreased appetite, nausea, vomiting, fatigue, and abdominal pain 1
• Document baseline vital signs, particularly heart rate and blood pressure, as atomoxetine can increase these parameters 1

Tapering Schedule

• Gradually taper atomoxetine over 1-2 weeks rather than stopping abruptly 1
• For your current dose of 80mg daily, consider the following tapering schedule:
  • Week 1: Reduce to 40mg daily 1, 2
  • Week 2: Reduce to 20mg daily, then discontinue 1
• If side effects are severe, a more rapid taper may be necessary, but avoid complete abrupt discontinuation if possible 1

Monitoring During Discontinuation

• Monitor for return of ADHD symptoms during and after discontinuation 1, 2
• Although atomoxetine does not typically cause withdrawal symptoms, monitor for potential discontinuation-emergent adverse events 2
• Continue monitoring cardiovascular parameters (heart rate, blood pressure) during the tapering period 1

Important Considerations

Advantages of Proper Discontinuation

• Unlike stimulants, atomoxetine discontinuation is not typically associated with rebound effects 2
• Research shows that atomoxetine can be discontinued without significant risk of discontinuation syndrome 2
• ADHD symptoms may worsen following discontinuation but typically do not return to pre-treatment levels 2

Special Precautions

• If the patient is taking other medications for ADHD or comorbid conditions, these should be maintained during atomoxetine discontinuation 1
• If atomoxetine was being used to manage specific symptoms (e.g., evening coverage of ADHD symptoms), consider alternative management strategies 1

Next Steps After Discontinuation

• Consider alternative ADHD treatment options after complete discontinuation 1, 3
• Approximately 50% of non-responders to methylphenidate will respond to atomoxetine and vice versa, so alternative medication options exist 3
• Allow a washout period of at least 1 week before initiating another non-stimulant medication 1

Common Pitfalls to Avoid

• Do not stop atomoxetine abruptly - while some research suggests it can be discontinued without tapering 2, clinical guidelines recommend gradual tapering to minimize potential adverse effects 1
• Avoid initiating a new ADHD medication immediately after discontinuing atomoxetine without an appropriate washout period 1
• Do not ignore cardiovascular monitoring during the discontinuation period, as changes in heart rate and blood pressure may occur 1

By following this tapering protocol, you can safely discontinue atomoxetine while minimizing potential adverse effects and managing the transition to alternative treatment options if needed.