Can Strattera (atomoxetine) be given to individuals in recovery from eating disorders?

Can Strattera (Atomoxetine) Be Given to Individuals in Recovery from Eating Disorders?

Yes, Strattera (atomoxetine) can be cautiously used in individuals recovering from eating disorders, but it requires careful monitoring of appetite, weight, and eating behaviors, as decreased appetite is a common side effect that could potentially interfere with nutritional rehabilitation goals.

Key Considerations for Use

Appetite and Weight Effects

• Atomoxetine commonly causes decreased appetite as a side effect, which is one of the most frequently reported adverse events in clinical trials 1
• This appetite suppression could theoretically interfere with recovery goals in eating disorders, where normalizing eating patterns and restoring/maintaining healthy weight are primary objectives 2
• The medication should be used with heightened monitoring when hyperglycemia and weight loss are unexplained, as treatment-related effects on hunger and caloric intake need evaluation 3

When Atomoxetine May Be Appropriate

For ADHD comorbidity in eating disorder recovery:

• Atomoxetine is particularly useful for patients at risk of substance abuse, those with comorbid anxiety or tics, or who do not wish to take a controlled substance 1
• It has negligible risk of abuse or misuse and is not a controlled substance 1
• This makes it potentially safer than stimulant medications in the eating disorder population, where there may be concerns about medication misuse for weight control

Critical Monitoring Requirements

Treatment plan reevaluation is essential:

• Consider reevaluating the treatment plan when symptoms of disordered eating behavior or disrupted patterns of eating emerge, in consultation with a qualified professional familiar with diabetes disease physiology, weight-related factors, and psychological risk factors 3
• Regular monitoring of weight, eating behaviors, and psychological symptoms is essential during treatment 4
• Screen for disordered or disrupted eating using validated screening measures when weight loss is unexplained based on self-reported behaviors 3

Practical Management Approach

Start with lower doses and titrate slowly:

• Usual starting dose is 40 mg orally daily, with titration every 7-14 days to 60 then 80 mg/day 3
• Maximum dose is the lesser of 1.4 mg/kg/day or 100 mg/day 3
• Close collaboration between the prescribing psychiatrist and eating disorder treatment team is mandatory to ensure appetite suppression doesn't compromise nutritional rehabilitation

Common side effects to anticipate:

• Headache, abdominal pain, decreased appetite, vomiting, somnolence, and nausea are the most common adverse events 1
• The majority of adverse events are mild or moderate 1

Important Caveats

Black box warning considerations:

• Atomoxetine carries a black-box warning for suicidal ideation, with meta-analysis showing significantly higher incidence than placebo 1
• This is particularly relevant in eating disorder populations who already have elevated psychiatric comorbidity and suicide risk

Avoid in active restrictive eating:

• In patients with anorexia nervosa requiring active weight restoration, atomoxetine's appetite-suppressing effects would be counterproductive to treatment goals 2
• The medication is more appropriate in later stages of recovery or in binge eating disorder/bulimia nervosa where appetite suppression is less problematic

Alternative Considerations

For eating disorders with ADHD comorbidity, if appetite suppression becomes problematic, non-stimulant alternatives or careful use of extended-release stimulants under close supervision may need consideration, though all ADHD medications carry some appetite-related risks 1.