From the FDA Drug Label
2.2 Maintenance/Extended Treatment It is generally agreed that pharmacological treatment of ADHD may be needed for extended periods. The benefit of maintaining pediatric patients (ages 6 to 15 years) with ADHD on atomoxetine hydrochloride after achieving a response in a dose range of 1.2 to 1.8 mg/kg/day was demonstrated in a controlled trial. Patients assigned to atomoxetine hydrochloride in the maintenance phase were generally continued on the same dose used to achieve a response in the open label phase The physician who elects to use atomoxetine capsules for extended periods should periodically reevaluate the long-term usefulness of the drug for the individual patient [see Clinical Studies (14.1)].
The recommended things to complete for a 15-year-old with ADHD on atomoxetine during a follow-up visit include:
- Periodically reevaluating the long-term usefulness of the drug for the individual patient 1
- Continuing the same dose used to achieve a response in the open label phase, if the patient is in the maintenance phase 1
- Monitoring the patient's response to the medication and adjusting the dose as needed, within the recommended dose range of 1.2 to 1.8 mg/kg/day 1
- Assessing the patient's overall condition and adjusting the treatment plan as necessary 1
From the Research
During a follow-up visit for a 15-year-old with ADHD on atomoxetine, clinicians should assess medication effectiveness, monitor vital signs, evaluate side effects, and screen for any psychiatric comorbidities, as recommended by the most recent study 2.
Key Components of the Follow-Up Visit
- Assessing medication effectiveness using standardized rating scales completed by parents, teachers, and the patient
- Monitoring vital signs, including blood pressure and heart rate, due to potential cardiovascular effects of atomoxetine
- Evaluating side effects, such as decreased appetite, nausea, fatigue, mood changes, and sleep disturbances
- Screening for psychiatric comorbidities, as ADHD often co-occurs with other conditions
Additional Considerations
- Plotting height and weight on growth charts to monitor for potential growth effects
- Discussing medication adherence, academic performance, social functioning, and behavioral concerns
- Considering dose adjustments (typical range 0.5-1.4 mg/kg/day) or medication changes if the response is inadequate, as suggested by previous studies 3, 4
Laboratory Monitoring
- Not routinely required unless there are specific concerns about liver function, as noted in earlier research 5, 6
Comprehensive Approach
- Ensures optimal management of ADHD symptoms while monitoring for potential medication-related issues in this adolescent population, as emphasized by the latest guideline update 2