atomoxetine, Strattera

 Indications

Attention-Deficit/Hyperactivity Disorder (ADHD).

Action

Selectively inhibits the presynaptic transporter of norepinephrine.

Therapeutic Effects: Increased attention

span.

Pharmacokinetics

Absorption: Well absorbed following oral administration.

Distribution: Unknown.

Protein Binding: 98%.

Metabolism and Excretion: Mostly metabolized

by the liver (CYP2D6 enzyme pathway). A small percentage

of the population are poor metabolizers and

will have higher blood levels withqeffects.

Half-life: 5 hr.

TIME/ACTION PROFILE

ROUTE ONSET PEAK DURATION

PO unknown 1–2 hr 12–24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Concurrent

or within 2 wk therapy with MAO inhibitors; Angle-closure

glaucoma; Pheochromocytoma; Hypertension,

tachycardia, cardiovascular, or cerebrovascular disease.

Use Cautiously in: Pre-existing psychiatric illness;

Pedi: Mayqrisk of suicide attempt/ideation especially

during dose early treatment or dose adjustment; risk

may be greater in children or adolescents; Concurrent

albuterol or vasopressors (qrisk of adverse cardiovascular

reactions); OB: Use only if benefits outweigh risks

to fetus; Lactation, Pedi: Safety not established.

Adverse Reactions/Side Effects

CNS: SUICIDAL THOUGHTS, dizziness, fatigue, mood

swings, behavioral disturbances, hallucinations, hostility,

mania, thought disorder; Adults, insomnia. CV: hypertension,

orthostatic hypotension, QT interval prolongation,

syncope, tachycardia. GI: HEPATOTOXICITY,

dyspepsia, nausea, vomiting; Adults, dry mouth, constipation.

Derm:qsweating, rash, urticaria. GU:

Adults—dysmenorrhea, ejaculatory problems, erectile

dysfunction, libido changes, priapism, urinary hesitation,

urinary retention.Metab:pappetite, weight/

growth loss. MS: RHABDOMYOLYSIS. Neuro: Adults—

paresthesia. Misc: allergic reactions including ANGIONEUROTIC

EDEMA and ANAPHYLAXIS.

Interactions

Drug-Drug: Concurrent use with MAO inhibitors

may result in serious, potentially fatal reactions (do not

use within 2 wk of each other).qrisk of cardiovascular

effects with albuterol or vasopressors(use cautiously).

Drugs which inhibit the CYP2D6 enzyme

pathway (quinidine, fluoxetine, paroxetine) will

qblood levels and effects, doseprecommended.

Route/Dosage

PO (Children and adolescents 70 kg): 0.5 mg/kg/

day initially, may beqevery 3 days to a daily target dose

of 1.2 mg/kg, given as a single dose in the morning or

evenly divided doses in the morning and late afternoon/

early evening (not to exceed 1.4 mg/kg/day or 100 mg/

day whichever is less). If taking concurrent CYP2D6

inhibitor (quinidine, fluoxetine, paroxetine)—0.5

mg/kg/day initially, mayqif needed to 1.2 mg/kg/day

after 4 wk.

PO (Adults , adolescents, and children 70 kg):

40 mg/day initially, may beqevery 3 days to a daily target

dose of 80 mg/day given as a single dose in the

morning or evenly divided doses in the morning and

late afternoon/early evening; may be furtherqafter 2–

4 wk up to 100 mg/day. If taking concurrent CYP2D6

inhibitor (quinidine, fluoxetine, paroxetine)—40

mg/day initially, mayqif needed to 80 mg/day after 4

wk.

Hepatic Impairment

PO (Adults and Children): Moderate hepatic impairment

(Child-Pugh Class B)—pinitial and target

dose by 50%; Severe hepatic impairment (Child-

Pugh Class C)—pinitial and target dose to 25% of

normal.

Availability (generic available)

Capsules: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80

mg, 100 mg.