Att%2520drugs

# Atomoxetine (Strattera) ## Overview Atomoxetine is a selective norepinephrine reuptake inhibitor (SNRI) non-stimulant medication used primarily for the management of Attention-Deficit/Hyperactivity Disorder (ADHD). It is not a controlled substance. ## Primary Indications * Attention-Deficit/Hyperactivity Disorder (ADHD). ## Adult Dosing * **Initial:** 40 mg orally once daily in the morning for at least 7 days. * **Titration:** Increase to a target dose of 80 mg daily (as a single morning dose or divided twice daily). * **Maximum:** 100 mg daily. ## Pediatric Dosing (≥ 6 years) * **Weight < 70 kg:** Initial 0.5 mg/kg/day for at least 7 days; increase to target ~1.2 mg/kg/day. Max 1.4 mg/kg/day or 100 mg, whichever is less. * **Weight ≥ 70 kg:** Initial 40 mg daily for at least 7 days; increase to target 80 mg daily. Max 100 mg daily. ## Dose Adjustments * **Hepatic Impairment:** Reduce starting and target doses by 50% in patients with moderate hepatic impairment (Child-Pugh Class B) and by 75% in severe impairment (Child-Pugh Class C). * **CYP2D6 Poor Metabolizers:** Consider starting at 50% of the recommended dose. ## Contraindications * Hypersensitivity to atomoxetine. * Concomitant use (or use within 14 days) of MAO inhibitors. * Narrow-angle glaucoma. * History of pheochromocytoma. * Severe cardiovascular disorders (where increases in BP or HR would be clinically serious). ## Adverse Effects * **Common:** Nausea, dry mouth, insomnia, fatigue, decreased appetite, dizziness, and constipation. * **Serious:** Severe liver injury (rare), increased suicidal ideation in children/young adults, cardiovascular events (tachycardia, hypertension), and priapism. ## Key Drug Interactions * **MAOIs:** Fatal hypertensive crisis risk; avoid concurrent use. * **CYP2D6 Inhibitors (e.g., paroxetine, fluoxetine, quinidine):** May significantly increase atomoxetine plasma concentrations; monitor closely. * **Antihypertensives:** Potential for decreased efficacy of blood pressure medication due to opposing pharmacodynamic effects. ## Monitoring * **Baseline/Ongoing:** Blood pressure and heart rate (monitor at each visit). * **Psychiatric:** Monitor for new or worsening anxiety, agitation, aggression, or suicidal ideation. * **Hepatic:** Monitor for signs of liver injury (jaundice, pruritus, dark urine, RUQ tenderness). ## Clinical Pearls * Atomoxetine typically requires 2–4 weeks of consistent daily dosing to reach full therapeutic effect. * Do not open the capsule; the medication is a potent ocular irritant. If contents contact the eye, flush immediately and seek medical assessment. * May be taken with or without food, but taking with food may mitigate initial GI distress. * Efficacy is generally lower than stimulant medications; consider as a primary option if stimulant abuse is a concern or if stimulants are poorly tolerated. *** *Disclaimer: This information is for educational purposes only. Clinical pharmacology varies by jurisdiction and institution; always verify current prescribing information, institutional protocols, and patient-specific factors via reliable clinical databases (e.g., Lexicomp, UpToDate) before prescribing or administering medication.*