Please check your internet connection and try again.
# Atomoxetine
## Overview
Atomoxetine is a selective norepinephrine reuptake inhibitor (SNRI) used as a non-stimulant treatment for ADHD. It differs from stimulants as it is not a controlled substance and lacks significant abuse potential.
## Primary Indications
Attention-Deficit/Hyperactivity Disorder (ADHD).
## Adult Dosing
* **Initial:** 40 mg daily in the morning for at least 7 days.
* **Target:** Increase to 80 mg daily (as a single dose or split bid) based on response and tolerability.
* **Maximum:** 100 mg daily.
## Pediatric Dosing
* **Weight < 70 kg:** Initial 0.5 mg/kg/day; increase after at least 7 days to a target of ~1.2 mg/kg/day.
* **Weight > 70 kg:** Initial 40 mg daily; increase after at least 7 days to a target of 80 mg daily.
* **Maximum:** 1.4 mg/kg/day or 100 mg/day, whichever is less.
## Dose Adjustments
* **Hepatic Impairment:** Adjust dose in moderate (Child-Pugh B) impairment by 50% and severe (Child-Pugh C) impairment by 75%.
* **CYP2D6 Metabolizers:** Sensitive to poor metabolizers (consider starting at lower doses).
## Contraindications
* Hypersensitivity to atomoxetine.
* Concomitant use (or use within 14 days) of MAO inhibitors.
* Narrow-angle glaucoma.
* History of pheochromocytoma.
* Severe cardiovascular disorders where increased blood pressure/heart rate would be dangerous.
## Adverse Effects
* **Common:** Dry mouth, insomnia, nausea, decreased appetite, fatigue, dizziness.
* **Serious:** Suicidal ideation (especially in children/adolescents), hepatotoxicity (rare), severe cardiovascular events (tachycardia/hypertension).
## Key Drug Interactions
* **MAOIs:** Fatal hypertensive crisis risk; ensure 14-day washout.
* **CYP2D6 Inhibitors (e.g., Fluoxetine, Paroxetine):** Increases plasma levels of atomoxetine.
* **Pressor agents:** May potentiate hypertensive effects.
## Monitoring
* Monitor blood pressure and pulse at baseline, after dose increases, and periodically.
* Assess for emergence/worsening of suicidal ideation or behavioral changes.
* Monitor weight and height in pediatric patients.
* Monitor for signs of liver injury (jaundice, pruritus, RUQ pain).
## Clinical Pearls
* **Onset:** Therapeutic effects may take 2 to 4 weeks to become fully apparent.
* **Administration:** May be taken with or without food. Do not open capsules as the contents are an ocular/mucosal irritant.
* **Non-Stimulant:** Preferred for patients with comorbid anxiety or history of substance use disorder where stimulant use is concerning.
***
*Disclaimer: This information is for educational purposes and is not a substitute for professional medical judgment. Always verify current prescribing information, institutional protocols, and patient-specific factors via reliable clinical databases (e.g., Lexicomp, UpToDate) before prescribing or administering medication.*
