Names and pronunciation
(at-o-mox′eh-teen) Strattera
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Drug reference
(at-o-mox′eh-teen) Strattera
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Func. class.: Psychotherapeutic— miscellaneous (ADHD)
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Chem. class.: Selective norepineph- rine reuptake inhibitor
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Do not confuse: atomoxetine/atorvastatin
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ACTION: Selective norepinephrine reuptake inhibitor; may inhibit the pre- synaptic norepinephrine transporter
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USES: Attention-deficit/hyperactivity disorder
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CONTRAINDICATIONS: Hyper- sensitivity, closed-angle glaucoma, MAOI therapy, history of pheochromocytoma Precautions: Pregnancy, breastfeeding, hepatic disease, angioedema, bipolar dis- order, dysrhythmias, CAD, hypo/hyperten- sion, arteriosclerosis, cardiac disease, cardiomyopathy, heart failure, jaundice
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Black Box Warning: Children <6 yr, sui- cidal ideation Black Box Warning: Mental status: mood, sensorium, affect, stimulation, memory loss, confusion, insomnia, aggressiveness, suicidal ideation in children/young adults, to notify prescriber immediately • VS, B/P; check patients with cardiac disease more often for increased B/P • Hepatic injury: may cause liver failure: monitor LFT; assess for jaundice, pruritus, flulike symptoms, upper right quadrant pain • Priapism: monitor for urinary function (hesitancy, retention), sexual changes • Appetite, sleep, speech patterns • ADHD: For increased attention span, decreased hyperactivity with ADHD, growth rate, weight; therapy may need to be discontinued Black Box Warning: To report suicidal ideation immediately • To notify prescriber immediately if erection >4 hr • To report immediately fainting, chest pain, difficulty breathing • Pregnancy/breastfeeding: to notify prescriber if pregnancy is planned or suspected, or if breastfeeding; avoid in pregnancy or breastfeeding
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SIDE EFFECTS CNS: Insomnia, dizziness, irritability, crying, mood swings, fatigue, lethargy, paresthesia, suicidal ideation CV: Palpitations, hot flushes, tachycar- dia, increased B/P, palpitations, ortho- static hypotension, QT prolongation GI: Dyspepsia, nausea, anorexia, dry mouth, weight loss, vomiting, diarrhea, constipation, hepatotoxicity GU: Urinary hesitancy, retention, dys- menorrhea, erectile disturbance, ejacu- lation failure, impotence, prostatitis INTEG: Sweating, rash MISC: Rhabdomyolysis, angioneurotic edema, anaphylaxis
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INTERACTIONS Increase: hypertensive crisis—MAOIs or within 14 days of MAOIs, vasopressors Increase: cardiovascular effects of albu terol, pressor agents Increase: effects of atomoxetine— CYP2D6 inhibitors (amiodarone, cimeti- dine [weak], clomiPRAMINE, delavir- dine, gefitinib, imatinib, propafenone, quiNIDine [potent], ritonavir, citalopram, escitalopram, FLUoxetine, sertraline, PARoxetine, thioridazine, venlafaxine)
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DOSAGE AND ROUTES ADHD • Adult and child >6 yr and >70 kg: PO 40 mg/day, increase after 3 days to target daily dose of 80 mg in AM or evenly divided doses AM, late afternoon; max 100 mg/day • Child >6 yr and ≤70 kg: PO 0.5 mg/kg/ day, increase after 3 days to target daily dose of 1.2 mg/kg in AM or evenly divided doses AM, late afternoon; max 1.4 mg/kg/ day or 100 mg/day, whichever is less Hepatic dose • Adult/Child PO Child-Pugh B: reduce dose by 50%; Child-Pugh C: reduce dose by 75% Strong CYP2D6 inhibitors Adult/child: PO, reduce dose if needed
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Available forms: Capsules 10, 18, 25, 40, 60, 80, 100 mg
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Administer: • Whole; do not break, crush, chew • Gum, hard candy, frequent sips of water for dry mouth • Without regard to food
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Assess:
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Evaluate: • Therapeutic response: decreased hy- peractivity (ADHD), improved attention
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To avoid OTC preparations, other medications, herbs, supplements unless approved by prescriber; no tapering needed when discontinuing product • To avoid alcohol ingestion • To avoid hazardous activities until sta- bilized on medication • To get needed rest; patients will feel more tired at end of day; not to take dose late in day, insomnia may occur
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PHARMACOKINETICS Peak 1-2 hr duration up to 24 hr, metabo- lized by liver, some are poor metabolizers , excreted by kidneys, 98% protein binding, half-life 5 hr
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• Adult and child >6 yr and >70 kg: PO 40 mg/day, increase after 3 days to target daily dose of 80 mg in AM or evenly divided doses AM, late afternoon; max 100 mg/day
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• Child >6 yr and ≤70 kg: PO 0.5 mg/kg/ day, increase after 3 days to target daily dose of 1.2 mg/kg in AM or evenly divided doses AM, late afternoon; max 1.4 mg/kg/ day or 100 mg/day, whichever is less Hepatic dose
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• Adult/Child PO Child-Pugh B: reduce dose by 50%; Child-Pugh C: reduce dose by 75% Strong CYP2D6 inhibitors Adult/child: PO, reduce dose if needed
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