atomoxetine STRATTERA

Class: NRI
FDA Indications: ADHD
Off-Label Use: Cataplexy
Prescribing
Forms: 10, 18, 25, 40, 60, 80, 100mg capsule
Dose Range: 40-100 mg/day
Starting: 40 mg PO qam for at least 3 days; Max: 100 mg/day; may ↑ to 100 mg/day after 2-4 weeks

NAMI drug fact sheet

Precautions
Contraindications: Pheochromocytoma, Narrow Angle Glaucoma, Cardiovascular Disease
Serious Side Effects: Aminotransferase elevations (~0.5%), several reports of clinically apparent acute liver injury
Possible Risk of TdP, Drugs to Avoid in Congenital Long QT
Side Effects: sedation/somnolence, dizziness, xerostomia, nausea, anorexia, weight loss, rash, modest increases in diastolic blood pressure and heart rate
Pharmacodynamics
1° MOA: Selective norepinephrine reuptake inhibitor → NE & DA levels to ↑ in the prefrontal cortex
Target: NET
Pharmacokinetics
t½: 5 (3-6)° TMAX:
Substrate of: 2D6; 2C19
Inhibits: ∅ ; Induces:
Active Metabolites: 4-hydroxyatomoxetine (t½6-8° similar pharmacologic activity to atomoxetine in terms of NET inhibition)
DDIs
  • - DO NOT CO-PRESCRIBE WITH MAOIs
  • - co-prescribed 2D6 inhibitors can ↑ serum levels
Misc
  • - the first truly novel non-stimulant medication to be developed and FDA approved for ADHD which was not already marketed for another indication
  • - low propensity for anticholinergic and adverse cardiovascular effects
  • - atomoxetine augmentation of antidepressants and anxiolytics may not only improve cognitive symptoms of ADHD, but has the potential of improving anxiety symptoms, depressive symptoms, and perhaps even heavy drinking
  • - no abuse potential
Special Populations

Category C—Although animal data suggest risk, the absence of detailed human pregnancy experience prevents an assessment of the embryo-fetal risk, ∴ safest course is to avoid the drug in pregnancy.

No reports describing the use of atomoxetine during human lactation have been located however the molecular weight of the parent drug and the relatively long t½ suggest that the drug and/or its metabolites will be excreted into breast milk.

The safety, efficacy and pharmacokinetics in geriatric patients have not been evaluated.

No dosage adjustment necessary.


Moderate hepatic impairment (Child-Pugh B): ↓ dose 50%; severe hepatic impairment (Child-Pugh C): ↓ dose 25%

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Last updated January 22 2018 19:18:05. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.