Prescribing
Forms: 10, 18, 25, 40, 60, 80, 100mg capsuleDose 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
Precautions
Contraindications: Pheochromocytoma, Narrow Angle Glaucoma, Cardiovascular DiseaseSerious 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: modest increases in diastolic blood pressure and heart rate, anorexia, weight loss, sedation/somnolence, dizziness, nausea, xerostomia, rash
Pharmacodynamics
1° MOA: Selective norepinephrine reuptake inhibitor → NE & DA levels to ↑ in the prefrontal cortexTarget: NET
Pharmacokinetics
t½: 5.2 (3-6)° TMAX: 1°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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