ATOMOXETINE
(a-to-mox'e-teen)
Strattera
Classifications: central nervous system (cns) agent; psychotherapeutic agent; norepinephrine reuptake inhibitor
Pregnancy Category: C
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10 mg, 18 mg, 25 mg, 40 mg, 60 mg capsules
Exact mechanism of action is unknown, but is thought to be related to selective inhibition of the pre-synaptic norepinephrine
transporter, resulting in norepinephrine reuptake inhibition.
Improved attentiveness, ability to follow through on tasks with less distraction and forgetfulness, and diminished hyperactivity.
Treatment of attention deficit/hyperactivity disorder (ADHD) in adults and children.
Hypersensitive to atomoxetine or any of its constituents; concomitant use or use within 2 wk of MAOIs; narrow angle glaucoma;
pregnancy (category C).
Severe liver injury may progress to liver failure or death in a small percentage of patients. Hypertension, tachycardia, cardiovascular
or cerebrovascular disease; any condition that predisposes to hypotension; urinary retention or urinary hesitancy; concomitant
use of CYP2D6 inhibitors (e.g., paroxetine, fluoxetine, quinidine), albuterol or other beta-2 agonists, vasopressor drugs, safety and efficacy in children <6 y and the older adult have not been established; lactation.
ADHD
Adult: PO Start with 40 mg in morning. May increase after 3 d to target dose of 80 mg/d given either once in the morning or divided
morning and late afternoon/early evening. May increase to max of 100 mg/d if needed.
Child/Adolescent: PO
<70 kg, start with 0.5 mg/kg/d. May increase after 3 d to target dose of 1.2 mg/kg/d. Administer once daily in morning or divide
dose and give morning and late afternoon/early evening. Max dose is 1.4 mg/kg or 100 mg, whichever is less. >70 kg, the max total daily dose is 100 mg.
Hepatic Impairment
Child-Pugh Class B: Initial and target doses should be reduced to 50% of the normal dose.
Child-Pugh Class C: Initial dose and target doses should be reduced to 25% of normal.
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Oral
- Note that total daily dose in children and adolescents is based on weight. Determine that ordered dose is appropriate for
weight prior to administration of drug.
- Note manufacturer recommends dosage adjustments with concomitant administration of strong CYP2D6 inhibitors (e.g., paroxetine,
fluoxetine, quinidine). Consult physician.
- Store at 15°–30° C (59°–86° F).
Body as a Whole: Flu-like syndrome, flushing, fatigue, fever, rigors. CNS: Dizziness, headache, somnolence, crying, tearfulness, irritability, mood swings, insomnia, depression, tremor, early morning awakenings, paresthesias, abnormal dreams, decreased libido, sleep disorder, suicidal ideation. CV: Increased blood pressure, sinus tachycardia, palpitations. GI:
Upper abdominal pain, constipation, dyspepsia, vomiting, decreased appetite, anorexia, dry mouth, diarrhea, flatulence, severe liver injury (rare). Endocrine: Hot flushes. Metabolic: Weight loss. Hepatic: Hepatotoxicity. Musculoskeletal: Arthralgia, myalgia. Respiratory:
Cough, rhinorrhea, nasal congestion, sinusitis. Skin: Dermatitis, pruritus, increased sweating. Special Senses: Mydriasis. Urogenital: Urinary hesitation/retention, dysmenorrhea, ejaculation dysfunction, impotence, delayed onset of menses, irregular menstruation,
prostatitis.
Drug:
Albuterol may potentiate cardiovascular effects of atomoxetine; fluoxetine,
paroxetine,
quinidine may increase atomoxetine levels and toxicity; maois may precipitate a hypertensive crisis; may attenuate effects of antihypertensive agents.
Absorption: Well absorbed from GI trace. Peak: 1–2 h. Metabolism: Metabolized in liver by CYP2D6. Elimination: Primarily excreted in urine. Half-Life: 5.2 h.
Assessment & Drug Effects
- Evaluate for continuing therapeutic effectiveness especially with long-term use.
- Monitor cardiovascular status especially with preexisting hypertension.
- Monitor HR and BP at baseline, following a dose increase, and periodically while on therapy.
- Lab tests: Periodic LFTs.
- Report increased aggression and irritability as these may indicate a need to discontinue the drug.
Patient & Family Education
- Report any of the following to physician: chest pains or palpitations, urinary retention or difficulty initiating voiding
urine, appetite loss and weight loss, or insomnia.
- Make position changes slowly if you experience dizziness with arising from a lying or sitting position.
- Do not drive or engage in potentially hazardous activities until reaction to the drug is known.
- Do not breast feed while taking this drug without consulting physician.
1%)
Canadian drug name; 
Prototype drug