1: Pharmacotherapy. 2004 Aug;24(8):1020-36.  

Atomoxetine, a novel treatment for attention-deficit-hyperactivity disorder.

Christman AK, Fermo JD, Markowitz JS.

Department of Pharmacy Practice, Medical University of South Carolina, Charleston 29425, USA.

Atomoxetine is the first nonstimulant drug approved by the United States Food and Drug Administration (FDA) for the treatment of attention-deficit-hyperactivity disorder (ADHD), and the only agent approved by the FDA for the treatment of ADHD in adults. Atomoxetine is a norepinephrine transport inhibitor that acts almost exclusively on the noradrenergic pathway. Its mechanism of action in the control and maintenance of ADHD symptoms is thought to be through the highly specific presynaptic inhibition of norepinephrine. Clinical trials to evaluate the short-term effects of atomoxetine in children and adults have shown that atomoxetine is effective in maintaining control of ADHD. Likewise, long-term trials have determined that atomoxetine is effective in preventing relapse of ADHD symptoms without an increase in adverse effects. A comparative trial of atomoxetine with methylphenidate in school-aged children indicated similar safety and efficacy without the abuse liability associated with some psychostimulants. The most commonly reported adverse effects in children and adolescents are dyspepsia, nausea, vomiting, decreased appetite, and weight loss. The rates of adverse events in the trials were similar for both the once- and twice-daily dosing regimens. The discontinuation rate was 3.5% in patients treated with atomoxetine versus 1.4% for placebo and appeared to be dose dependent, wit a higher percentage of discontinuation at dosages greater than 1.5 mg/kg/day. In clinical trials involving adults, the emergence of clinically significant or intolerable adverse events was low. The most common adverse events in adults were dry mouth, insomnia, nausea, decreased appetite, constipation, urinary retention or difficulties with micturition, erectile disturbance, dysmenorrhea, dizziness, and decreased libido. Sexual dysfunction occurred in approximately 2% of patients treated with atomoxetine. Atomoxetine should be used with caution in patients who have hypertension or any significant cardiovascular disorder. Overall, atomoxetine therapy in patient with ADHD appears to be effective in controlling symptoms and maintaining remission, with the advantages being comparable efficacy with that of methylphenidate, a favorable safety profile, and non-controlled substance status. Additional long-term studies are needed to determine its continued efficacy for those who require lifelong treatment, and comparative trials against other stimulant and nonstimulant agents.

Publication Types:
Review
Review, Tutorial

PMID: 15338851 [PubMed - indexed for MEDLINE]

: Drugs. 2004;64(2):205-22. Related Articles, Links  


Atomoxetine: a review of its use in adults with attention deficit hyperactivity disorder.

Simpson D, Plosker GL.

Adis International Limited, Auckland, New Zealand. demail@auckland.co.nz

Atomoxetine (Strattera) is a selective norepinephrine reuptake inhibitor and nonstimulant that has shown greater efficacy than placebo in attention deficit hyperactivity disorder (ADHD) in adults. In two large, well controlled, 10-week trials in adults with ADHD, improvements in ADHD symptoms, as assessed by investigator- and patient-rated scores, were greater with oral atomoxetine (60, 90 or 120 mg/day) than with placebo. Mean reductions in the total ADHD symptom score on the investigator-rated Conners' Adult ADHD Rating Scale (CAARS) in atomoxetine versus placebo recipients were 28.3% versus 18.1% and 30.1% versus 19.6%, respectively. Mean reductions in the scores on the Clinician Global Impression of Severity Scale, patient-rated CAARS and Wender-Reimherr Adult Attention Deficit Disorder Scale were also significantly greater with atomoxetine than with placebo. Continued efficacy was demonstrated in a noncomparative, 34-week extension phase. Atomoxetine was generally well tolerated in clinical trials; withdrawal rates due to adverse events in atomoxetine-treated versus placebo-treated patients participating in the two major trials were 7.8% versus 4.3% and 9.3% versus 2.4% (p<0.05 for the latter trial). Adverse events reported significantly more frequently with atomoxetine than placebo included dry mouth, insomnia, nausea, decreased appetite, constipation, dizziness, sweating, dysuria, sexual problems and palpitations. Modest increases in heart rate and blood pressure were well tolerated and gradually decreased on cessation of treatment. Atomoxetine was not associated with QT interval prolongation. Atomoxetine can be administered once or twice daily. Its subjective-effects profile is different to that of methylphenidate and atomoxetine is not associated with abuse or diversion; it is therefore not a controlled substance in the US. This also means repeat prescriptions during long-term treatment can be more conveniently processed. CONCLUSION: Atomoxetine is an effective and generally well tolerated treatment for adults with ADHD. It is a nonstimulant and is the first ADHD treatment to be approved specifically for adult use based on its efficacy in well controlled adult trials. It can be administered as a single daily dose or split into two evenly divided doses. It carries negligible risk of abuse or diversion and is not a controlled substance. Atomoxetine is a valuable new treatment option for adults with ADHD and is particularly useful in patients who are at risk for substance abuse or who do not wish to take a controlled substance.

Publication Types:
Review
Review, Tutorial

PMID: 14717619 [PubMed - indexed for MEDLINE]

I stopped taking Strattera a week ago.
They wrote ( Eli Lilly) that I could stop directly without a problem.
I was so stupid to believe them.
So I stopped, it's a week ago, and I start to feel more and more strange in my body.
Is that normal?
I can hardly write this message, I can but it cost me alot of strength.
and I can almost not walk, I feel soooooooo tired, like I weight 300 kilo's!
I do weight 'only' 83 kg's.

Is the feelings I decribe possible Strattera after effects?
Or is that not the case at all?
If it is Strattera, how long will this complains takes?
I'm going to report myself ill tomorrow, I really can't work the way I feel now.
What can i do?

interesting

sounds like the side effects i had when i came of cymbalta an SNRI ... total nightmare to come off and really bad withdrawal
i think its the short half life and also the norepinephrine bit that makes it hard to just stop cold turkey
it took me 6 weeks to feel better ... i wish you luck

which brings me to my dilema ... my son ( 11 years old ) has been prescribed strattera for his severe adhd symptoms
as ritalin didnt suit him at all and made him quite ill

part of me is frightened of giving him this drug as i know that coming off can be difficult even though lilly tell us its not!
but his adhd is so bad at the moment the school wont even have him back until its more controlled.

hard deciding what to do as a parent eh?

i know medication effects everyone different however I thought I would share my experience. I tried strattera for 6 weeks and reached a dosage of 80mg/day - after realizing the therapeutic effects were not out weighing the severe side effects I stopped taking it suddenly without any problem. My usual side effects ceased within the days.

Do not go cold turkey from medication. Just because one person stopped the same drug dead does in no way mean you can. Taking away any drug in your drug regime can cause serious problems either withdrawal or upsetting medication you already take. With out you really knowing your medication is fine tuned in order to avoid any drug interactions.

Cutting the crap just see you Psychiatrist/doctor a pain in the *** I know but trust me from a guy who thought he knew best about screwing with his drugs to find himself ****** quickly in HDU.