Strattera (atomoxetine) is a nonstimulant drug generally
considered a second line medication for ADHD. That is, it is typically offered if stimulants are not effective, or present intolerable side effects. This article provides an overview of the effectiveness of atomoxetine
for ADHD and it’s side effects.
General information
Strattera (atomoxetine) is supplied only as a capsule. It must not be opened or chewed, and
therefore is not a good option for young children or others who cannot swallow
pills.
Genetic
testing is available which can reveal if a person is a fast or slow
metabolizer of atomoxetine. This can
sometimes assist a doctor at arriving at an effective dose while minimizing
side effects.
Effectiveness
Strattera (atomoxetine) is effective for core symptoms of
ADHD in adults and children (age 5 and older) , as well as for mood swings and
emotional impulsiveness (i.e. temper outbursts) in adults. Compared to stimulants, it seems to have less
of an effect.
Patients will generally not notice an effect right
away. This medication can take from 1 to
4 weeks before any effect is noticed.
Maximum effectiveness can take 6 to 8 weeks or longer. Missing an
occasional dose is not a big deal. No
one will probably notice. If forgetting
your medications is a problem, this might be a good one for you. However, taking medication breaks for a
weekend or vacation is pretty much impossible as the long lead in period pretty
much wipes out shorter breaks.
The main advantage of Strattera (atomoxetine) compared to
stimulants is that it has a very different side effect profile. Strattera does not interfere with sleep and
does not have an addictive potential. It
does not increase anxiety and preliminary trials suggest that it can reduce
anxiety with or without the use of a stimulant.
Atomoxetine has been found not to increase tics compared to
placebo. However, case reports exist
that implicate atomoxetine as possibly a cause of tics in certain
patients.
A second advantage of atomoxetine is that it works all
day. Patients who struggle with mornings
or nights or with significant rebound symptoms may find this particularly
attractive.
Side effects
Strattera (atomoxetine) has some serious, although rare,
side effects. Liver failure, while
never reported in any clinical trial, has surfaced in some patients taking
atomoxetine. Likewise, there is an increase
in suicidal thoughts in young adults and children who take atomoxetine. Also, the medication can trigger mania in
patients with bipolar disorder.
Most patients who stop atomoxetine will do so due to
appetite disturbance, stomach upset, or nausea.
Some children will lose weight although most gain it back again with no
trouble. Fatigue can also be a problem.
These issues often fade over the first 6 weeks of taking the medication.
Atomoxetine in high doses has been shown to increase the
risk of miscarriage in rats, so pregnant women are encouraged to consider an
alternative with the assistance of their
physician.
In summary, Strattera (atomoxetine) is a nonstimulant which
is not as effective for ADHD as stimulants, but which offers a distinct side
effect profile and 24 hour coverage which may be helpful to some patients.
This article is part of a series on nonstimulants, including bupropion (Wellbutrin), clonidine (Kapvay) , and guanfacine (Intuniv, Tenex)
References:
Childress, Ann C. "A
Critical Appraisal of Atomoxetine in the Management of ADHD." Therapeutics and Clinical Risk
Management. Dove Medical Press, 23 Dec. 2015. Web. 12 May
2016.
Garnock-Jones, Karly P., and
Gillian M. Keating. "Spotlight on Atomoxetine in Attention-Deficit
Hyperactivity Disorder in Children and Adolescents†." CNS Drugs 24.1
(2010): 85-88. Print.
Harfterkamp, M., J. K.
Buittelaar, R. B. Minderaa, G. Van De Loo-Neus, R. J. Van Der Gaag, and P. J.
Hoekstra. "Long-Term Treatment with Atomoxetine for
Attention-Deficit/Hyperactivity Disorder Symptoms in Children and Adolescents
with Autism Spectrum Disorder: An Open-Label Extension Study." Journal
of Child and Adolescent Psychopharmacology (2013): n. pag. Web.
Strattera [package insert].
Lilly USA , LLC., Indianapolis , IN
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