Atomoxetine

What is atomoxetine?

Atomoxetine is a non-stimulant medication and is not related to amphetamine like other medications commonly used in attention-deficit and hyperactivity disorder (ADHD). It increases attention and decreases impulsivity and hyperactivity.

What is atomoxetine used for in child psychiatry?

Atomoxetine is licensed for the treatment of ADHD in children over the age of 6 and can be considered along with other drugs as a first-line choice of medication depending on the profile of the patient. It is particularly recommended for patients who also suffer with tics and anxiety. Usually atomoxetine will be used alongside some psychological or behavioural interventions.

It may be prescribed for children under 6 years of age out of license if this is deemed necessary by a specialist.

How does it work?

Atomoxetine increases the amount of noradrenaline in the brain and can also affect the levels of dopamine. These are important chemical messengers, which also occur naturally.

In what form is atomoxetine available?

Strattera^® capsules 10mg, 18mg, 25mg, 40mg, 60mg and 80mg.

The capsules cannot be opened and can be taken with or without food.

Why is this medication prescribed?

Your doctor will explain the need for your child to be on this medication and which symptoms are expected to improve by taking it. It is usually used to reduce impulsivity and hyperactivity and improve concentration and behavioural difficulties secondary to ADHD.

How well will this medication work?

How well your child responds to medication is individual. Extensive studies have shown that atomoxetine is effective in reducing core ADHD symptoms as rated by parents and teachers.

What should my doctor check before starting this medication?

Your doctor will check if your child suffers from any medical conditions especially:

• liver problems
• heart problems
• high or low blood pressure
• any other mental health disorders

It is also important to mention if your child takes any other medications especially:

• antidepressants
• antibiotics
• nebulisers for severe asthma
• over-the-counter preparations such as decongestants

Your doctor will also record your child’s height, weight, blood pressure and pulse.

What are the side effects of atomoxetine?

Different people can get different side effects. The side effects can be managed by building up the dose slowly, decreasing the dose or changing the time of day that the tablet is taken.

Most common side effects

• headaches
• decreased appetite
• feeling sick (nausea)
• being sick (vomiting)
• drowsiness
• skin rash
• moderate weight loss
• small increase in blood pressure
• problems sleeping

Uncommon side effects

• fast heartbeat and palpitations
• allergic reactions
• aggression
• fainting
• increased sweating

Very rare side effects

• liver inflammation
• psychotic symptoms (such as hallucinations)
• lower tummy (loin) pain
• problems urinating for boys
• painful or prolonged erections

There have been some reports of children developing suicidal thoughts and occasionally attempting suicide whilst on atomoxetine. This is a very rare occurrence.

How long will it take to act?

You may see a small change in your child after the first few doses, but to get the full effect atomoxetine has to be taken for 4 to 6 weeks.

What is the right dose of this medication?

Children under 70kg

• 500micrograms (mcg) per kg of their weight for 7 days
• Then increased according to response
• Maintenance dose of 1.2milligrams (mg) per kg of their weight a day

Children over 70kg

• 40mg daily for 7 days to start with
• Then increased according to response
• Maintenance dose of 80mg daily
• Maximum dose 100mg daily

How often is atomoxetine needed to be taken in the day?

Atomoxetine can be taken once a day or twice a day with the last dose being no later than early evening.

What happens if a dose is missed?

Do not worry too much if your child misses a single dose. If they are taking it only once a day the dose can be taken when you remember as long as it is on the same day. Continue with the medication regime as before. If you or your child would like atomoxetine to be stopped it is best to discuss this with the specialist who is prescribing the medication.

What should be done if more than the prescribed dose is taken accidentally or intentionally?

You should immediately contact your GP. Symptoms of overdose include excess sedation, gastrointestinal disturbances, agitation, hyperactivity and abnormal behaviour. These symptoms will depend on how much atomoxetine has been taken, your child’s medical fitness and interaction with any other medications. You may have to take your child to the Emergency Department for treatment of the overdose.

For how long should this medication be taken?

It is recommended that atomoxetine is taken for as long as it makes a clinical difference. Some patients with ADHD find that their symptoms improve with time. Therefore the clinical need is reviewed at least once a year and a medication-free trial may be needed to determine whether atomoxetine is still required.

What happens if this medication is stopped?

There have not been any withdrawal symptoms reported when medication is stopped. However, symptoms of ADHD are likely to recur soon after stopping

How does this medication react with alcohol?

There is no evidence available about the interaction of atomoxetine with alcohol, however as with all medications, alcohol is best avoided.

Can atomoxetine be used in pregnancy and while breastfeeding?

Currently there is no information available about the effects atomoxetine can have on an unborn child and whether it is passed on in human milk. Therefore if there are any concerns that the patient may be pregnant or if a patient is breastfeeding, it is very important to let the doctor know.

What monitoring is needed for this medication?

Weight and height is monitored regularly to ensure growth and weight-gain continue as normal. Blood pressure and pulse are also monitored regularly as rarely they may increase. Occasionally, if there is a history of heart problems, a heart tracing may be done before starting the medication.