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Drugs Affecting the Central Nervous System
Published in Radhwan Nidal Al-Zidan, Drugs in Pregnancy, 2020
Risk Summary: It should be used with caution because the pregnancy experience in humans is limited, and the reproduction studies in animals have shown risk associated with the use of Atomoxetine.
Disorders
Published in Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson, Pocket Prescriber Psychiatry, 2019
Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson
Clonidine and guanfacine should be gradually tapered down to avoid rebound HTN. Atomoxetine may be stopped abruptly. The situation is less clear with stimulants, but drug holidays are possible with effective abrupt temporary discontinuation (Shier et al., J Cent Nerv Syst Dis 2013; 5: 1–17).
Substrates of Human CYP2D6
Published in Shufeng Zhou, Cytochrome P450 2D6, 2018
Atomoxetine is a nonstimulant, highly selective noradrenaline reuptake inhibitor approved by the FDA for the treatment of attention-deficit/hyperactivity disorder in children, adolescents, and adults (Corman et al. 2004; Simpson and Plosker 2004). In humans, atomoxetine is extensively metabolized via aromatic ring hydroxylation, benzylic oxidation, and N-demethylation (Figure 3.48). Subsequent O-glucuronidation of the ring-hydroxylated metabolites is the only Phase II metabolic pathway to participate in the conjugation of the hydroxylated metabolites. Atomoxetine is predominantly metabolized by CYP2D6 to 4-hydroxyatomoxetine (>80% in EMs), but multiple other CYPs including CYP2C19, 3A, 1A2, 2A6, and 2E1 also form 4-hydroxyatomoxetine at a 475-fold slower rate (Ring et al. 2002). 4-Hydroxyatomoxetine has activity similar to the parent drug.
Impulsivity in Alcohol-Dependent Patients with and without ADHD: The Role of Atomoxetine
Published in Journal of Psychoactive Drugs, 2018
Maurizio Coppola, Raffaella Mondola
The pharmacological treatment with atomoxetine in patients with ADHD produced a significant reduction in the levels of impulsivity, in accordance with information in the scientific literature (De Bruyckere et al. 2016). Atomoxetine is a nonstimulant medicine acting like a blocker of norepinephrine transporters. Unlike stimulant drugs, it is not associated with addictive potential because it does not increase the dopamine transmission in the brain reward area (Upadhyaya et al. 2013). This pharmacological characteristic is relevant in the treatment of ADHD in patients affected by alcohol and/or drug dependence because it reduces the risk of misuse. The clinical improvement found at both 8 and 12 weeks was not negatively influenced by higher alcohol consumption, suggesting that even alcohol-dependent patients may obtain benefit from the therapy. Atomoxetine did not induce significant side-effects and all patients completed the study, suggesting a good tolerability in alcohol-dependent patients. The reduction of impulsivity in alcohol-dependent patients represents a key point in the treatment of alcoholism because impulsivity can influence numerous clinical aspects of this disorder, including age of onset, quantity and frequency of alcohol consumption, binge drinking behavior, and inhibitory control (Blonigen et al. 2011). Furthermore, impulsivity represents an important and independent mortality risk factor in alcohol-dependent patients. On the whole, reduction in impulsivity level could improve the outcomes and social costs, reducing both alcohol-related diseases and mortality (Blonigen et al. 2011).
Evaluation of dystonia in children and adolescents treated with atomoxetine within the Truven MarketScan database: a retrospective cohort study
Published in Expert Opinion on Drug Safety, 2018
Kristin J. Meyers, Himanshu P. Upadhyaya, Robert Goodloe, Ludmila A. Kryzhanovskaya, Marie A. Liles-Burden, Nicole A. Kellier-Steele, Michele Mancini
In addition to the primary comparative analyses, an evaluation of the 15 dystonia cases occurring within the atomoxetine-treated cohort did not show a time to onset consistent with the expected clinical presentation of drug-induced dystonia. Dystonia induced by antipsychotic drugs is well understood; reactions develop within a few days (approximately seven days) of initiation, or increasing the dose of an antipsychotic medication, or after reducing the dose of a medication used to treat EPS [35]. Instead, the median time to onset after atomoxetine initiation and dose increase was 94.0 and 58.5 days, respectively (Table 2). Furthermore, the earliest time to onset was 18 days after atomoxetine initiation without considering the one patient who initiated lamotrigine on the same day as atomoxetine; dystonia is a known side effect of lamotrigine. The information used in the study included commercial claims, Medicaid, and Medicare data from THAM and is generalizable to an insured population in the US. In the matched cohorts, 13% of the patients were using an antidepressant at baseline. This is consistent with a study conducted in Texas, which found that 14.8% of children who were prescribed an ADHD medication were concomitantly using an antidepressant [21]. The similarity in this baseline characteristic pointed toward the generalizability of our study population and study results to a broader ADHD population.
The effects of atomoxetine on weight, height, and body mass index in Turkish children and adolescents with attention deficit hyperactivity disorder
Published in Psychiatry and Clinical Psychopharmacology, 2019
Serkan Turan, Aynur Pekcanlar Akay
Attention deficit hyperactivity disorder (ADHD) is defined as a neurodevelopmental disorder that reflects the persistence of ADHD symptoms such as inattention, overactivity, and impulsivity across lifespan [1]. Atomoxetine (Atx) is the first non-stimulant drug approved by the FDA in the treatment of ADHD. In recent years, it has been suggested that atomoxetine may have a role in the treatment of ADHD with an increasing understanding of the importance of noradernal mechanism in the aetiology of ADHD [2]. The most common side effects associated with atomoxetine include dry mouth (16–55%), decreased appetite (12–50%), insomnia (17–35%), irritability (35%), constipation (7–20%), nausea (12–40%), dizziness (6–15%), and fatigue (16–25%) [3].