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Atomoxetine (Dosage)

Atomoxetine is a non-stimulant drug used in the treatment of attention deficit hyperactivity disorder (ADHD). Atomoxetine is a selective inhibitor of noradrenaline reuptake and is used in combination with other educational and social support actions.

ACTION MECHANISM

Atomoxetine is a potent and highly selective inhibitor of the presynaptic norepinephrine transporter, without acting directly on the serotonin or dopamine transporters.

CONTRAINDICATIONS

Hypersensitivity to atomoxetine.

The concomitant treatment with MAOIs is contraindicated, the treatments must be distanced at least two weeks.

Treatment with atomoxetine is contraindicated in patients with narrow-angle glaucoma, pheochromocytoma, or those who have a history of pheochromocytoma.

Atomoxetine is contraindicated in patients with severe cardiovascular or cerebrovascular disorders that are worsened by an increase in blood pressure or heart rate.

CAUTIONS

Do not use in children under 6 years.

Extreme caution should be exercised when atomoxetine is prescribed in patients with hypertension, tachycardia, cardiovascular or cerebral diseases. It is advisable to monitor blood pressure and heart rate: record and measure heart rate and blood pressure before and during treatment, after each dose adjustment and then at least every 6 months. In pediatric population, the use of a percentile table is recommended, following the usual reference guidelines for arterial hypertension, as well as monitoring growth Caution should be exercised in patients with prolongation of the cardiac QT interval or family history, in situations that predispose to hypotension, in patients with risk factors for cerebrovascular diseases, in patients with a history of seizures.

Treatment with atomoxetine causes risk of allergic events. The appearance or worsening of suicidal attitude, hostility or emotional instability, symptoms of anxiety, depression or tics should be monitored.

Poor (or slow) CYP2D6 metabolizers have an increased exposure to atomoxetine and an increased risk of adverse reactions, as well as a greater likelihood of obtaining a good pharmacological response. In CYP2D6 poor metabolizers patients, the starting dose should sometimes be reduced and progressively increased.

SIDE EFFECTS

Decreased appetite, anorexia, irritability, mood swings, insomnia, agitation, anxiety, depression and depressed mood, tics, headache, drowsiness, dizziness, mydriasis, dry mouth, abdominal pain, vomiting, nausea, constipation, dyspepsia, dermatitis, pruritus, rash, fatigue, lethargy, chest pain, increased blood pressure, increased heart rate and weight loss.

PHARMACOLOGIC INTERACTIONS

Do not use together with IMAOs.

Concentrations of atomoxetine are increased by concomitancy with CYP2D6 inhibitors (SSRI, quinidine, terbinafine). In these cases, the dose of atomoxetine should be adjusted.

Atomoxetine potentiates the action of β2-agonists.

Atomoxetine may increase the risk of prolonging the QTc interval if taken concomitantly with neuroleptics, class IA and III antiarrhythmics, moxifloxacin, erythromycin, methadone, mefloquine, tricyclic antidepressants, lithium, cisapride, thiazide diuretics, CYP2D6 inhibitors.

Atomoxetine increases the risk of seizures if taken concomitantly with antidepressants, neuroleptics, phenothiazines, butyrophenone, mefloquine, chloroquine, bupropion, and tramadol.

Atomoxetine reduces the effectiveness of antihypertensive drugs.

Extreme caution should be exercised when prescribing atomoxetine together with vasodilators and medications that increase blood pressure.

Atomoxetine has a synergistic or additive effect of its activity with imipramine, venlafaxine, mirtazipine, pseudoephedrine and phenylephrine.

BRAND NAME

  • Strattera ®

Gene or region studied

  • CYP2D6
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