atomoxetine (Strattera)
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Introduction
Tradename: Strattera (atomoxetine HCL) (NOT a DEA controlled substance). FDA clears 1st generic 2017[6]
Indications
Contraindications
- not recommended in patients with narrow-angle glaucoma
- use with caution in patients with hypertension, tachycardia or cardiovascular disease
Dosage
- QD-BID dosing, up to 150 mg/day, 120 mg single dose
- when switching to atomoxetine from another agent, NO need to taper discontinued agent)
Capsules: 10, 18, 25, 40, 60 mg
Pharmacokinetics
- absorption minimally affected by food
- absolute bioavailability 63%-94% (poor metabolizers)
- volume of distribution 0.85 L/kg
- 98% plasma protein bound, mainly albumin
- metabolized by cyt P450 2D6
- major metabolite is 4-OH atomoxetine
- elimination 1/2life of 5 hours
Monitor
Adverse effects
- not common (< 5%)
- GI upset (constipation, dyspepsia)
- dizziness
- mood swings
- decreased appetite 8%
- may slow growth
- mydriasis[2]
- allergic reactions have been reported
- hypertension (mean systolic BP increase 3 mm Hg, adult)
- orthostatic hypotension (1%)
- urinary hesitancy (3%) & urinary retention (3%)
- hepatitis several months after initial dose (2 cases)[3]
- increased risk of suicidal ideation in children, adolescents[4]
- supportive care
- no deaths reported
Drug interactions
- drugs that inhibit cyt P450 2D6 may increase levels of atomoxetine (paroxetine, fluoxetine, quinidine ...)
- atomoxetine potentiates heart rate & blood pressure increase induced by albuterol
Laboratory
Mechanism of action
- blocks reuptake of norepinephrine
More general terms
References
- ↑ Prescriber's Letter 10(1):1 2003
- ↑ 2.0 2.1 2.2 http://www.strattera.com http://pi.lilly.com/us/strattera-pi.pdf
- ↑ 3.0 3.1 Prescriber's Letter 12(2): 2005 New Warning for Strattera Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210205&pb=PRL (subscription needed) http://www.prescribersletter.com http://www.fda.gov/bbs/topics/ANSWERS/2004/ANS01335.html
- ↑ 4.0 4.1 FDA MedWatch http://www.fda.gov/medwatch/safety/2005/safety05.htm#Strattera
Prescriber's Letter 12(9): 2005 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=211111&pb=PRL (subscription needed) http://www.prescribersletter.com - ↑ Prescriber's Letter 17(7): 2010 Recommended Lab Monitoring for Common Medications Liver Function Test Scheduling Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260704&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 6.0 6.1 Brooks M FDA Clears First Generic Versions of Strattera for ADHD. Medscape - May 30, 2017. http://www.medscape.com/viewarticle/880860
FDA News Release. May 30, 2017 FDA approves first generic Strattera for the treatment of ADHD. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm561096.htm