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Atomoxetine
is the first non-stimulant medication approved for the treatment of
ADHD. It was released in the
U.S. in 2003 and was studied in over 3,200 adults and children before
this. Atomoxetine increases attention and decreases
restlessness in people who are overactive, cannot concentrate for very long
or are easily distracted. Atomoxetine is
non-addictive and cannot be abused.
An important difference from stimulant medications is that
atomoxetine does not work immediately – it's benefits come on over the
first week or two and remain throughout the day.
How does
atomoxetine work?
Atomoxetine
works by increasing the levels of norepinephrine, which indirectly affects
dopamine in the brain's attention center. This is different from stimulant medications, which
affect dopamine directly.
What side
effects can this medication cause?
Atomoxetine is a safe
medication but may cause side effects. Some early effects may go away as
your body adjusts to the medicine; others may improve by taking the
medicine twice a day with food, especially protein. Tell me if any of the
following continue or are bothersome.
Most common side effects:
Decreased appetite, tiredness,
nausea, vomiting, dizziness, mood swings, upset stomach.
Side effects that occurred more often than with
placebo (sugar-pill):
Palpitations, constipation, dry
mouth, acid or sour stomach, belching, bloating, gas, trouble sleeping,
decreased sex drive, sweating, hot flashes, bleeding between periods,
change in amount of bleeding during periods, change in pattern of
monthly periods, decrease in frequency of urination, difficulty in passing
urine (dribbling), tightness of chest or wheezing, increased blood pressure
or heart rate.
Rare but
serious side effects:
Very rarely, atomoxetine has been associated with liver injury; if this
happens you would notice yellowing of skin and eyes, abdominal pain and/or
flu-like symptoms. It is not
known if atomoxetine can cause this reaction: as of January 2005 there were
only 2 cases of liver injury out of more than 2 million patients who have
taken atomoxetine. Both cases recovered after stopping the medicine.
An allergic reaction is possible with any
medication. Symptoms include
the following; stop the medication and call me if these occur:
Pounding heartbeat; swelling of the
face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs;
hoarseness; difficulty swallowing or breathing; hives; rash.
Precautions
Take the capsule whole; do not open it up.
Make sure I know if you have any medical conditions
before taking atomoxetine, particularly glaucoma, high blood pressure,
rapid heart beat, a stroke, a mini-stroke, or heart or liver disease.
Atomoxetine has not been studied in pregnant
women. Atomoxetine may be
passed through breast milk.
Atomoxetine may make you drowsy. Do not drive a car
or operate machinery until you know how this medication affects you.
Remember that alcohol can add to the drowsiness
caused by this medication.
Atomoxetine has no known food interactions.
Atomoxetine may cause dizziness, lightheadedness,
and fainting when you get up too quickly from a lying position. To avoid
this problem, get out of bed slowly, resting your feet on the floor for a
few minutes before standing up.
Drug Interactions
These
medicines may raise blood levels of atomoxetine:
bupropion (Wellbutrin), fluoxetine (Prozac), paroxetine (Paxil), quinidine
(Cardioquin, Quinaglute, Quinidex)
These
medicines should not be taken with atomoxetine:
monoamine oxidase (MAO) inhibitors (isocarboxazid, Marplan, phenelzine,
Nardil, procarbazine, Matulane, selegiline, Eldepryl, tranylcypromine,
Parnate, Saint John's Wort).
Other
medications that can interact with atomoxetine:
albuterol (Ventolin, Proventil), amiodarone (Cordarone, Pacerone),
celecoxib (Celebrex), chlorpromazine (Thorazine), cimetidine (Tagamet),
clomipramine (Anafranil), doxorubicin (Adriamycin), metaproterenol syrup or
tablets (Metaprel), metoclopramide (Reglan), methadone (Dolophine),
ranitidine (Zantac), ritonavir (Norvir), sertraline (Zoloft), and
terbinafine (Lamisil), blood pressure medications.
What should I do if I forget a dose?
Take the missed dose as soon as
you remember it. However, if it is almost time for the next dose, skip the missed
dose and continue your regular dosing schedule. Do not take a double dose
to make up for a missed one. Do not take more than the prescribed daily
amount of atomoxetine in 24 hours.
Storage
- Keep
out of the reach of children.
- Store
away from heat and direct light.
- Do
not store in the bathroom, near the kitchen sink, or in other damp
places. Heat or moisture may cause the medicine to break down.
- Do
not keep outdated medicine or medicine no longer needed. Be sure that
any discarded medicine is out of the reach of children.
Updated 1/18/5 by Chris Aiken,
M.D.
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