Atomoxetine for the treatment of attention-deficit/hyperactivity disorder in children and adolescents: a review

Abstract

Objective: This review examines and summarizes the pharmacodynamic and pharmacokinetic properties, short-and longer-term effi cacy, the moderating effect of comorbid disorders, as well as short-and long-term safety and tolerability of atomoxetine for the treatment of pediatric attention-defi cit/hyperactivity disorder (ADHD). Methods: A systematic literature search was performed to review the extant literature on articles pertaining to the pharmacological treatment with atomoxetine in pediatric and/or adolescent ADHD. Results: There is an extensive literature on atomoxetine; over 4000 children have participated in clinical trials of atomoxetine, demonstrating its short-and longer-term effi cacy. In addition, studies have examined the moderating effect of comorbid disorders on atomoxetine response, as well as atomoxetine's therapeutic potential for other psychiatric conditions. Short-and longerterm safety and tolerability continue to be reported. Conclusions: Atomoxetine is indicated for both acute and maintenance/extended treatment of pediatric ADHD. Clinicians and families must be familiar with atomoxetine's evidence base, including its profi le of clinical response and its possible effectiveness in the presence of comorbidity.

Treatment Response and Remission in a Double-Blind, Randomized, Head-to-Head Study of Lisdexamfetamine Dimesylate and Atomoxetine in Children and Adolescents with Attention-Deficit Hyperactivity Disorder

“…Indeed, a meta-analysis of pooled data from ATX studies ( N = 601) indicated that the response to ATX continued to grow for as long as 12 weeks, although most of the improvement occurred during the first 4 weeks and any subsequent further improvement occurred in conjunction with increasing mean ATX dose [ 33 ]. There is also evidence to suggest that higher doses of ATX than used in the present study and recommended in the product’s prescribing information (up to 1.8 mg/kg) may result in higher levels of efficacy of ATX [ 34 , 35 ]. In addition, there is some evidence that ATX is more effective when administered twice daily than once daily, as used in the present study [ 34 ].…”

A Randomized, Open-Label Assessment of Response to Various Doses of Atomoxetine in Korean Pediatric Outpatients with Attention-Deficit/Hyperactivity Disorder

“…This is consistent with findings in studies of Caucasian and non-Caucasian pediatric patients 7 , 11 - 13 , 15 , 17 , 24 , 26 and may be expected given the increases in noradrenergic tone observed with atomoxetine. 27 …”

Cardiovascular Side Effects of Atomoxetine and Its Interactions with Inhibitors of the Cytochrome P450 System

“…As noted in a recent review by Hammerness and colleagues, “serious cardiovascular side effects have not been noted in trials with therapeutic doses of atomoxetine” [ 4 ]. Usually, the increase in heart rate was estimated to be between 5 and 9 beats.…”

“…Classically, stimulants have been used in the treatment of this condition [ 3 ]. Atomoxetine (Strattera; Eli Lilly and Company) is a selective norepinephrine reuptake inhibitor (SNRI), one of the first medications in the nonstimulant class of medications that has been approved by the FDA for the treatment of attention deficit hyperactivity disorder [ 4 ]. “Atomoxetine is a phenoxypropylamine derivative and is structurally related to the antidepressant fluoxetine” [ 5 ].…”