Spotlight on Atomoxetine in Attention-Deficit Hyperactivity Disorder in Children and Adolescents†

Garnock-Jones, Karly P.; Keating, Gillian M.

doi:10.2165/11203670-000000000-00000

Cited by 91 publications

(130 citation statements)

References 47 publications

(75 reference statements)

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“…In a current review, which investigated the ATX treatment, it was concluded that ATX was significantly less effective than OROS-MPH and other extended-release mixed amphetamine salts. However, in this report, ATX was found non-inferior to IR-MPH regarding efficacy [18]. A recent study indicated that the balance of benefits and risks of ATX in the treatment of ADHD was positive [19].…”

Section: Discussioncontrasting

confidence: 60%

Brief report of efficacy and side effect profile of crossing over to modified-release capsules of methylphenidate in ADHD patients receiving other treatments: case series

Özbaran

Köse

Ocakoğlu

et al. 2017

Psychiatry and Clinical Psychopharmacology

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OBJECTIVES: Stimulants are recommended as the first-line pharmacotherapy in attention deficit/hyperactivity disorder (ADHD). Methylphenidate (MPH) is the most used stimulant. Medikinet Retard has modified-release capsules of MPH (MRC-MPH). In this study, we aimed to report observations on a sample of outpatients, who had been previously treated with other agents, but switched to MRC-MPH treatment. These observations focus on the treatment course, efficacy, side effects, and switching reasons. METHODS: We included 20 out of the 163 patients with ADHD, who were previously treated with other medications, and switched to MRC-MPH. Turgay DSM-IV Based Child and Adolescent Behavior Disorders Screening as diagnosing tool and Rating Scale, Barkley's Stimulants Side Effects Rating Scale for screening side effects and Clinical Global Impression Scale-Severity and -Improvement were administered. RESULTS: Patients' ages ranged between 9 and 17 years. Mean Clinical Global Impression ScaleSeverity (CGI-S) score before the MRC-MPH treatment was 3.2, whereas after treatment it was 3.15. CGI-S scores were not significantly different (p = .593). Loss of appetite (n = 4, 20%) and drowsiness (n = 4, 20%) were the most common adverse events during the MRC-MPH treatment. CONCLUSIONS: We did not observe significant difference between other treatment options and MRC-MPH with respect to efficacy. In terms of side effect profile, Osmotic Release Oral System-MPH was observed to be more problematic than immediate-release MPH and MRC-MPH formulations, while these two regimens did not differ significantly. ARTICLE HISTORY

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Section: Discussioncontrasting

confidence: 60%

Brief report of efficacy and side effect profile of crossing over to modified-release capsules of methylphenidate in ADHD patients receiving other treatments: case series

Özbaran

Köse

Ocakoğlu

et al. 2017

Psychiatry and Clinical Psychopharmacology

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“…For example, immediate-release methylphenidate demonstrates similar efficacy to atomoxetine, but when comparing Concerta to atomoxetine, a clear advantage is observed with Concerta. 39 As of 2013, only 1 small pilot study formally evaluated using atomoxetine with methylphenidate. Although the pilot study had promising results, this combination cannot be recommended at this time owing to the limited amount of data available.…”

Section: Atomoxetinementioning

confidence: 99%

A Review of Pharmacological Management of Attention-Deficit/Hyperactivity Disorder

Briars

Todd

2016

The Journal of Pediatric Pharmacology and Therapeutics

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Attention-deficit/hyperactivity disorder (ADHD) is a common psychological diagnosis in children. This disorder impacts children and adolescents in all areas of life, including academic performance, extracurricular activities, and social interactions. ADHD can continue into adulthood where unemployment and substance abuse has been described. Although behavioral therapy is recommended for all patients with ADHD, medication management typically is initiated soon after diagnosis. Psychostimulants remain the primary medication of choice. This review focuses on the clinical use of psychostimulant medication in children and adolescents. The pharmacodynamic and pharmacokinetic differences between the newest long-acting formulations as well as commonly encountered adverse drug reactions, with suggested management strategies, will be highlighted. Non-stimulant therapy with atomoxetine or alpha 2 -adrenergic agonists is also reviewed. These agents may be warranted for patients who cannot tolerate psychostimulant therapy or have a comorbid condition. Finally, the 8-year multimodal treatment study results are also discussed.INDEX TERMS: adolescent, alpha 2 -agonist, amphetamine, atomoxetine, attention deficit disorder with hyperactivity, central nervous system stimulants, child, clonidine, methylphenidate, pediatric J Pediatr Pharmacol Ther 2016;21(3) :192-206

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“…Atomoxetine is considered to be particularly beneficial as an adjunct therapy in ADHD patients presenting tics and comorbid anxiety (14)(15)(16). As it is devoid of abuse potential, atomoxetine is regarded as an appropriate alternative to the drugs that are misused (17).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a Potential Metabolism-Mediated Drug-Drug Interaction Between Atomoxetine and Bupropion in Healthy Volunteers

et al. 2016

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ABSTRACT-Purpose:To evaluate the impact of bupropion on the pharmacokinetic profile of atomoxetine and its main active metabolite (glucuronidated form), 4-hydroxyatomoxetine-O-glucuronide, in healthy volunteers.Methods: An open-label, non-randomized, two-period, sequential clinical trial was conducted as follows: during Period I (Reference), each volunteer received a single oral dose of 25 mg atomoxetine, whilst during Period II (Test), a combination of 25 mg atomoxetine and 300 mg bupropion was administered to all volunteers, after a pretreatment regimen with bupropion for 7 days. Next, after determining atomoxetine and 4-hydroxyatomoxetine-O-glucuronide plasma concentrations, their pharmacokinetic parameters were calculated using a noncompartmental method and subsequently compared to determine any statistically significant differences between the two periods. Results: Bupropion intake influenced all the pharmacokinetic parameters of both atomoxetine and its metabolite. For atomoxetine, C max increased from 226±96.1 to 386±137 ng/mL and more importantly, AUC 0-∞ was significantly increased from 1580±1040 to 8060±4160 ng*h/mL, while the mean t 1/2 was prolonged after bupropion pretreatment. For 4-hydroxyatomoxetine-O-glucuronide, C max and AUC 0-∞ were decreased from 707±269 to 212±145 ng/mL and from 5750±1240 to 3860±1220 ng*h/mL, respectively. Conclusions: These results demonstrated that the effect of bupropion on CYP2D6 activity was responsible for an increased systemic exposure to atomoxetine (5.1-fold) and also for a decreased exposure to its main metabolite (1.5-fold). Additional studies are required in order to evaluate the clinical relevance of this pharmacokinetic drug interaction.

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Spotlight on Atomoxetine in Attention-Deficit Hyperactivity Disorder in Children and Adolescents†

Cited by 91 publications

References 47 publications

Brief report of efficacy and side effect profile of crossing over to modified-release capsules of methylphenidate in ADHD patients receiving other treatments: case series

Brief report of efficacy and side effect profile of crossing over to modified-release capsules of methylphenidate in ADHD patients receiving other treatments: case series

A Review of Pharmacological Management of Attention-Deficit/Hyperactivity Disorder

Evaluation of a Potential Metabolism-Mediated Drug-Drug Interaction Between Atomoxetine and Bupropion in Healthy Volunteers

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