atomoxetine hydrochloride

(at oh mox' ah teen)

Strattera

Pregnancy Category C

Drug class
Selective norepinephrine reuptake inhibitor

Therapeutic actions
Selectively blocks the reuptake of norepinephrine at the neuronal synapse. The
mechanism by which this action has a therapeutic effect in attention deficit hyperactivity
disorder (ADHD) is not understood.

Indication
• Treatment of ADHD as part of a total treatment program

Contraindications and cautions

• Contraindicated with hypersensitivity to atomoxetine or constituents of Strattera;
use of MAOIs within the past 14 days; narrow-angle glaucoma
• Use cautiously with hypertension, tachycardia, CV or cerebrovascular disease,
pregnancy, lactation

Pharmacokinetics
Route Onset Peak
Oral Rapid 1–2 hr

Metabolism: Hepatic; T1/2: 5 hr

Distribution: May cross placenta; may enter breast milk
Excretion: Urine and feces

Available forms
Capsules—10, 18, 25, 40, 60 mg

Dosages
ADULTS AND CHILDREN > 70 KG
40 mg/day PO, increase after a minimum of 3 days to a target total daily dose of 80 mg
PO given as a single dose in the morning or two evenly divided doses, in the morning and
late afternoon or early evening; after 2–4 wk, total dosage may be increase to a maximum
of 100 mg/day if needed.
PEDIATRIC PATIENTS < 70 KG
Initially, 0.5 mg/kg/day PO, increase after a minimum of 3 days to a target total daily
dose of approximately 1.2 mg/kg/day PO as a single daily dose in the morning; may be
given in two evenly divided doses in the morning and late afternoon or early evening. Do
not exceed 1.4 mg/kg or 100 mg/day, whichever is less.
PATIENTS WITH HEPATIC IMPAIRMENT
For moderate hepatic impairment, reduce dose to 50% of the normal dose; for severe
hepatic impairment, reduce dose to 25% of the normal dose.

Adverse effects
• CNS: Aggression, irritability, crying, somnolence, dizziness, headache, mood
swings, insomnia
• CV: Palpitations
• Dermatologic: Dermatitis, increased sweating
• GI: Dry mouth, nausea, dyspepsia, flatulence, decreased appetite, constipation,
upper abdominal pain, vomiting
• GU: Urinary hesitation, urinary retention, dysmenorrhea, erectile problems
• Respiratory: Cough, rhinorrhea, sinusitis
• Other: Fever, rigors, sinusitis, weight loss, myalgia

Interactions
Drug-drug
• Possible increased serum levels if combined with potent CYP2D6 inhibitors—
paroxetine, fluoxetine, quinidine; monitor and adjust dosage of atomoxetine to
0.5 mg/kg/day with a target dose of 1.2 mg/kg/day for children < 70 kg or
40 mg/day with a target dose of 80 mg/day for children > 70 kg or adults
• Risk of neuroleptic malignant syndrome if combined with MAOIs; do not
combine with an MAOI and do not give atomoxetine within 14 days of using an
MAOI

Nursing considerations
Assessment
• History: Hypersensitivity to atomoxetine or constituents of Strattera; use of
MAOIs within the past 14 days; narrow-angle glaucoma, hypertension,
tachycardia, CV or cerebrovascular disease, pregnancy, lactation
• Physical: Height, weight, T; skin color, lesions; orientation, affect; P, BP,
auscultation; R, adventitious sounds; bowel sounds, normal output

Interventions
• Ensure proper diagnosis before administering to children for behavioral
syndromes: drug should not be used until other causes and concomitants of
abnormal behavior (learning disability, EEG abnormalities, neurological deficits)
are ruled out.
• Ensure that drug is being used as part of an overall treatment program including
education and psychosocial interventions.
• Arrange to interrupt drug dosage periodically in children being treated for
behavioral disorders to determine if symptoms recur at an intensity that warrants
continued drug therapy.
• Monitor growth of children on long-term atomoxetine therapy.
• Administer drug before 6 PM to prevent insomnia if that is a problem.
• Monitor blood pressure early in treatment, particularly with adult patients.
 • Arrange for consult with school nurse of school-age patients receiving this drug.
• For women of childbearing age who are using this drug, suggest using
contraceptives.

Teaching points
• Take this drug exactly as prescribed. It can be taken once a day in the morning, if
adverse effects are a problem, the drug can be taken in two evenly divided doses
in the morning and in the late afternoon or early evening.
• Take drug before 6 PM to avoid night-time sleep disturbance.
• Avoid the use of alcohol and over-the-counter drugs, including nose drops, cold
remedies, and herbal therapies while taking this drug; some of these products
cause dangerous effects. If you feel that you need one of these preparations,
consult your health care provider.
• The effects of this drug on the unborn baby are not known, women of
childbearing age are advised to use contraceptives.
• These side effects may occur: Dizziness, insomnia, moodiness (these effects may
become less pronounced after a few days; avoid driving a car or engaging in
activities that require alertness if these occur; notify your health care provider if
these are pronounced or bothersome); headache (analgesics may be available to
help), loss of appetite, dry mouth (eat small, frequent meals and suck on sugarless
lozenges).
• Report palpitations, dizziness, weight loss, severe dry mouth and difficulty
swallowing, pregnancy.

Adverse effects in Italic are most common; those in Bold are life-threatening.