Atomoxetine (Straterra)

Antidepressant structure (norepinephrine reuptake inhibitor)

Dosing

40-100mg/d. Start 40mg 1 qd x7days then 2 qd (take after dinner to reduce nausea). Improvement in ADHD is gradual over 2-3 weeks.

Management

Like stimulants, has cardiotoxic effects so avoid combining with them (better to combine with alpha-agonists that do the opposite to the heart). Levels get extremely high in slow CYP 2D6 metabolizers and those taking CYP 2D6 inhibitors (like many antidepressants), causing extreme fatigue and possibly QTc prolongation.

Developed as a noradrenergic antidepressant but did not work in depression, although does help ADHD with anxiety. About half as effective as stimulants and similar efficacy to viloxazine (Qelbree), although viloxazine actually works in depression. Avoid in bipolar.

EMR Text