Atomoxetine: Difference between revisions
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{{MedTemplate | {{MedTemplate | ||
| generic | | generic = Atomoxetine | ||
| brand | | brand = Strattera | ||
| structure | | structure = | ||
| classes | | classes = [[:Category:NRIs|Selective norepinephrine reuptake inhibitor (NRI)]], [[:Category:ADHD medicines|ADHD medicine]] | ||
| | | uses = <vote slug="adhd-atomoxetine-use">Attention-deficit/hyperactivity disorder (FDA, ages 6+ and adult; the first non-controlled FDA-approved ADHD medicine)</vote> | ||
| uses | | starting_dose = Children ≤70 kg: 0.5 mg/kg/day, titrate to 1.2 mg/kg/day after 3 days. Adults and children >70 kg: 40 mg PO once daily for 3 days, then 80 mg/day, then if needed 100 mg/day after 2-4 weeks | ||
| starting_dose | | preparations = Capsules 10, 18, 25, 40, 60, 80, 100 mg | ||
| preparations | | fda_max = 100 mg/day (adult); 1.4 mg/kg/day or 100 mg total (pediatric, whichever lower) | ||
| fda_max = | | pill_id = | ||
| routes | | routes = Oral | ||
| onset | | onset = ADHD effect emerges over 1-2 weeks (slower than psychostimulants); full effect 4-6 weeks | ||
| duration | | duration = 24 hours (once-daily or split BID dosing) | ||
| halflife | | halflife = ~5 hours in extensive CYP2D6 metabolizers; ~21 hours in CYP2D6 poor metabolizers<ref name="strattera-label">FDA Prescribing Information, Strattera (atomoxetine hydrochloride), Eli Lilly, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021411s044lbl.pdf</ref> | ||
| bioavailability = ~63% (oral; extensive first-pass)<ref name="strattera-label" /> | |||
| pregnancy = Limited human data.{{citation needed}} | |||
| legal = [[USLegal:Prescription only|Rx-only]] in US. '''Not a controlled substance''', the principal clinical selling point versus psychostimulant ADHD options. Carries the antidepressant-class '''Boxed Warning''' for suicidal ideation in pediatric patients<ref name="strattera-label" /> | |||
| | | mechanism = <vote slug="atomoxetine-mech-claim">Selective inhibition of the presynaptic norepinephrine transporter (NET). Increases extracellular norepinephrine and, in the prefrontal cortex, dopamine (since prefrontal dopamine reuptake is largely NET-mediated in that region, accounting for the ADHD efficacy despite no direct dopamine targeting).</vote> '''Not a psychostimulant''': no euphoric or rewarding effect, no abuse liability, no Schedule classification. CYP2D6 substrate with a strong pharmacogenomic signal: poor metabolizers have approximately 5-10-fold higher plasma exposure than extensive metabolizers, and CPIC provides CYP2D6 dosing guidance<ref name="cpic-atomoxetine">CPIC Guideline for Atomoxetine and CYP2D6 Genotype, 2019. https://cpicpgx.org/guidelines/cpic-guideline-for-atomoxetine-based-on-cyp2d6-genotype/</ref>. | ||
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[[Category: | == References == | ||
<references /> | |||
[[Category:NRIs]] | |||
[[Category:ADHD medicines]] | |||
Latest revision as of 07:08, 23 May 2026
Atomoxetine
Strattera
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Summary
Common uses
Attention-deficit/hyperactivity disorder (FDA, ages 6+ and adult; the first non-controlled FDA-approved ADHD medicine)0
Pharmacy
Starting dose
Children ≤70 kg: 0.5 mg/kg/day, titrate to 1.2 mg/kg/day after 3 days. Adults and children >70 kg: 40 mg PO once daily for 3 days, then 80 mg/day, then if needed 100 mg/day after 2-4 weeks
Preparations
Capsules 10, 18, 25, 40, 60, 80, 100 mg
US FDA Max
100 mg/day (adult); 1.4 mg/kg/day or 100 mg total (pediatric, whichever lower)
Pharmacology
Routes
Oral
Onset
ADHD effect emerges over 1-2 weeks (slower than psychostimulants); full effect 4-6 weeks
Duration
24 hours (once-daily or split BID dosing)
Half-life
~5 hours in extensive CYP2D6 metabolizers; ~21 hours in CYP2D6 poor metabolizers[2]
Bioavailability
~63% (oral; extensive first-pass)[2]
Pregnancy
Limited human data.[citation needed]
Legal status
Purported mechanism
Selective inhibition of the presynaptic norepinephrine transporter (NET). Increases extracellular norepinephrine and, in the prefrontal cortex, dopamine (since prefrontal dopamine reuptake is largely NET-mediated in that region, accounting for the ADHD efficacy despite no direct dopamine targeting).0 Not a psychostimulant: no euphoric or rewarding effect, no abuse liability, no Schedule classification. CYP2D6 substrate with a strong pharmacogenomic signal: poor metabolizers have approximately 5-10-fold higher plasma exposure than extensive metabolizers, and CPIC provides CYP2D6 dosing guidance[1].
References
- ↑ CPIC Guideline for Atomoxetine and CYP2D6 Genotype, 2019. https://cpicpgx.org/guidelines/cpic-guideline-for-atomoxetine-based-on-cyp2d6-genotype/
- ↑ 2.0 2.1 2.2 FDA Prescribing Information, Strattera (atomoxetine hydrochloride), Eli Lilly, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021411s044lbl.pdf