Atomoxetine
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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