James is a 7-year-old boy who was diagnosed with ADHD 2 years ago and was started on short-acting Ritalin 10mg in the morning and 10mg at lunch. Since you saw him 6 months ago, you notice that he has lost 3kg. This is in addition to the 2kg he lost when first starting stimulant medication. His mother has been supplementing his diet with high energy foods such as avocado, butter and nut but she is concerned about his weight loss despite these efforts and would like to discuss other medication options (as he has had a good effect reported by school with treatment). You have heard great things about atomoxetine (Strattera) but aren’t comfortable using it yet…
How does it work?
Strattera is thought to be a selective noradrenaline reuptake inhibitor (SNRI).
Indications for usage
Atomoxetine is indicated for ADHD (diagnosed according to DSM-V criteria) with any of the following:
- Contraindication to dexamfetamine, methylphenidate or lisdexamfetamine as specified in TGA-approved product information
- Co-morbid mood disorder that has developed or worsened as a result of dexamfetamine, methylphenidate or lisdexamfetamine treatment and is of a severity necessitating treatment withdrawal
- Unacceptable medical risk of a severity necessitating permanent stimulant treatment withdrawal if given a stimulant treatment with another agent
- Experienced adverse reactions of a severity necessitating permanent treatment withdrawal following treatment with dexamfetamine, methylphenidate, and lisdexamfetamine (not simultaneously)
TGA contraindications
- Symptomatic cardiovascular disease – moderate/severe hypertension, atrial fibrillation/flutter, ventricular tachycardia, ventricular fibrillation, advanced atherosclerosis
- Severe cardiovascular disorders – those whose condition would be expected to deteriorate if they experienced increases in blood pressure or in heart rate (for example, 15 to 20 mmHg in blood pressure or 20 beats per minute in heart rate)
- Uncontrolled hyperthyroidism
- Phaeochromocytoma – active or history of
- MAO inhibitors
- Narrow-angle glaucoma
Dosage and Administration
Initiated at 0.5mg/kg and increased after a minimum of 3 days to a target total daily dose of approximately 1.2mg/kg (may be given as a single daily dose or as evenly divided doses twice daily)
Adverse effects
Most common (>10%):
- Headache
- Insomnia or drowsiness
- Hyperhidrosis
- Xerostomia
- Nausea/vomiting
- Anorexia
- Abdominal pain
- Constipation
WARNING – There is an increased risk of suicidal ideation in children and adolescents
