Atomoxetine

Overview

What is Strattera?

Atomoxetine (Strattera) is a selective norepinephrine reuptake inhibitor. Strattera is a prescription medicine used for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD). It may help increase attention and decrease impulsiveness and hyperactivity in patients with ADHD.

Global Name

• Generic name: Atomoxetine hydrochloride
• Brand name: Strattera

Usage

What is Strattera used for?

Strattera is indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in paediatric and adult patients. It should be used as part of a total treatment program for ADHD that may include counselling or other measures (psychological, educational, social).

How do you use Strattera?

Availability: Strattera is only available in capsule for oral use.

Strength: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg

Dosage information:

The dosage is based on body weight.

• Children and adolescents up to 70 kg: Initiate at approximately 0.5 mg/kg/day. Increase after a minimum of 3 days to a target total daily dose of approximately 1.2 mg/kg/day. The maximum total daily dose should not exceed 1.4 mg/kg or 100 mg, whichever is less.
• Children and adolescents over 70 kg and adults: Initiate at 40 mg/day. Increase after a minimum of 3 days to a target total daily dose of approximately 80 mg/day. After 2 to 4 additional weeks, the dose may be increased to a maximum of 100 mg in patients who have not achieved an optimal response.
• Maintenance treatment: Patients were generally continued the dose that achieved therapeutic response. A dosage range of 1.2 to 1.8 mg/kg/day for paediatric patients (6-15 years) with ADHD on Strattera was proven beneficial in clinical trials. 

Are the following suitable for getting Strattera?

• Children: Suitable for children aged 6 years or older.
• Adults: Suitable.
• Elderlies: Not suitable for patients over 65 years old.
• Patients with moderate-to-severe hepatic impairment: Dose adjustment is required.
• Patients with severe renal impairment: No dosage adjustment needed.
• Pregnant/ nursing women: should not use Strattera unless potential benefit justifies potential risk to foetus or infant.

• Individuals with known serious structural cardiac abnormalities or symptomatic or severe cardiovascular disease.
• Individuals taking or have taken monoamine oxidase inhibitor (MAOIs) within the past 14 days
• Patients with narrow angle glaucoma
• Patients who are allergic to any constituents of Strattera
• Patients with pheochromocytoma
• Patients with moderate/severe hypertension

• Suicidal Ideation: Patients should be monitored closely for suicidality, clinical worsening, or unusual changes in behaviour.
• Severe Liver Injury: Discontinue and do not restart in patients with jaundice or laboratory evidence of liver injury.
• Serious Cardiovascular Events: Avoid the use of Strattera in patients with known serious structural cardiac abnormalities or severe, symptomatic cardiovascular disease. Patients with emergent cardiovascular symptoms during Strattera treatment should be given a prompt cardiac evaluation.
• Effect of on Blood Pressure and Heart Rate: Use with caution in patients with hypertension, tachycardia, or cardiovascular or cerebrovascular disease. Monitor blood pressure and pulse periodically while on therapy.
• Emergent Psychotic or Manic Symptoms: Consider discontinuing treatment if such new symptoms occur.
• Bipolar Disorder: Screen patients prior to treatment to reduce the risk of manic or mixed episodes.
• Priapism: Prompt medical attention is required for any suspected priapism.
• Effects on Urine Outflow: Urinary hesitancy and retention may occur.
• Aggressive Behaviour: Aggressive behaviour or hostility should be monitored.
• Growth: Height and weight should be monitored in paediatric patients (due to appetite suppression).
  
  

Drug interaction

• Monoamine Oxidase Inhibitors.
• CYP2D6 Inhibitors: Concomitant use may increase atomoxetine steady–state plasma concentrations in EMs.
• Pressor Agent: Use cautiously with Strattera.
• Albuterol (or other beta2 agonists): use cautiously with Strattera.

Side Effects

Common adverse reactions in children and adolescents:

• Upset stomach
• Decreased appetite
• Nausea or vomiting
• Dizziness
• Tiredness
• Mood swings

Common adverse reactions in adults:

• Constipation  
• Dry mouth
• Nausea  
• Decreased appetite 
• Dizziness 
• Trouble sleeping
• Sexual side effects
• Menstrual cramps 
• Problems passing urine

Pharmacist Tips

• Storage information: Strattera should be stored at room temperature (15 to 30°C). Keep Strattera out of the reach of children. 
• Administration: Strattera can be taken with or without food. Do not chew, crush, or open the capsules. Swallow Strattera capsules whole with water or other liquids.
  
  

Availability

Where is Strattera available in Hong Kong?

Strattera is a prescription-only medication available through healthcare providers upon doctor’s prescription.

FAQs

Is Strattera a controlled substance in Hong Kong?

No, Strattera is not a controlled substance in Hong Kong, and studies suggest it does not have the same abuse potential or pattern of response associated with stimulants.

Can Strattera affect growth in children?

Yes. Data suggests that weight and height gain in paediatric patients may lag behind normative data during the first 9–12 months of treatment. 

How does Strattera work?

The exact mechanism is unknown, but ex vivo uptake and neurotransmitter depletion studies suggests that it acts by selectively inhibiting the presynaptic norepinephrine transporter. 

How much does Strattera cost? 

Strattera is a prescription-only medicine, and the price varies depending on the healthcare provider.