Atomoxetine adverse effects

Atomoxetine increases the brain concentrations of norepinephrine. Adverse effects (constipation, dry mouth, nausea, fatigue, decreased appetite, insomnia, chest pain, palpitations, anxiety, erectile dysfunction, mood swings, nervousness and urinary retention) are more common in poor metabolizers of CYP2D6, as atomoxetine is metabolized through the cytochrome CYP2D6 pathway. 

SSRIs ATOMOXETINE t plasma concentrations and risk of adverse effects (abdominal pain, vomiting, nausea, fatigue, irritability) Atomoxetine is a selective norepinephrine reuptake inhibitor, t plasma concentrations due to inhibition of CYP2D6 by fluoxetine and paroxetine (potent), fluvoxamine and sertraline (less potent) and escitalopram and citalopram (weak) Avoid concurrent use. The interaction is usually severe with fluoxetine and paroxetine... 

Paroxetine markedly increases atomoxetine levels in extensive metabolisers of CYP2D6. Fluoxetine also raises atomoxetine levels. There is a possibility that this may increase adverse effects, and a slower titration of atomoxetine dose is su ested for patients taking paroxetine and other CYP2D6 inhibitors. 

It would also seem prudent to be alert to the possibility of an increase in adverse effects ifCYP2D6 inhibitors are added to established atomoxetine... 

A placebo-controlled, crossover study in 12 healthy subjects examined the effects of giving either atomoxetine 60 mg twice daily or and methyiphenidate 60 mg daily for 5 days, with the other drug added for the final 2 days. No additional changes in blood pressure or heart rate were seen when the drugs were given together, and concurrent use did not increase the frequency of adverse effects. ... 

Psychiatric A report of aggression in a boy taking atomoxetine has again raised the question of whether this is an adverse effect of the drug [47 ]. 

R-(-)-atomoxetine, a 2-methylphenoxyphenylpropylamine, was marketed in 2003 as a nonstimulant treatment for attention-deficit hyperactivity disorder (ADHD) in both adults and children and for treatment of adult depression. The 2-methyl substitution (c.f., nisoxetine) (Fig. 21.8) confers selectivity for inhibiting NE reuptake (Table 21.6) (21,22,45). The R-enantiomer is 10 times more potent than the S-enantiomer as a NET reuptake inhibitor. Atomoxetine has a low propensity for anticholinergic and adverse cardiovascular effects. 

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