Aggression atomoxetine

Children and adolescents taking atomoxetine should be monitored for the appearance or worsening of aggressive or hostile behavior because these symptoms were noted more frequently in children and adolescents taking atomoxetine than in those taking placebo in clinical trials (Strattera 2005). 

Henderson, T., Hartman, K. (2004). Aggression, mama and hypomama induction associated with atomoxetine. Pediatrics, 114, 895—896. 

At this time, the preferred first-line drug therapy for ADHD is either methylphenidate, dexmethylphenidate, mixed amphetamine salts, or dextroamphetamine. Atomoxetine, bupropion, or TCAs are good options for those umesponsive to or unable to tolerate stimulants. Clonidine and guanfacine are third-line options or adjuncts that require careful cardiovascular monitoring. Mood stabilizers (e.g., lithium, divalproex, and carbamazepine) and atypical antipsychotics are adjuncts for control of aggression or comorbid bipolar disorder. Other agents require further investigation before their status in the treatment of ADHD can be fuUy determined. 

Observational studies In an open study of the use of atomoxetine in 20 adults with ADHD, aged 19-47 years, for 10 weeks initially and 1 year in responders, adverse events that were reported in more than 5% of patients were dry mouth, fatigue, sweating, erectile dysfunction, insomnia, reduced appetite, restlessness, low mood, constipation, urine retention, weight loss, vertigo, irritability, emotional lability, and headache [50 ]. Six patients discontinued before 10 weeks and 13 at 10 weeks or later, mainly because of adverse reactions (aggression, low mood, and altered liver enzymes, thyroid hormones, or diastolic blood pressure). 

Systematic reviews In a systematic review of data from 13 double-blind, placebo-controlled trials and three open extension studies in 714 children and adolescents with ADHD treated with atomoxetine for at least 3 years, under 6% had aggressive/hos-tile behavior and under 1.6% reported suicidal ideation/behavior there were no clinically significant effects on growth rate, vital signs, or electrocardiography [42 ]. 

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 ]. 

A 13-year-old boy with ADHD was given atomoxetine and 5 weeks later developed changed behavior, disorientation, irrelevant speech, and self-harming behavior. He was very aggressive and hostile towards other children and adults. No organic cause was found. The boy improved after withdrawal of atomoxetine. 

Banerjee S, Ayyash HF. Does atomoxetine increase the risk of aggression and hostility in children with attention deficit hyperactivity disorder Arch Dis Child Educ Pract Ed 2008 93(4) 131-2. 

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