Atomoxetine dependence

ATOMOXETINE DRUG DEPENDENCE THERAPIES-BUPROPION 1. t plasma concentrations of atomoxetine with risk of toxic effects 2. t risk of seizures. This risk is marked in elderly people, in patients with a history of seizures, with addiction to opiates/cocaine/ stimulants, and in diabetics treated with oral hypoglycaemics or insulin 1. Bupropion and its metabolite hydroxybupropion inhibit CYP2D6 2. Bupropion is associated with a dose-related risk of seizures. These drugs, which lower seizure threshold, are individually epileptogenic. Additive effects when combined 1. Initiate therapy of these drugs, particularly those with a narrow therapeutic index at the lowest effective dose 2. Extreme caution. The dose of bupropion should not exceed 450 mg/day (or 150 mg/day in patients with severe hepatic cirrhosis)... 

Susceptibility factors Alcohol abuse and dependence increase the risk of atomoxetine-related adverse events [52 ]. 

Adler L, Wilens T, Zhang S, Durell T, Walker D, Schuh L, Jin L, Feldman P, Trzepacz P. Retrospective safety analysis of atomoxetine in adult ADHD patients with or without comorbid alcohol abuse and dependence. Am J Addict 2009 18(5) 393-401. 

---