Atomoxetine ideation

Additionally, current product labeling contains a boxed warning regarding an increased risk of suicidal ideation in children and adolescents. Pooled analyses of 12 short-term atomoxetine trials showed an average risk of suicidal ideation of 0.4% in patients taking atomoxetine, compared with none in patients receiving placebo (Strattera 2005). Patients should be advised of the risks associated with atomoxetine prior to treatment. 

Suicidal ideation in Child and Adolescents—STRATTERA (atomoxetine) increased the risk of suicidal ideation in short-term studies in children or adolescents with Attention-Deficit Hyperactivity Disorder (ADHD). Anyone considering the use of STRATTERA in a child or adolescent must balance this risk with the clinical needs. Patients who are started on therapy should be monitored closely for suicidality (suicidal thinking and behavior), clinical worsening, or unusual changes in behavior. 

Strattera (atomoxetine), the supposedly safer nonstimulant treatment for ADHD, turned out to be highly stimulating and is the only ADHD treatment required to carry a black-box warning, with a heading about how it can cause Suicidal Ideation in Children and Adolescents (chapter 11). 

SSRIs, SNRIs, or mirtazapine for treatment-resistant depression (use combinations ot antidepressants with atomoxetine with caution as this may theoretically activate bipolar disorder and suicidal ideation)... 

Bupropion, reboxetine, nortriptyline, desipramlne, maprotlllne, atomoxetine (all potentially powerful enhancers of noradrenergic action, but observe for activation of bipolar disorder and suicidal Ideation)... 

Bupropion, mirtazapine, reboxetine, or atomoxetine (use combinations of antidepressants with caution as this may activate bipoiar disorder and suicidai ideation)... 

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 ]. 

Acute agitation and suicidal ideation occurred in an 11-year-old boy after he started to take atomoxetine [49 ]. However, a previous meta-analysis was negative (SEDA-32, 8). 

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