Atomoxetine Strattera

Eli Lilly promoted and continues to promote Strattera as the nonstimulant drug to treat ADHD (Eli Lilly and Company, 2006). While the company maintains this position, the drug is nonetheless listed under Central Nervous System Stimulants in the Physicians Desk Reference (2007, p. 208). Lilly s extremely shrewd marketing ploy of promoting Strattera as a nonstimulant is meant to allay the concerns of parents and doctors about their children taking stimulants for ADHD. 

It is true that Strattera has not been demonstrated to cause dependence and abuse like Ritalin, Adderall, and the other stimulant drugs used to treat ADHD and therefore has not been placed in Schedule II by the DEA. But Strattera is a highly stimulating drug. According to the label for Strattera, as found in the Physicians Desk Reference (2007, p. 1817, Table 1), in the clinical trials used for FDA approval, irritability was reported in 8% of subjects, crying in 2%, and mood swings in 2%. 

In overdose, like any stimulant, Strattera can cause severe seizures (Sawant et al., 2004). 

---

Althongh some gronps have used the controversy snrronnding ADHD as a platform to attack the nse of psychiatric medications as a whole, we should not in onr haste to dismiss snch perspectives overlook the fact that these are fair and reasonable qnestions. For that reason, we will try in this chapter to address these questions as we discnss the diagnosis, the long-term conrse, and the treatment of ADHD. The treatment options have recently expanded with the FDA approval of atomoxetine (Strattera), a selective norepinephrine renptake inhibitor that is not a psychostimn-lant, for the treatment of ADHD. 

Atomoxetine (Strattera). Atomoxetine has recently been approved as a treatment for ADHD. Atomoxetine, similar to some of the antidepressants discussed later, is a preferential inhibitor of norepinephrine reuptake. Because nerve terminals in the cerebral cortex have no dopamine reuptake sites, dopamine is taken up at nearby norepinephrine reuptake sites. Consequently, all norepinephrine reuptake inhibitors increase the availability of dopamine in the prefrontal cortex, likely the primary mechanism of atomoxetine action in ADHD. 

Medications that enhance norepinephrine activity can do so in one of several ways. First, they can block the reuptake of norepinephrine back into the nerve cell once it has been released. This keeps the norepinephrine in the synapse longer and therefore makes it more active. The tricyclic antidepressants (TCAs), duloxetine (Cymbalta), and venlafaxine (Effexor) act in this manner, as does paroxetine (Paxil) at higher doses. Atomoxetine (Strattera), a treatment for ADHD, also works in this way. 

Atomoxetine (Strattera) Galantamine (Razadyne) Lisdexamfetamine (Vyvanse)... 

Atomoxetine (Strattera) [ADHD/Selective Norepinephrine Reuptake Inhioiter] WARNING Severe liver injury may rarely occur D/C w/ jaundice or TLFT, T frequency of suicidal thoughts Uses ADHD Action Selective norepinephrine reuptake inhibitor Dose Adults Children >70 kg. 40 mg X 3 d, T to 80-100 mg -s- daily-bid Feds <70 kg. 0.5 mg/kg x 3 d, then T 1.2 mg/kg daily or bid (max 1.4 mg/kg or 100 mg) Caution [C, /-] Contra ... 

In summary, Ritalin s advocates view it as a nearly miraculous treatment for ADHD, whereas its detractors argue that it is a greatly overprescribed drug with substantial abuse potential. This controversy cannot be resolved here and is expected to be a major research focus in the next decade. Hopefiil developments are the introduction of new nonstimulant drugs, atomoxetine (Strattera) and modafinil (Provigil) that appear to be effective in the treatment of ADHD but may present fewer problems to the user (Waxmonsky, 2005). 

Table 2.3 Atomoxetine (STRATTERA ) label recommendations in patients defined by various intrinsic and extrinsic factors [21],...

Which statement is the scientific rationale for prescribing atomoxetine (Strattera), a norepinephrine reuptake inhibitor, for a child diagnosed with attention deficit-hyperactivity disorder (ADHD) ... 

---