Insomnia atomoxetine

Take the last daily dose of atomoxetine early in the evening to avoid insomnia... 

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. 

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). 

In an open study in children aged 6-17 years the addition of OROS methylphenidate increased the rates of insomnia, irritability, and loss of appetite compared with atomoxetine alone [M ]. 

A retrospective cohort study of new atomoxetine users (n = 20,995) showed that the propensity-score adjusted hazard ratio for sudden death/ventricular arrhythmia was 0.41 (95% Cl 0.10-1.75), for stroke 1.30 (95% Cl 0.52-3.29), for myocardial infarction 0.56 (95% CLO.16-2.00) and 0.92 for stroke/myocardial 0.75 infarction (95% CEO.44-1.92) [2 ]. For atomoxetine, the most commonly reported ADRs in >5% of patients using the agent were decreased appetite, weight loss, suicidal thoughts in children, abdominal pain, erectile dysfunction, headache, insomnia, nausea, xerostomia and tachycardia [6 ] [7 j [36 j [37 ]. 

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