Home Drug Guide Atomoxetine Hydrochloride

Drug Guide

Generic Name

Atomoxetine Hydrochloride

Brand Names Strattera

Classification

Therapeutic: Central nervous system stimulant, used for ADHD

Pharmacological: Selective norepinephrine reuptake inhibitor

FDA Approved Indications

  • Attention deficit hyperactivity disorder (ADHD) in children, adolescents, and adults

Mechanism of Action

Atomoxetine selectively inhibits the norepinephrine reuptake transporter, increasing norepinephrine levels in the synaptic cleft, which helps improve attention and reduce impulsivity and hyperactivity.

Dosage and Administration

Adult: Starting dose of 40 mg once daily or divided into two doses; dose may be increased after at least 3 days to a maximum of 100 mg/day based on response and tolerability.

Pediatric: Recommended starting dose is 0.5 mg/kg once daily; may be increased to a maximum of 1.4 mg/kg/day or 100 mg/day after at least 3 days.

Geriatric: Use with caution, starting with lower doses and monitoring closely.

Renal Impairment: Use with caution; may require dose adjustments, particularly in severe impairment.

Hepatic Impairment: Start with 0.5 mg/kg once daily; maximum dose of 100 mg/day due to hepatic metabolism.

Pharmacokinetics

Absorption: Well absorbed orally, with peak plasma concentrations in 1-2 hours.

Distribution: Approximately 99% bound to plasma proteins.

Metabolism: Extensively metabolized by liver enzymes, predominantly CYP2D6, to inactive metabolites.

Excretion: Primarily excreted in urine as inactive metabolites; a small amount is eliminated via feces.

Half Life: Approximately 5.2 hours with CYP2D6 extensive metabolizers; longer (up to 21 hours) in poor metabolizers.

Contraindications

  • Hypersensitivity to atomoxetine or any component of the formulation
  • Use of monoamine oxidase inhibitors (MAOIs) within the past 14 days

Precautions

  • History of glaucoma, cardiovascular or cerebrovascular disease, urinary retention, severe hot flushes, or pheochromocytoma.
  • Increased risk of suicidal thoughts, especially in children and adolescents. Close monitoring recommended.

Adverse Reactions - Common

  • Dry mouth (Common)
  • Appetite suppression (Common)
  • Nausea (Common)
  • Insomnia (Common)
  • Dizziness (Common)

Adverse Reactions - Serious

  • Liver injury (hepatotoxicity) (Rare)
  • Cardiovascular events such as increased blood pressure or heart rate (Uncommon)
  • Suicidal ideation or behavior (Uncommon)

Drug-Drug Interactions

  • CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine) increase plasma levels of atomoxetine.
  • Blood pressure medications may have additive effects.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, heart rate, and mental health status regularly.

Diagnoses:

  • Risk of decreased cardiac output
  • Risk of suicidal ideation

Implementation: Administer as prescribed, monitor for adverse effects, educate patient about signs of liver injury and suicidal thoughts.

Evaluation: Assess behavioral improvements and side effects periodically.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report symptoms of liver problems (jaundice, dark urine).
  • Avoid abrupt discontinuation.
  • Seek medical attention if symptoms of cardiovascular issues or mood changes occur.

Special Considerations

Black Box Warnings:

  • Risk of suicidality in children and adolescents.
  • Hepatotoxicity—severity and need for monitoring.
  • Potential for aggressive behavior or hostility.

Genetic Factors: CYP2D6 metabolizer status affects drug levels; poor metabolizers have higher plasma concentrations.

Lab Test Interference: May interfere with certain liver function tests.

Overdose Management

Signs/Symptoms: Altered mental status, agitation, tachycardia, hypertension, vomiting, drowsiness.

Treatment: Supportive care, activated charcoal if ingestion is recent, and monitoring of cardiac status.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F).

Stability: Stable under recommended storage conditions for at least 24 months.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.