Atomoxetine (
Strattera) is a selective
norepinephrine reuptake inhibitor and nonstimulant that has shown greater efficacy than placebo in
attention deficit hyperactivity disorder (
ADHD) in adults. In two large, well controlled, 10-week trials in adults with
ADHD, improvements in
ADHD symptoms, as assessed by investigator- and patient-rated scores, were greater with oral
atomoxetine (60, 90 or 120 mg/day) than with placebo. Mean reductions in the total
ADHD symptom score on the investigator-rated Conners' Adult
ADHD Rating Scale (CAARS) in
atomoxetine versus placebo recipients were 28.3% versus 18.1% and 30.1% versus 19.6%, respectively. Mean reductions in the scores on the Clinician Global Impression of Severity Scale, patient-rated CAARS and Wender-Reimherr Adult
Attention Deficit Disorder Scale were also significantly greater with
atomoxetine than with placebo. Continued efficacy was demonstrated in a noncomparative, 34-week extension phase.
Atomoxetine was generally well tolerated in clinical trials; withdrawal rates due to adverse events in
atomoxetine-treated versus placebo-treated patients participating in the two major trials were 7.8% versus 4.3% and 9.3% versus 2.4% (p<0.05 for the latter trial). Adverse events reported significantly more frequently with
atomoxetine than placebo included dry mouth,
insomnia,
nausea, decreased appetite,
constipation,
dizziness, sweating,
dysuria, sexual problems and palpitations. Modest increases in heart rate and blood pressure were well tolerated and gradually decreased on
cessation of treatment.
Atomoxetine was not associated with QT interval prolongation.
Atomoxetine can be administered once or twice daily. Its subjective-effects profile is different to that of
methylphenidate and
atomoxetine is not associated with abuse or diversion; it is therefore not a
controlled substance in the US. This also means repeat prescriptions during long-term treatment can be more conveniently processed.
CONCLUSION:
Atomoxetine is an effective and generally well tolerated treatment for adults with
ADHD. It is a nonstimulant and is the first
ADHD treatment to be approved specifically for adult use based on its efficacy in well controlled adult trials. It can be administered as a single daily dose or split into two evenly divided doses. It carries negligible risk of abuse or diversion and is not a
controlled substance.
Atomoxetine is a valuable new treatment option for adults with
ADHD and is particularly useful in patients who are at risk for
substance abuse or who do not wish to take a
controlled substance.