Atomoxetine

Benjamin Clanner-Engelshofen is a freelance writer in the medical department. He studied biochemistry and pharmacy in Munich and Cambridge / Boston (USA) and noticed early on that he particularly enjoyed the interface between medicine and science. That is why he went on to study human medicine.

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The active ingredient atomoxetine is used to treat attention deficit / hyperactivity disorder (ADHD). In contrast to other active ingredients for ADHD treatment, it is not classified as a narcotic and has no potential for dependence. Here you can read everything you need to know about atomoxetine effects, use and possible side effects.

This is how atomoxetine works

Attention deficit / hyperactivity disorder (ADHD), sometimes also called hyperkinetic disorder, usually begins in childhood and includes various symptoms. As a rule, those affected show reduced alertness, increased impulsiveness and physical restlessness.The extent of the mental disorder determines whether psychotherapeutic or drug treatment is necessary.

Atomoxetine differs considerably from the stimulants typically used in ADHD therapy (such as methylphenidate and amphetamine). The mentioned stimulants increase the concentration of certain messenger substances in the brain (mainly of noradrenaline and dopamine) through which nerve cells (neurons) communicate with each other. This will improve the ADHD symptoms.

The active ingredient atomoxetine, which is chemically very similar to the antidepressant fluoxetine, occupies an intermediate position between ADHD medication and antidepressant. As with antidepressants, the effects only appear after a few weeks, but atomoxetine does not have an antidepressant effect. Rather, it acts in the brain as a so-called selective noradrenaline reuptake inhibitor (NARI - "noradrenaline reuptake inhibitor"). This increases the concentration of this messenger substance. However, the dopamine hormone balance is not affected to any relevant extent. Experts assume that this is one of the reasons why atomoxetine does not have any potential for dependence - it works at different times and does not cause the "happiness hormone" dopamine to be released immediately.

Another effect that still needs to be investigated in detail is the effect of atomoxetine on so-called NMDA receptors in the brain. Scientists currently assume that this messenger substance is also significantly involved in the development of ADHD.

Atomoxetine uptake, breakdown and excretion

After ingestion by mouth, the active ingredient atomoxetine is quickly absorbed into the blood through the intestinal mucosa. There it reaches the highest level after an hour or two. Atomoxetine is broken down in the liver by the enzyme cytochrome 2D6, whereupon it is quickly excreted in the urine. However, around seven percent of the Caucasian population have a variant of this enzyme that works less well, which may delay the breakdown and excretion of atomoxetine. At the beginning of therapy with atomoxetine, a very low dose is chosen and this is increased gradually. In patients with normal enzyme activity, about half of the active ingredient is excreted in the urine after three and a half hours.

When is atomoxetine used?

Atomoxetine is used to treat ADHD in children six years and older, adolescents and adults. The therapy should be carried out by a doctor with the appropriate specialist knowledge and should be integrated into an overall treatment concept, including, for example, psychological, educational and social measures.

Atomoxetine is not approved for other uses. However, the active ingredient is also used by doctors “off-label” (ie outside the specified approval range) for eating disorders, depression in connection with ADHD, bed-wetting in children and for weight reduction.

This is how atomoxetine is used

Atomoxetine is usually taken as a single dose in the morning. The capsule can be taken with sufficient liquid regardless of a meal. In the event of adverse drug effects after ingestion (e.g. nausea), the intake can also be half in the morning and half in the evening.

For children and adolescents over 70 kilograms body weight and adults, a dosage of 40 milligrams atomoxetine is usually used for at least one week. The dosage can be increased to 80 milligrams of atomoxetine depending on the effect (this does not fully set in until two to four weeks). For children and adolescents weighing less than 70 kilograms, the dosage must be reduced accordingly. The maximum daily dose recommended by the manufacturer is 100 milligrams of active ingredient, as higher doses do not necessarily produce an increased effect.

What are the side effects of atomoxetine?

More than one in ten patients experience adverse effects such as decreased appetite, headache, drowsiness, abdominal pain, nausea, vomiting, increased blood pressure and a faster heartbeat.

One in ten to one hundred people treated will experience atomoxetine side effects such as irritability, mood swings, insomnia, anxiety, depression, tics, dizziness, pupil dilation, constipation, indigestion, rash, itching, fatigue and weight loss.

What should be considered when taking atomoxetine?

If atomoxetine and other active ingredients are used at the same time, which are broken down by the same enzyme (cytochrome 2D6), there may be mutual interference, since one active ingredient is usually broken down preferentially and the other accumulates in the body. Examples of such active ingredients are antidepressants such as MAOIs (such as tranylcypromine, moclobemide) and SSRIs (selective serotonin reuptake inhibitors such as fluoxetine, paroxetine), antiallergics (such as terbinafine) and agents against cardiac arrhythmias (such as quinidine).

Medicines that affect the heart rhythm in a certain way (cause QT prolongation) should not be combined with atomoxetine. There are numerous examples of such active substances, such as agents against psychoses and schizophrenia, agents against cardiac arrhythmias, antibiotics and antidepressants.

The effect of β2 agonists used for acute treatment (such as salbutamol) or long-term treatment (such as salmeterol, formoterol) of asthma can be increased in combination with atomoxetine. This can lead to increased blood pressure and an accelerated heartbeat, for example. At the same time, atomoxetine can weaken the effect of antihypertensive drugs.

Since the data on the use of atomoxetine during pregnancy and breastfeeding are limited, treatment should be avoided. According to animal studies, atomoxetine is excreted in breast milk.

As with antidepressants, atomoxetine use can lead to increased suicidal behavior in adolescents. Young people at risk should be monitored accordingly.

Studies show that atomoxetine can be used safely and effectively in children and adolescents from six years of age and adults, but not in patients over 65 years of age.

The treatment of patients with liver dysfunction should only be carried out with a reduced dose of atomoxetine.

This is how you get drugs with the active ingredient atomoxetine

Atomoxetine requires a prescription and is therefore only available at the pharmacy upon presentation of a doctor's prescription.

How long has atomoxetine been known?

The active ingredient atomoxetine was approved in Germany in 2005 for the treatment of children and adolescents with ADHD. In 2013 the approval was extended to the treatment of adults. Since the patent protection expires in 2017 at the earliest, only the original manufacturer (Eli Lilly and Company) has been selling preparations with the active ingredient atomoxetine.

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