Atomoxetine 

Overview

Atomoxetine is the first of a new family of nonstimulant drugs licensed to treat attention-deficit/hyperactivity disorder. Its manner of action differs from that of stimulants Methylphenidate and amphetamines. Atomoxetine seems to have minimal to no misuse potential. Atomoxetine works by inhibiting the reuptake of norepinephrine, a neurotransmitter. Consequently, It’s termed a selective norepinephrine reuptake inhibitor. A description of the mechanism of neurotransmission may give some insight into how Atomoxetine works. During neurotransmission, one neuron releases neurotransmitters into the space between that neuron and the subsequent neuron. Neurotransmitters interact with particular places on the surface membrane.

A network of neurons known as receptors. The chemical signal is then turned into an electrical impulse, which travels along the neuron, prompting the release of more neurotransmitters. The process of neurotransmission is repeated along a network of neurons. Neurotransmission occurs when neurotransmitters are produced and chemical signal is sent to neurons, and neurotransmitters are recovered back into brain cells, the process is termed as reuptake. By preventing neurotransmitters from re-entering neurons,

When a neurotransmitter is produced, the antidepressant has the potential to enhance its effects. Atomoxetine increases norepinephrine neurotransmission by inhibiting its reuptake. Studies on patients with ADHD suggests that faulty operation of the norepinephrine and dopamine (another kind of neurotransmitter) systems may be partly responsible for the inattention and hyperactivity difficulties found with the disorder. ADHD and other mental diseases, such as depression, may be caused by unusually low amounts (or improper neurotransmission of neurotransmitters. The changed amounts of the neurotransmitter might then create changes in some parts of the brain, which may generate the clinical signs and symptoms of a mental disorder such as ADHD, depression, or generalized anxiety disorder. When neurotransmission is enhanced by medication restores the afflicted parts of the brain to normal functioning, lowering the symptoms of the illness.

Dosing Information

Atomoxetine ‘s beginning dose for adults is 40 mg, given once in the morning. After a three-day break, the dosage may be raised to 80 mg/day, either as a single morning dose or divided equally.

Divided dosages in the morning, afternoon, or early evening. The patient should be given a trial period of 2-4 weeks at that dose before any future increases. If the reaction is insufficient, the dose might be raised to maximum of 100 mg per day, taken in morning and afternoon dosages.

Common Side Effects

Atomoxetine ‘s typical adverse effects include jitteriness, nausea, drowsiness, anxiety, dizziness, headaches, reduced appetite, and insomnia. Side effects often appear immediately after beginning the medicine or when increasing the dose. If the adverse effects become unbearable, the doctor may reduce the dose to enable the person to acclimate to the drug before gradually increasing its dosage. Atomoxetine could induce urinary retention in some people.

Adverse effects and precautions

Some Atomoxetine users using standard doses may have moderate hypertension. Higher doses may increase the risk of Atomoxetine -induced hypertension. A rise in blood pressure is normally low, and very few individuals have to quit Atomoxetine due to hypertension.

In general, reducing the dose will help to stabilize blood pressure. Consequently, the patient’s blood pressure should be examined before beginning Atomoxetine and periodically during treatment, particularly for patients with pre-Existing hypertension or a history of heart disease.

Atomoxetine may produce sleepiness and sedation while also impairing physical coordination and mental attentiveness. Patients should avoid potentially harmful tasks, such as driving a vehicle or using equipment, until they are certain that these adverse effects will not impair their ability to do these jobs.

Atomoxetine may reduce children’s development and weight. Some youngsters on Atomoxetine may lag behind in weight and height during the first 9-12 months of therapy. The statistics from a sample of treated youngsters reveal the gap in weight and height is often modest, and these youngsters usually catch up to other children after around 12 months. Growth should be watched while the kid is on Atomoxetine, and treatment may be required to be halted if he or she does not develop or acquire weight regularly.

Atomoxetine, in rare situations, may cause liver damage. This discovery was made after two incidents of liver impairment were reported among the millions of Atomoxetine users. Although Atomoxetine -related liver disease is very uncommon, patients should be aware of the signs and symptoms of a liver issue. Patients should call their doctors promptly if they experience any of the following: Yellowing of the skin or the whites Jaundice in the eyes, itchy skin (pruritus), black urine, upper right-sided abdominal discomfort, and inexplicable, persistent flu-like symptoms.

Atomoxetine functions similarly to antidepressants, despite the fact that it is meant to treat ADHD. There are concerns that antidepressants as a group may be connected with an increased risk of suicide thoughts in children and teenagers. In short-term trials, antidepressants were shown to increase the likelihood of suicide behavior.

Thinking and behavior among children and teenagers suffering from serious depression or other mental conditions. Based on these results, the United States Food and Drug Administration mandates a warning in the package insert saying prescribers must be aware of the suicide risks in their patients who begin antidepressant medication, notably in the pediatric population. Therefore, people, particularly children and teenagers, should be carefully observed and helped to treat worsening depression symptoms after starting or changing antidepressant treatment.

Pregnancy and Breastfeeding: Category C

Atomoxetine has not been studied in women to confirm its safety during pregnancy. The medication’s impact on the growing fetus in pregnant mothers remains unclear. Women who are pregnant or could become pregnant. They should address this with their doctor.

Nursing moms should not use Atomoxetine since tiny levels will pass via breast milk and be in the infant ate the food. If discontinuing Atomoxetine is not an option, breastfeeding should not be started or should be discontinued.

Possible Drug Interactions

Atomoxetine, like many other drugs, is processed by the liver. The simultaneous use of Atomoxetine and certain other drugs may have negative interactions because one medication may change the blood levels of the Atomoxetine and should not be used with antidepressants called monoamine oxidase inhibitors (MAOIs).
nation may induce dangerously high blood pressure. This and other notable medication interactions. The behaviors reported with Atomoxetine are listed in the following. 

• Patients on Atomoxetine should avoid or drink alcohol in moderation.
•  Ventolin (albuterol), Atomoxetine may enhance the cardiovascular effects Ventolin inhalers and inhalant solutions, including palpitations, fast heart rate, and increased
  Blood pressure. 
• (fluoxetine), (paroxetine) and Cimetidine, (bupropion), and (ritonavir), these drugs when taken with Atomoxetine may impede and accelerate the metabolism. Blood levels of Atomoxetine may increase adverse side effects. Use of any of this medication may need lesser doses of Atomoxetine. 
• Monoamine Oxidase Inhibitors (MAOIs) as (phenelzine) and (isocarboxazid), & (phenelzine), Monoamine Oxidase Inhibitors should not be combined with Atomoxetine. This combination may cause dangerously high blood pressure.

Overdose

The consequences of Atomoxetine overdose are not completely recognized, since this medicine was just recently released. Clinical experience is minimal. It is most likely less hazardous in overdose than tricyclic antidepressants and MAOIs.

Any suspected overdose should be considered an emergency. The individual should be rushed to the emergency. There is space for observation and therapy. The prescription bottle of medicine (and any additional drug implicated in the overdose) should also be presented, since the information on the prescription label is beneficial to the treating physician in knowing the number of tablets consumed.

Special Considerations

• Warning: If you develop suicidal thoughts, contact your doctor or a family member immediately. Notify your doctor if you have any depression symptoms while using Atomoxetine or anytime you are unable to control your suicide ideas and feelings.
• If you miss a dosage, take it as soon as possible, within 2-3 hours after the planned time. If it is near the next dose, skip the missing dosage and continue with your usual dosing routine. Do not take two doses.
• Atomoxetine may produce dizziness, sleepiness, or sedation. Until you’re sure that the drug
does not impair your coordination, it is advised to avoid driving and using machines.
• Do not use Atomoxetine if you are allergic to it or if you have had a severe response after taking it.
• Atomoxetine may be taken with meals to reduce gastrointestinal adverse effects.
• Take Atomoxetine in split doses early in the morning and afternoon, or early evening. Do not take the medicine close to bedtime since it might disrupt your sleep.
• Keep the medicine in the original labeled, light-resistant container, away from heat and moisture. Heat and Moisture may accelerate the breakdown of your drug, causing it to lose its medicinal properties.
• Keep your medications out of reach of youngsters.