Side Effects of atomoxetine: A Synthesis of Findings from 28 Studies

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Original Abstract of the Article

Major research findings

Atomoxetine is a non-stimulant medication used to treat attention-deficit/hyperactivity disorder (ADHD). Several studies have shown atomoxetine to be effective, but they have also pointed out the possibility of side effects. For example, a report in 13 indicates that atomoxetine may cause side effects such as drowsiness, agitation, hyperactivity, tremors, tachycardia, hyperreflexia, hypertension, and seizures. In addition, a study in 4 suggests that atomoxetine may be associated with side effects such as ineffectiveness, fatigue, and somnolence. Furthermore, 25 suggests that atomoxetine may rarely cause severe side effects such as complex partial seizures with CK-elevation, transient hypoperfusion of the temporal, parietal and occipital lobes, and prolonged reorientation.

Reasons for side effects

Atomoxetine works as a norepinephrine reuptake inhibitor, increasing the levels of norepinephrine in the brain. Norepinephrine is a neurotransmitter that plays an important role in concentration, attention, arousal, mood, and motor control. Atomoxetine may cause side effects by excessively increasing the levels of norepinephrine, thus affecting these functions.

Common side effects

Fatigue

A study in 4 reported that about 8.93% of atomoxetine users experienced fatigue.

Somnolence

A study in 4 reported that about 8.8% to 10.16% of atomoxetine users experienced somnolence. A review in 10 mentions that atomoxetine may be effective for ADHD symptoms but can cause side effects such as somnolence.

Ineffectiveness

A study in 4 reported that about 9.91% to 14.15% of atomoxetine users reported that atomoxetine was ineffective. A study in 20 suggests that CYP2C19 polymorphisms may affect the response to atomoxetine treatment.

Gastrointestinal symptoms

A review in 10 mentions that atomoxetine may cause gastrointestinal symptoms, such as nausea and vomiting. A review in 26 mentions that atomoxetine may cause side effects such as decreased appetite, but these are often mild and transient.

Cardiovascular symptoms

A review in 26 mentions that atomoxetine may cause cardiovascular symptoms such as hypertension. However, a study in 28 found that atomoxetine had the highest risk of hypertension. In addition, 25 suggests that atomoxetine may rarely cause severe side effects such as complex partial seizures with CK-elevation, transient hypoperfusion of the temporal, parietal and occipital lobes, and prolonged reorientation.

Psychiatric symptoms

A report in 13 indicates that atomoxetine may cause side effects such as drowsiness, agitation, hyperactivity, tremors, tachycardia, hyperreflexia, hypertension, and seizures. A meta-analysis in 1 suggests that atomoxetine may cause side effects such as anxiety and mood lability. A study in 5 suggests that atomoxetine may worsen psychiatric symptoms in people with psychotic disorders such as schizophrenia spectrum disorders.

Other

A study in 16 found that atomoxetine has a higher risk of sexual dysfunction compared to other ADHD medications.

Side effect management

Fatigue

To reduce fatigue, you may be able to adjust the time of day you take atomoxetine or consume caffeine.

Somnolence

To reduce somnolence, you may be able to adjust the time of day you take atomoxetine, take naps, or reduce your dosage.

Ineffectiveness

If atomoxetine is ineffective, you may be able to adjust your dosage or try other ADHD medications.

Gastrointestinal symptoms

To reduce gastrointestinal symptoms, you may be able to take atomoxetine with meals or adjust your meal size. Reducing your dosage may also be considered.

Cardiovascular symptoms

To reduce cardiovascular symptoms, you may be able to adjust your dosage or try other ADHD medications. It is also important to monitor your blood pressure regularly.

Psychiatric symptoms

To reduce psychiatric symptoms, you may be able to adjust your dosage or try other ADHD medications. If symptoms are severe, it is important to seek consultation with a psychiatrist.

Other

If you experience symptoms such as sexual dysfunction, it is important to consult your doctor.

Comparison of studies

Common points

Many studies have shown that atomoxetine is an effective drug for improving ADHD symptoms. However, some studies suggest that atomoxetine can cause side effects such as fatigue, somnolence, ineffectiveness, gastrointestinal symptoms, cardiovascular symptoms, and psychiatric symptoms. These side effects may be caused by excessive increases in norepinephrine levels due to atomoxetine.

Differences

Studies have shown differences in the type and frequency of side effects caused by atomoxetine. This may be due to factors such as age, gender, severity of ADHD, and dosage of atomoxetine. In addition, some studies suggest that atomoxetine is at higher risk of causing certain side effects. For example, a study in 28 found that atomoxetine had the highest risk of hypertension.

Notes on application to real life

Atomoxetine is an effective drug for improving ADHD symptoms, but it carries the risk of side effects. When taking atomoxetine, it is important to discuss the potential side effects with your doctor and take the necessary precautions. Atomoxetine may interact with other drugs, so it is important to tell your doctor about any other medications you are taking before you take it. In addition, atomoxetine may not be suitable for pregnant or breastfeeding women. When taking atomoxetine, it is important to understand these precautions and take it safely.

Limitations of current research

Research on the side effects of atomoxetine is still insufficient. In particular, long-term side effects are still poorly understood and further research is needed. It is also difficult to predict what side effects atomoxetine will cause in a particular individual. Therefore, when taking atomoxetine, it is important to consult with your doctor about your individual situation and take appropriate action.

Future research directions

Further research on the side effects of atomoxetine is needed. In particular, more research is needed on long-term side effects, individual patient effects, and drug interactions. Research into new ways to reduce the side effects of atomoxetine is also needed. These studies are expected to lead to the development of ways to use atomoxetine more safely.

Conclusion

Atomoxetine is an effective drug for improving ADHD symptoms, but it carries the risk of side effects. When taking atomoxetine, it is important to discuss the potential side effects with your doctor and take the necessary precautions. Atomoxetine may interact with other drugs, so it is important to tell your doctor about any other medications you are taking before you take it. In addition, atomoxetine may not be suitable for pregnant or breastfeeding women. When taking atomoxetine, it is important to understand these precautions and take it safely.

Literature analysis of 28 papers
Positive Content
19
Neutral Content
3
Negative Content
6
Article Type
2
2
3
7
26
1.

Adverse drug events related to mood and emotion in paediatric patients treated for ADHD: A meta-analysis.

Author: PozziMarco, CarnovaleCarla, PeetersGabriëlla G A M, GentiliMarta, AntoniazziStefania, RadiceSonia, ClementiEmilio, NobileMaria

Emotional symptom exacerbation

The influence of ADHD drugs on emotional symptoms demands investigation to improve therapies.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

5.

Treatment with psychostimulants and atomoxetine in people with psychotic disorders: reassessing the risk of clinical deterioration in a real-world setting.

Author: CorbeilOlivier, BrodeurSébastien, CourteauJosiane, BéchardLaurent, Huot-LavoieMaxime, AngelopoulosElaine, Di StefanoSamanta, MarroneErica, VanasseAlain, FleuryMarie-Josée, StipEmmanuel, LesageAlain, JooberRidha, DemersMarie-France, RoyMarc-André

ADHD treatment
Psychostimulant safety

In a real-world setting, methylphenidate, amphetamines, and atomoxetine, when used concurrently with antipsychotic medication, were associated with a decreased risk of hospital admission for psychosis in individuals with psychotic disorders.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

6.

Probable Genitourinary Adverse Events Associated With Atomoxetine in an Adult Male: A Case Report.

Author: McGraneIan R, CampbellTrevor J

Priapism
Urinary hesitancy

Atomoxetine, a norepinephrine reuptake inhibitor used for attention-deficit/hyperactivity disorder (ADHD), has been associated with genitourinary side effects, including urinary hesitancy and retention. This case report describes a 42-year-old male who experienced urinary hesitancy and discharge after starting atomoxetine, which resolved after discontinuing the medication. The authors emphasize the importance of educating and monitoring patients for these potential side effects.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

7.

A systematic review of the use of atomoxetine for management of comorbid anxiety disorders in children and adolescents with attention-deficit hyperactivity disorder.

Author: KhoodoruthMohamed Adil Shah, OuanesSami, KhanYasser Saeed

ADHD treatment

This study examines the efficacy of atomoxetine, a non-stimulant medication, in managing anxiety disorders in children and adolescents with ADHD.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

8.

Dutch pharmacogenetics working group (DPWG) guideline for the gene-drug interaction of CYP2D6 and COMT with atomoxetine and methylphenidate.

Author: NijenhuisMarga, SoreeBianca, JamaWafa O M, de Boer-VegerNienke J, BuunkAnne Marie, GuchelaarHenk-Jan, HouwinkElisa J F, RongenGerard A, van SchaikRon H N, SwenJesse J, TouwDaan, van der WeideJan, van WestrhenenRoos, DeneerVera H M, RisseladaArne

Optimized atomoxetine therapy
Atomoxetine side effects

This guideline describes how to optimize atomoxetine therapy based on genetic variation in the CYP2D6 gene, which encodes an enzyme involved in metabolizing atomoxetine. The guideline, developed by the Dutch Pharmacogenetics Working Group (DPWG), recommends dose adjustments based on CYP2D6 genotype to optimize treatment effectiveness and minimize side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

10.

An update on pharmacotherapy of autism spectrum disorder in children and adolescents.

Author: GoelRitu, HongJi Su, FindlingRobert L, JiNa Young

ADHD treatment
Reduced sleep problems
Metabolic side-effects
Poor tolerance

This article reviews evidence for pharmacotherapy, novel therapeutic agents, and CAM in children and adolescents with ASD.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

11.

Viloxazine for the Treatment of Attention Deficit Hyperactivity Disorder.

Author: RobinsonChristopher L, ParkerKatelyn, KatariaSaurabh, DownsEvan, SupraRajesh, KayeAlan D, ViswanathOmar, UritsIvan

Treats ADHD

Nonstimulant medications like viloxazine, atomoxetine, guanfacine, and clonidine are becoming increasingly popular for treating attention deficit hyperactivity disorder (ADHD) due to their minimal adverse effects compared to stimulants.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

13.

Use of Intravenous Lipid Emulsion Therapy in a Case of Atomoxetine (Strattera®) Toxicity.

Author: GünEmrah, KocabayKenan

Lipid emulsion therapy
Atomoxetine toxicity

A case of atomoxetine toxicity was reported, and intravenous lipid emulsion therapy was used successfully to treat it. While atomoxetine overdose typically results in mild symptoms, it can cause moderate or severe effects including drowsiness, agitation, tremors, and seizures.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

16.

Pharmacologic treatment of attention deficit hyperactivity disorder in adults: A systematic review and network meta-analysis.

Author: ElliottJesse, JohnstonAmy, HusereauDon, KellyShannon E, EaglesCaroline, CharachAlice, HsiehShu-Ching, BaiZemin, HossainAlomgir, SkidmoreBecky, TsakonasEva, ChojeckiDagmara, MamdaniMuhammad, WellsGeorge A

ADHD treatment

This systematic review and network meta-analysis compared the relative effects of various pharmacologic treatments for adults with ADHD.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

17.

Pharmacotherapy for ADHD in children and adolescents: A summary and overview of different European guidelines.

Author: Van VyveL, DierckxB, LimC G, DanckaertsM, KochB, HägeA, BanaschewskiT

ADHD treatment
Improved symptoms
Mood changes
Psychotic symptoms
Tics

This study reviews pharmacological treatment options for ADHD in children and adolescents and highlights the importance of multimodal approaches. It compares treatment guidelines across different European countries and identifies discrepancies in medication selection and sequencing.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

18.

Alternative pharmacological strategies for adult ADHD treatment: a systematic review.

Author: BuoliMassimiliano, SeratiMarta, CahnWiepke

ADHD treatment
Amphetamine side effects

Adult ADHD is a common condition that can be disabling. While standard medications are helpful, they don't always work long-term, and some people don't respond well. This review examines alternative medications for ADHD. Amphetamines have shown the most effectiveness but can have serious side effects. Certain antidepressants may also be effective but should be avoided in people with bipolar disorder. Finally, metadoxine and lithium might be better options for those with alcohol misuse or bipolar disorder.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

19.

Atomoxetine Efficacy in Methamphetamine Dependence during Methadone Maintenance Therapy.

Author: RabieyAli, Hassani-AbharianPeyman, FarhadMajid, MoravvejiAli Reza, AkashehGoodarz, BanafsheHamid Reza

Improved METH use disorder treatment

Methamphetamine (METH) use is a significant problem for people in Iran who are on methadone maintenance therapy (MMT). There are no approved medications to treat METH use disorder, so this study is exploring the potential benefits of atomoxetine for these individuals.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

24.

Atomoxetine, Parent Training, and Their Combination in Children With Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder.

Author: HandenBenjamin L, AmanMichael G, ArnoldL Eugene, HymanSusan L, TumuluruRameshwari V, LecavalierLuc, Corbett-DickPatricia, PanXueliang, HollwayJill A, Buchan-PageKristin A, SilvermanLaura B, BrownNicole V, RiceRobert R, HellingsJessica, MruzekDaniel W, McAuliffe-BellinSarah, HurtElizabeth A, RyanMelissa M, LevatoLynne, SmithTristram

ATX for ADHD
PT for noncompliance
Side effects

This study investigates the individual and combined effectiveness of atomoxetine (ATX) and parent training (PT) for treating attention-deficit/hyperactivity disorder (ADHD) symptoms and noncompliance in children with autism spectrum disorder (ASD). ADHD is common in children with ASD, and this study aims to improve treatment strategies.

Clinical Trial, Phase IVPost-marketing surveillance. Monitors long-term safety/efficacy after approval.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

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