atomoxetine hcl Nursing Considerations & Management

atomoxetine hydrochloride

(at oh mox‘ ah teen)

Strattera

Pregnancy Category C

Drug class

Selective norepinephrine reuptake inhibitor

Therapeutic actions

Selectively blocks the reuptake of norepinephrine at the neuronal synapse. The mechanism by which this action has a therapeutic effect in attention deficit hyperactivity disorder (ADHD) is not understood.

Indication

• Treatment of ADHD as part of a total treatment program

Contraindications and cautions

• Contraindicated with hypersensitivity to atomoxetine or constituents of Strattera; use of MAOIs within the past 14 days; narrow-angle glaucoma
• Use cautiously with hypertension, tachycardia, CV or cerebrovascular disease, pregnancy, lactation

Pharmacokinetics

Metabolism: Hepatic; T_1/2: 5 hr

Distribution: May cross placenta; may enter breast milk

Excretion: Urine and feces

Available forms

Capsules—10, 18, 25, 40, 60 mg

Dosages

ADULTS AND CHILDREN > 70 KG

40 mg/day PO, increase after a minimum of 3 days to a target total daily dose of 80 mg PO given as a single dose in the morning or two evenly divided doses, in the morning and late afternoon or early evening; after 2–4 wk, total dosage may be increase to a maximum of 100 mg/day if needed.

PEDIATRIC PATIENTS < 70 KG

Initially, 0.5 mg/kg/day PO, increase after a minimum of 3 days to a target total daily dose of approximately 1.2 mg/kg/day PO as a single daily dose in the morning; may be given in two evenly divided doses in the morning and late afternoon or early evening. Do not exceed 1.4 mg/kg or 100 mg/day, whichever is less.

PATIENTS WITH HEPATIC IMPAIRMENT

For moderate hepatic impairment, reduce dose to 50% of the normal dose; for severe hepatic impairment, reduce dose to 25% of the normal dose.

Adverse effects

• CNS: Aggression, irritability, crying, somnolence, dizziness, headache, mood swings, insomnia
• CV: Palpitations
• Dermatologic: Dermatitis, increased sweating
• GI: Dry mouth, nausea, dyspepsia, flatulence, decreased appetite, constipation, upper abdominal pain, vomiting
• GU: Urinary hesitation, urinary retention, dysmenorrhea, erectile problems
• Respiratory: Cough, rhinorrhea, sinusitis
• Other: Fever, rigors, sinusitis, weight loss, myalgia

Interactions

Drug-drug

• Possible increased serum levels if combined with potent CYP2D6 inhibitors—paroxetine, fluoxetine, quinidine; monitor and adjust dosage of atomoxetine to 0.5 mg/kg/day with a target dose of 1.2 mg/kg/day for children < 70 kg or 40 mg/day with a target dose of 80 mg/day for children > 70 kg or adults
• Risk of neuroleptic malignant syndrome if combined with MAOIs; do not combine with an MAOI and do not give atomoxetine within 14 days of using an MAOI

Nursing considerations

Assessment

• History: Hypersensitivity to atomoxetine or constituents of Strattera; use of MAOIs within the past 14 days; narrow-angle glaucoma, hypertension, tachycardia, CV or cerebrovascular disease, pregnancy, lactation
• Physical: Height, weight, T; skin color, lesions; orientation, affect; P, BP, auscultation; R, adventitious sounds; bowel sounds, normal output

Interventions

• Ensure proper diagnosis before administering to children for behavioral syndromes: drug should not be used until other causes and concomitants of abnormal behavior (learning disability, EEG abnormalities,neurological deficits) are ruled out.
• Ensure that drug is being used as part of an overall treatment program including education and psychosocial interventions.
• Arrange to interrupt drug dosage periodically in children being treated for behavioral disorders to determine if symptoms recur at an intensity that warrants continued drug therapy.
• Monitor growth of children on long-term atomoxetine therapy.
• Administer drug before 6 PM to prevent insomnia if that is a problem.
• Monitor BP early in treatment, particularly with adult patients.
• Arrange for consult with school nurse of school-age patients receiving this drug.
• For women of childbearing age who are using this drug, suggest using contraceptives.

Teaching points

• Take this drug exactly as prescribed. It can be taken once a day in the morning, if adverse effects are a problem, the drug can be taken in two evenly divided doses in the morning and in the late afternoon or early evening.
• Take drug before 6 PM to avoid night-time sleep disturbance.
• Avoid the use of alcohol and OTC drugs, including nose drops, cold remedies, and herbal therapies while taking this drug; some of these products cause dangerous effects. If you feel that you need one of these preparations, consult your health care provider.
• The effects of this drug on the unborn baby are not known. Women of childbearing age are advised to use contraceptives.
• You may experience these side effects: Dizziness, insomnia, moodiness (these effects may become less pronounced after a few days; avoid driving a car or engaging in activities that require alertness if these occur; notify your health care provider if these are pronounced or bothersome); headache (analgesics may be available to help), loss of appetite, dry mouth (eat frequent small meals and suck on sugarless lozenges).
• Report palpitations, dizziness, weight loss, severe dry mouth and difficulty swallowing, pregnancy.