Atomoxetine adverse effects
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Adverse Effects of Atomoxetine: A Comprehensive Review
Cardiovascular Adverse Effects of Atomoxetine
Atomoxetine, a selective norepinephrine reuptake inhibitor, has been associated with several cardiovascular effects. Studies have shown that atomoxetine treatment can lead to small but statistically significant increases in systolic blood pressure in adults and diastolic blood pressure in children and adolescents. Additionally, mean pulse rates tend to increase across all age groups treated with atomoxetine . These cardiovascular changes typically occur early in the treatment, stabilize over time, and return to baseline upon discontinuation of the drug. Palpitations have been reported more frequently in adults treated with atomoxetine compared to those on placebo. However, the overall risk of significant cardiovascular events remains low, and discontinuations due to cardiovascular issues are uncommon .
Common Adverse Events: Appetite and Weight Changes
One of the most frequently reported adverse effects of atomoxetine is decreased appetite, which can lead to initial weight loss. This effect is particularly noted in children and adolescents, with the appetite reduction appearing early in the treatment course and often diminishing over time . In studies involving children with autism spectrum disorder (ASD), decreased appetite and fatigue were also common, but these adverse events were generally short-lived, lasting four weeks or less .
Gastrointestinal and Neurological Side Effects
Atomoxetine has been associated with several gastrointestinal and neurological side effects. Commonly reported issues include nausea, dry mouth, constipation, and dizziness. Somnolence, or excessive sleepiness, is another frequently observed side effect, particularly when atomoxetine is initiated with a fast titration schedule. In contrast, a slower titration schedule can reduce the incidence of somnolence and other early adverse events.
Psychiatric and Behavioral Effects
While atomoxetine is generally well-tolerated, there are some concerns regarding its psychiatric and behavioral effects. Symptoms such as irritability and aggression have been reported, especially in individuals with developmental disabilities like ASD. However, these effects are not significantly higher than those observed with placebo in most studies. There is no strong evidence linking atomoxetine to increased suicidality or severe psychiatric events in children and adolescents.
Liver and Urinary System Complications
High doses of atomoxetine have been linked to liver disorders and urinary system complications. Although these adverse effects are rare, they can be severe, necessitating careful monitoring, especially in patients with pre-existing liver conditions.
Conclusion
Atomoxetine is an effective treatment for ADHD with a generally favorable safety profile. The most common adverse effects include cardiovascular changes, decreased appetite, gastrointestinal issues, and somnolence. While serious adverse events are rare, clinicians should monitor patients for cardiovascular changes, liver function, and behavioral symptoms, particularly during the initial stages of treatment. Overall, atomoxetine remains a valuable option for managing ADHD, especially in patients who may not respond well to stimulant medications.
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