Atomexetine in ADHD

1.Is Atomextine associated with liver damage?

This is a good point. According to the NICE guidelines, liver damage occurs however very rarely in the use of Atomoxetine. It usually presents as abdominal pain, nausea, darkening of the urine or jaundice. I would therefore agree that if a patient has pre-existing liver problems or develops abnormal LFTs after starting Atomoxetine that it is contraindicated.

Also of note, according to the most recent NICE guidelines, it is best to warn patients and carers about the potential for any increased agitation, self harming or suicidal behaviour with Atomoxetine. This is again rare but it is best to advise them about it.

ONLY if the task’s emphasis in the MRCPsych CASC station changed to having to explain Atomexetine treatment example phrases to use could be:

“An alternative treatment to Methylphenidate is a medication called Atomextine, have you heard of this before?”

“There are however some rare but serious side effects that we would need to monitor (you/your son/your daughter) for if we started this treatment”

“Atomoxetine can in rare cases can cause liver damage. It is therefore extremely important that we get an idea of how well (you/your son/your daughter’s) liver is working by taking what we call a baseline measurement with a blood test. After beginning treatment we would need to repeat this periodically to ensure that there have been no significant changes. Does that make sense?”

“Also, if you experience any symptoms of nausea, abdominal pain, or yellowing of the skin, then please contact us immediately”

“Another extremely rare side effect is that Atomoxetine can cause an increase in agitation. It has also lead to some reports of patients harming themselves as well. I completely appreciate that this is a distressing side effect so it is extremely important that if you notice any changes to his/her personality that you contact us immediately. I do want to reassure you that these are very rare reports but it is important that I make you aware of them – is there any thing you would like to ask me?”

2. Just a comment when we are asked why we are giving a ‘stimulant’ drug to someone who has attention problems. I just say that ‘the evidence suggests that stimulant medications like methylphenidate improve focus on tasks, aid more control in behaviour and better decision making’

Thanks! This is also a really useful statement.