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Atomoxetine is indicated for treating attention deficit hyperactivity disorder (ADHD) in adults and children over six years. Although atomoxetine is only FDA-approved for treating ADHD, it is sometimes used off-label to treat adult patients with treatment-resistant depression. This activity outlines the indications, mechanism of action, administration, adverse effects, contraindications, and monitoring of atomoxetine. Objectives: Identify the mechanism of action of atomoxetine. Outline the contraindications of atomoxetine. Review the appropriate follow-up monitoring for atomoxetine therapy. Summarize some interprofessional team strategies for improving care coordination and communication to enhance patient outcomes and minimize adverse events with atomoxetine. Access free multiple choice questions on this topic.

Exercise caution when prescribing atomoxetine with other medications metabolized via CYP2D6, as plasma concentrations can be significantly affected, leading to toxicity. Evidence regarding the toxicity of atomoxetine is limited, with much of the data coming from case studies of overdoses. Tachycardia, nausea, vomiting, and hypertension were among the most common symptoms of toxicity. Activated charcoal therapy and support of vital signs appear to be sufficient care during acute toxicity.[4][23] The concomitant administration of atomoxetine and MAOIs, eg, phenelzine, is contraindicated because the combination may increase the risk of serious and potentially fatal adverse events. It includes hyperthermia, rigidity, myoclonus, autonomic instability, extreme agitation, and mental status changes, leading to delirium and coma. A 2-week washout period should be observed between discontinuation and initiation of either of these agents.[24] The clinician should consult with a Certified Poison Control Center. Atomoxetine is highly protein-bound; hence, dialysis is not likely to be useful in treating overdose.

When atomoxetine is used to treat ADHD, the healthcare team needs to prescribe it carefully and monitor patients regularly, eg, children's growth. Pharmacists should perform medication reconciliation and watch for potential drug interactions to report to the clinician. Nursing staff should record patients' vital signs at each clinic visit and provide consultation. Additionally, the medication can significantly affect behavior, and thus the healthcare team needs to monitor patients for anxiety, aggression/hostility, and suicidal ideation, especially in children. If adverse effects appear, discontinuing the drug might be necessary, and the clinician should refer the patient to a psychiatrist for a follow-up consultation. The outcomes for patients treated with atomoxetine can be fair; some patients respond positively, but adverse effects often reduce adherence. Thus, communication between the healthcare team is vital for safety and optimal patient outcomes.