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Side Effects of Atomoxetine (Strattera)


Description: Atomoxetine, commonly referred to by its brand name Strattera, is a drug that inhibits both norepinephrine and serotonin transporters. It is normally used in the treatment of attention deficit hyperactivity disorder (ADHD), although is can sometimes be prescribed to those with major depressive disorder. A non-stimulant drug without the side effects and potential for addiction typically associated with ADHD medications, atomoxetine works by inhibiting both norepinephrine and serotonin presynaptic transporters, according to research although its precise mechanism of action is not well understood.

Serious Side Effects of Strattera

There are rare but serious side effects of ADHD medications such as Strattera in susceptible patients. These require emergency treatment and some can be life-threatening.

  • Hives or welts
  • Irregular heartbeat
  • Itching
  • Large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • Redness of the skin
  • Skin rash
  • Rare
  • Convulsions
  • Dark colored urine
  • Fainting
  • Flu-like symptoms
  • Loss of bladder control
  • Muscle spasm or jerking of all extremities
  • Pelvic pain in male
  • Right upper belly pain or tenderness
  • Sudden loss of consciousness
  • Common Side Effects of Strattera

    As atomoxetine exhibits activity in the central nervous system, it has a myriad of side effects. Common adverse reactions according to the Strattera label as reported by the FDA (Nov 2006), include (occur in more than 1% of patients):

  • Dry mouth (up to 35%)
  • Nausea (up to 26%)
  • Abdominal pain and discomfort (18%)
  • Constipation (11%)
  • Vomiting (11%)
  • Decreased appetite (24%)
  • Increased heart rate
  • Hypertension (high blood pressure)
  • Orthostatic hypotension (low blood pressure when standing up)
  • Palpitations
  • Headache (19%)
  • Somnolence (general lack of energy)
  • Dizziness
  • Tremor
  • Syncope (fainting)
  • Paresthesia (pins and needles)
  • Dysgeusia (metallic taste in mouth)
  • Insomnia (19%)
  • Aggression
  • Irritability
  • Mood swings
  • Depression
  • Decreased libido
  • Agitation
  • Anxiety
  • Hyperhidrosis (increased sweating)
  • Fatigue
  • Chills
  • Thirst
  • Influenza
  • Pyrexia (fever)
  • Chest pain
  • Urinary retention
  • Decreased urine flow
  • Dysuria (painful urination)
  • Conjunctivitis
  • Blurred vision
  • Upper respiratory tract infections
  • How Does Pharmacogenetic Testing Work?

    Atomoxetine is metabolized by the cytochrome P450 superfamily of enzymes, primarily the isoenzyme CY2D6. Known alleles can cause CYP2D6 to metabolize atomoxetine slowly, increasing the probability that the patient will suffer from adverse drug reactions. (Pharmacogenomics “Atomoxetine pharmacogenetics: associations with pharmacokinetics, treatment response and tolerability,” Aug 2015).

    Understand Your Risk for Side Effects with the Rxight® Genetic Test

    Some patients do not develop side effects when taking atomoxetine, however a portion of patients may develop multiple severe adverse reactions. This inter-patient variability is accounted for in part by variations between patients genomes. Polymorphisms (individual differences) in the genes that code for the enzymes and receptors that interact with atomoxetine can increase the probability of developing side effects. Identifying genetic variations can therefore aid clinical decision making. A physician prescribing atomoxetine will be vigilant for the common side effects and change dosage accordingly. Unfortunately routine genomic screening is not provided by most healthcare providers.

    MD Labs’ genetic test, Rxight®, is grounded in the sequencing 18 genes and their alleles to establish how a patient is likely to respond to hundreds of clinically relevant medications on its testing panel (including atomoxetine) across fifty pharmacological classes. All that is required is a simple cheek swab of your DNA which you send to our lab for analysis. Your results will be reviewed with you in detail by a Rxight® pharmacist trained and certified in pharmacogenetic testing. Your prescribers and pharmacist will be able to then tailor your medication treatment based on the DNA test results. Moreover, the Rxight® test results can guide all of your current and future therapy and most importantly help you avoid potentially dangerous medication side effects or, conversely, medication inefficacy.

    Contributors to this Article:
    Michael Sapko, MD, PhD;
    Deborah Kallick, PhD, Medicinal Chemistry

    Read more about Rxight® pharmacogenomics