Atomoxetine is the first non stimulant drug approved for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). Its indications cover both pediatric and adult patient populations, and special attention should be paid to cardiovascular monitoring, special population adjustments, and drug interactions during medication.

1. Indications

(1) Childhood ADHD: Long term treatment for attention deficit hyperactivity disorder in children aged 6 and above, which can improve symptoms of inattention, hyperactivity, and impulsivity.

(2) Adult ADHD: Used for symptom control in adult patients over 18 years old, especially for those who are intolerant to stimulant drugs or at risk of abuse.

(3) Comorbidity treatment: Suitable for ADHD patients with comorbidities such as tic disorders and anxiety disorders, it has a safety advantage over stimulant drugs.

2. Medication precautions

(1) Cardiovascular monitoring

Before medication, electrocardiogram and blood pressure should be evaluated, and regular monitoring should be conducted during treatment. Use with caution in patients with hypertension or tachycardia. If there is a sustained increase in blood pressure ≥ 15mmHg or heart rate ≥ 120 beats/minute, the medication should be reduced or stopped.

(2) Medication for special populations

Patients with liver dysfunction need to adjust the dosage (Child Pugh B grade halved, C grade 1/4 dose). Use only during pregnancy when the benefits outweigh the risks, and it is recommended to suspend breastfeeding during lactation. Elderly patients should start with low doses.

(3) Drug interactions

Do not use in combination with MAOI drugs (with a 14 day interval). CYP2D6 strong inhibitors (such as fluoxetine) can increase blood drug concentrations and require a 50% reduction. Combined use with beta agonists such as salbutamol may enhance cardiovascular effects.

(4) Suicide risk monitoring

During the early stages of medication for children and adolescents, close observation of emotional changes is necessary. If suicidal ideation or abnormal behavior occurs, medication should be stopped immediately. It is recommended that family members participate in medication supervision, especially during the critical treatment period of the first 2 months.

(5) Adjustment of dosing regimen

The initial dose is usually 0.5mg/kg/day, and it should be increased to the target dose of 1.2mg/kg/day at least 3 days later. The maximum dose for individuals weighing over 70kg should not exceed 100mg/day. Capsules should be swallowed whole, avoiding opening or chewing.