title: Tic exacerbation and precipitation during atomoxetine treatment in two children with attention-deficit hyperactivity disorder.
abstract: Stimulants have been the mainstay of treatment for children with Attention-deficit/hyperactivity Disorder (ADHD). However, stimulants have been controversially purported to precipitate and exacerbate tics. Atomoxetine, a selective norepinephrine inhibitor, was introduced as a safe non-stimulant alternative treatment for ADHD children with comorbid tics or TS. We are presenting two children with ADHD, in which atomoxetine, at relatively low doses, exacerbated and precipitated tics. The diagnoses of ADHD and tic disorder were based on clinical observations and standardized rating scales. Case 1, an 8-year-old boy, had history of stimulant-induced tics. This child was placed on atomoxetine reported to be safe for patients with tics. This patient's tic control was adequate prior to atomoxetine treatment. However, while on atomoxetine, the patient promptly experienced tic exacerbation. Case 2, a 6-year-old boy, had no previous history of stimulant therapy and was receiving citalopram due to a comorbid anxiety disorder. Atomoxetine was initiated for the treatment of ADHD with improvement in the ADHD symptoms. But, upon a mild dose increase, the patient presented tic precipitation consisting primarily of neck twitches. Both cases experienced a decrease in tic activity when atomoxetine was discontinued, but tics did not fully resolve, causing psychosocial disturbance. Atypical neuroleptics were used with good results. Periodic assessments of the need for continued neuroleptic treatment were emphasized. These two children exemplify atomoxetine's potential to exacerbate and precipitate tics in children with ADHD. Independent controlled studies are needed to determine if atomoxetine should be used in children with ADHD and comorbid tic disorders or TS.
authors.affiliation: Fourth Street Clinic, Springfield, Illinois 62703, USA. Parragahc@aol.com
authors.forename: Humberto C
authors.initials: HC
authors.lastname: Párraga
authors.forename: Marianela I
authors.initials: MI
authors.lastname: Párraga
authors.forename: David K
authors.initials: DK
authors.lastname: Harris
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000188:drug therapy; D000069445:Atomoxetine Hydrochloride; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D015283:Citalopram / Q000009:adverse effects / Q000627:therapeutic use; D003987:Dibenzothiazepines / Q000009:adverse effects / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D011437:Propylamines / Q000009:adverse effects* / Q000627:therapeutic use; D000069348:Quetiapine Fumarate; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D020323:Tics / Q000139:chemically induced*
chemical_list: D018759:Adrenergic Uptake Inhibitors; D014150:Antipsychotic Agents; D000069445:Atomoxetine Hydrochloride; D000697:Central Nervous System Stimulants; D015283:Citalopram; D003987:Dibenzothiazepines; D011437:Propylamines; D000069348:Quetiapine Fumarate; D017367:Selective Serotonin Reuptake Inhibitors