title: A review of atomoxetine effects in young people with developmental disabilities.
abstract: This review summarizes the pharmacokinetic characteristics, pharmacodynamic properties, common side effects, and clinical advantages and disadvantages associated with atomoxetine (ATX) treatment in typically developing children and adults with ADHD. Then the clinical research to date in developmental disabilities (DD), including autism spectrum disorders (ASD), is summarized and reviewed. Of the 11 relevant reports available, only two were placebo-controlled randomized clinical trials, and both focused on a single DD population (ASD). All trials but one indicated clinical improvement in ADHD symptoms with ATX, although it was difficult to judge the magnitude and validity of reported improvement in the absence of placebo controls. Effects of ATX on co-occurring behavioral and cognitive symptoms were much less consistent. Appetite decrease, nausea, and irritability were the most common adverse events reported among children with DD; clinicians should be aware that, as with stimulants, irritability appears to occur much more commonly in persons with DD than in typically developing individuals. Splitting the dose initially, starting below the recommended starting dose, and titrating slowly may prevent or ameliorate side effects. Patience is needed for the slow build-up of benefit.
  
  
  CONCLUSIONS
  ATX holds promise for managing ADHD symptoms in DD, but properly controlled, randomized clinical trials of atomoxetine in intellectual disability and ASD are sorely needed. Clinicians and researchers should be vigilant for the emergence of irritability with ATX treatment. Effects of ATX on cognition in DD are virtually unstudied.
authors.affiliation: The Nisonger Center UCEDD, Ohio State University, McCampbell Hall, 1581 Dodd Dr., Columbus, OH 43210, United States. Electronic address: aman.1@osu.edu.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Aman
authors.affiliation: Division of Neurodevelopmental and Behavioral Pediatrics at the University of Rochester, Box 671, 601 Elmwood Avenue, Rochester, NY 14642, United States.
authors.forename: Tristram
authors.initials: T
authors.lastname: Smith
authors.affiliation: The Nisonger Center UCEDD, Ohio State University, McCampbell Hall, 1581 Dodd Dr., Columbus, OH 43210, United States.
authors.forename: L Eugene
authors.initials: LE
authors.lastname: Arnold
authors.affiliation: Division of Neurodevelopmental and Behavioral Pediatrics at the University of Rochester, Box 671, 601 Elmwood Avenue, Rochester, NY 14642, United States.
authors.forename: Patricia
authors.initials: P
authors.lastname: Corbett-Dick
authors.affiliation: Department of Psychiatry at the Western Psychiatric Institute and Clinic, Thomas Detre Hall, 3811 O'Hara Street, Pittsburgh, PA 15213, United States.
authors.forename: Rameshwari
authors.initials: R
authors.lastname: Tumuluru
authors.affiliation: The Nisonger Center UCEDD, Ohio State University, McCampbell Hall, 1581 Dodd Dr., Columbus, OH 43210, United States.
authors.forename: Jill A
authors.initials: JA
authors.lastname: Hollway
authors.affiliation: Division of Neurodevelopmental and Behavioral Pediatrics at the University of Rochester, Box 671, 601 Elmwood Avenue, Rochester, NY 14642, United States.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Hyman
authors.affiliation: Department of Psychiatry at the Western Psychiatric Institute and Clinic, Thomas Detre Hall, 3811 O'Hara Street, Pittsburgh, PA 15213, United States.
authors.forename: Marissa
authors.initials: M
authors.lastname: Mendoza-Burcham
authors.affiliation: Center for Biostatistics, Ohio State University, 2012 Kenny Road, Columbus, OH 43221, United States.
authors.forename: Xueliang
authors.initials: X
authors.lastname: Pan
authors.affiliation: Division of Neurodevelopmental and Behavioral Pediatrics at the University of Rochester, Box 671, 601 Elmwood Avenue, Rochester, NY 14642, United States.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Mruzek
authors.affiliation: The Nisonger Center UCEDD, Ohio State University, McCampbell Hall, 1581 Dodd Dr., Columbus, OH 43210, United States.
authors.forename: Luc
authors.initials: L
authors.lastname: Lecavalier
authors.affiliation: Division of Neurodevelopmental and Behavioral Pediatrics at the University of Rochester, Box 671, 601 Elmwood Avenue, Rochester, NY 14642, United States.
authors.forename: Lynne
authors.initials: L
authors.lastname: Levato
authors.affiliation: Division of Neurodevelopmental and Behavioral Pediatrics at the University of Rochester, Box 671, 601 Elmwood Avenue, Rochester, NY 14642, United States.
authors.forename: Laura B
authors.initials: LB
authors.lastname: Silverman
authors.affiliation: Department of Psychiatry at the Western Psychiatric Institute and Clinic, Thomas Detre Hall, 3811 O'Hara Street, Pittsburgh, PA 15213, United States.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Handen
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use*; D000069445:Atomoxetine Hydrochloride; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000188:drug therapy*; D002659:Child Development Disorders, Pervasive / Q000150:complications*; D002658:Developmental Disabilities / Q000150:complications*; D006801:Humans; D011437:Propylamines / Q000627:therapeutic use*
chemical_list: D018759:Adrenergic Uptake Inhibitors; D011437:Propylamines; D000069445:Atomoxetine Hydrochloride
keywords: Atomoxetine (Strattera); Autism spectrum disorders; Developmental disabilities; Review
references.citation: CNS Drugs. 2011 Jun 1;25(6):503-9
references.pmid: 21649450
references.citation: Neuropharmacology. 2006 May;50(6):755-60
references.pmid: 16427661
references.citation: J Pharmacol Exp Ther. 2004 Feb;308(2):410-8
references.pmid: 14610241
references.citation: Res Dev Disabil. 2011 Sep-Oct;32(5):1399-421
references.pmid: 21570809
references.citation: Drug Saf. 2003;26(10):729-40
references.pmid: 12862507
references.citation: Acta Paediatr. 2011 Sep;100(9):1258-61
references.pmid: 21392103
references.citation: J Intellect Disabil Res. 2003 Jan;47(Pt 1):51-8
references.pmid: 12558695
references.citation: J Child Adolesc Psychopharmacol. 2003 Spring;13(1):53-63
references.pmid: 12804126
references.citation: J Child Adolesc Psychopharmacol. 2006 Oct;16(5):611-9
references.pmid: 17069549
references.citation: J Am Acad Child Adolesc Psychiatry. 2008 Feb;47(2):209-218
references.pmid: 18176331
references.citation: Clin Pharmacokinet. 2005;44(6):571-90
references.pmid: 15910008
references.citation: J Child Adolesc Psychopharmacol. 2003 Spring;13(1):29-40
references.pmid: 12804124
references.citation: J Am Acad Child Adolesc Psychiatry. 2007 May;46(5):566-572
references.pmid: 17450047
references.citation: J Child Adolesc Psychopharmacol. 2009 Jun;19(3):319-20
references.pmid: 19519271
references.citation: Neuropsychiatr Dis Treat. 2009;5:215-26
references.pmid: 19557116
references.citation: J Atten Disord. 2011 Nov;15(8):684-9
references.pmid: 20686100
references.citation: Am J Ment Defic. 1985 Mar;89(5):485-91
references.pmid: 3993694
references.citation: J Clin Psychopharmacol. 2009 Dec;29(6):561-4
references.pmid: 19910721
references.citation: Drug Metab Dispos. 2003 Jan;31(1):98-107
references.pmid: 12485958
references.citation: J Am Acad Child Adolesc Psychiatry. 2006 Aug;45(8):919-927
references.pmid: 16865034
references.citation: Dev Med Child Neurol. 2000 Apr;42(4):266-70
references.pmid: 10795566
references.citation: J Child Adolesc Psychopharmacol. 2006 Oct;16(5):599-610
references.pmid: 17069548
references.citation: Neuropsychopharmacology. 2002 Nov;27(5):699-711
references.pmid: 12431845
references.citation: J Child Adolesc Psychopharmacol. 2005 Apr;15(2):325-30
references.pmid: 15910217
references.citation: J Child Adolesc Psychopharmacol. 2013 Apr;23(3):194-9
references.pmid: 23578015
references.citation: Child Adolesc Psychiatry Ment Health. 2008 Sep 15;2(1):25
references.pmid: 18793405
references.citation: Pediatr Neurol. 2010 Nov;43(5):341-7
references.pmid: 20933178
references.citation: J Am Acad Child Adolesc Psychiatry. 2012 Jul;51(7):733-41
references.pmid: 22721596
references.citation: Health Technol Assess. 2006 Jul;10(23):iii-iv, xiii-146
references.pmid: 16796929
references.citation: CNS Drugs. 2009 Sep;23(9):739-53
references.pmid: 19689165
references.citation: J Am Acad Child Adolesc Psychiatry. 2006 Feb;45(2):149-157
references.pmid: 16429085
references.citation: Clin Neuropharmacol. 2011 Mar-Apr;34(2):51-60
references.pmid: 21406998
references.citation: Arch Gen Psychiatry. 2005 Nov;62(11):1266-74
references.pmid: 16275814
references.citation: J Learn Disabil. 1980 Feb;13(2):87-97
references.pmid: 7391681
references.citation: Atten Defic Hyperact Disord. 2011 Dec;3(4):319-26
references.pmid: 21833565
references.citation: Child Adolesc Psychiatr Clin N Am. 2008 Oct;17(4):713-38, vii
references.pmid: 18775366
references.citation: J Child Psychol Psychiatry. 2006 Sep;47(9):871-82
references.pmid: 16930381
references.citation: J Am Acad Child Adolesc Psychiatry. 2014 Feb;53(2):174-87
references.pmid: 24472252
references.citation: Psychopharmacology (Berl). 2007 Oct;194(2):197-209
references.pmid: 17572882
references.citation: Paediatr Drugs. 2009;11(3):203-26
references.pmid: 19445548
references.citation: J Am Acad Child Adolesc Psychiatry. 2006 Oct;45(10):1196-1205
references.pmid: 17003665