title: Switch in Therapy from Methylphenidate to Atomoxetine in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: An Analysis of Patient Records.
abstract: The purpose of this study was to investigate therapy switching from methylphenidate (MPH) to atomoxetine (ATX) in a clinical sample of Danish children and adolescents with attention-deficit/hyperactivity disorder (ADHD); specifically, to determine the duration of MPH treatment before switching to ATX, and the reasons leading to a switch in therapy.
  
  
  
  We included 55 patients with ADHD who switched from first-line MPH to second-line ATX during January 01, 2012 and May 15, 2014. Patient and treatment characteristics along with clinical reasons for switching therapy were extracted from individual patients' records.
  
  
  
  Mean duration of MPH treatment until switch to ATX was 11.2 months (range = 0.3-28.5 months); 36% of the patients switched within the first 6 months, 56% within the first year, and 76% within 1.5 years of initiating MPH; 24% continued MPH treatment for up to 2.5 years prior to switching. Most common reasons for switching were "adverse events" (AEs) (78%), "wish for more optimal day coverage" (24%), and "lack of efficacy" (16%). Other reasons for switching included "patient/parental request" (13%) and "noncompliance" (2%). Most common AEs leading to switch were psychiatric disorders (insomnia, aggression, tic, depression, anxiety) and decreased appetite.
  
  
  
  Our findings highlight the importance of continuous evaluation of the need for prescription switch to ATX in children and adolescents treated with MPH, taking into consideration various factors including potential AEs, non-optimal day coverage, lack of efficacy, patient/parental preferences, and noncompliance. These factors should be considered, not only at the initial stage of MPH treatment but throughout the whole treatment course.
authors.affiliation: 1 Department of Pharmacy, Section for Social and Clinical Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark .|2 Danish Pharmacovigilance Research Project (DANPREP), Copenhagen, Denmark .
authors.forename: Pernille
authors.initials: P
authors.lastname: Warrer
authors.affiliation: 3 Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark .
authors.forename: Per Hove
authors.initials: PH
authors.lastname: Thomsen
authors.affiliation: 4 Department of Economics and Business, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark .
authors.forename: Søren
authors.initials: S
authors.lastname: Dalsgaard
authors.affiliation: 1 Department of Pharmacy, Section for Social and Clinical Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark .|2 Danish Pharmacovigilance Research Project (DANPREP), Copenhagen, Denmark .
authors.forename: Ebba Holme
authors.initials: EH
authors.lastname: Hansen
authors.affiliation: 2 Danish Pharmacovigilance Research Project (DANPREP), Copenhagen, Denmark .|5 Clinical Pharmacology, Institute of Public Health, University of Southern Denmark , Odense, Denmark .
authors.forename: Lise
authors.initials: L
authors.lastname: Aagaard
authors.affiliation: 1 Department of Pharmacy, Section for Social and Clinical Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark .|2 Danish Pharmacovigilance Research Project (DANPREP), Copenhagen, Denmark .
authors.forename: Helle
authors.initials: H
authors.lastname: Wallach Kildemoes
authors.affiliation: 6 Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark .
authors.forename: Henrik Berg
authors.initials: HB
authors.lastname: Rasmussen
mesh_terms: D000293:Adolescent; D018759:Adrenergic Uptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D000069445:Atomoxetine Hydrochloride / Q000008:administration & dosage*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D003718:Denmark; D057915:Drug Substitution; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008774:Methylphenidate / Q000008:administration & dosage* / Q000009:adverse effects; D057240:Patient Preference; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018759:Adrenergic Uptake Inhibitors; D000697:Central Nervous System Stimulants; D008774:Methylphenidate; D000069445:Atomoxetine Hydrochloride