atomoxetine (Rx)

Brand and Other Names:Strattera
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

  • 10mg
  • 18mg
  • 25mg
  • 40mg
  • 60mg
  • 80mg
  • 100mg

Attention-Deficit/Hyperactivity Disorder

40 mg PO once daily initially; increased after ≥3 days to 80 mg PO once daily or divided q12hr; may be increased to ≤100 mg if optimal response is not achieved

Dosing considerations

  • When drug is coadministered with strong CYP2D6 inhibitors (eg, paroxetine, fluoxetine, quinidine) or used in patients known to be poor CYP2D6 metabolizers, decrease dosage; initiate with 40 mg/day, but do not exceed 80 mg/day

Dosing Modifications

Renal impairment: Dosage adjustment not necessary

Mild hepatic impairment (Child-Pugh class A): Dosage adjustment not necessary

Moderate hepatic impairment (Child-Pugh class B): Decrease initial and target dosage by 50%

Severe hepatic impairment (Child-Pugh class C): Decrease initial and target dosage by 75%

Dosage Forms & Strengths

capsule

  • 10mg
  • 18mg
  • 25mg
  • 40mg
  • 60mg
  • 80mg
  • 100mg

Attention-Deficit/Hyperactivity Disorder

>6 years and ≤70 kg: 0.5 mg/kg PO once daily; increased after ≥3 days to target dosage of ~1.2 mg/kg PO once daily or divided q12hr; total daily dose not to exceed 1.4 mg/kg or 100 mg, whichever is less; no benefit observed with higher doses  

>70 kg: 40 mg PO once daily initially; increased after ≥3 days to 80 mg PO once daily or divided q12hr; if necessary, may be increased after 2-4 additional weeks to 100 mg PO once daily

Dosing considerations

  • When drug is coadministered with strong CYP2D6 inhibitors (eg, paroxetine, fluoxetine, quinidine) or used in patients known to be poor CYP2D6 metabolizers, decrease dosage
  • ≤70 kg: 0.5 mg/kg/day initially; increased to usual target dosage of 1.2 mg/kg/day only if symptoms fail to improve after 4 weeks and initial dosage is well tolerated
  • >70 kg: 40 mg/day initially; not to exceed 80 mg/day

Next:

Interactions

Interaction Checker

and atomoxetine

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            Contraindicated (12)

            • cisapride

              atomoxetine and cisapride both increase QTc interval. Contraindicated.

            • dronedarone

              atomoxetine and dronedarone both increase QTc interval. Contraindicated.

            • iobenguane I 123

              atomoxetine decreases effects of iobenguane I 123 by receptor binding competition. Contraindicated. If clinically appropriate, discontinue drugs that compete for NE receptor sites for at least 5 half-lives; may cause false-negative imaging results.

            • isocarboxazid

              isocarboxazid increases effects of atomoxetine by pharmacodynamic synergism. Contraindicated. The use of atomoxetine with monoamine oxidase inhibitors (MAOIs) is contraindicated. Risk of acute hypertensive episode.

            • linezolid

              linezolid increases effects of atomoxetine by pharmacodynamic synergism. Contraindicated. The use of atomoxetine with monoamine oxidase inhibitors (MAOIs) is contraindicated. Risk of acute hypertensive episode.

            • phenelzine

              phenelzine increases effects of atomoxetine by pharmacodynamic synergism. Contraindicated. The use of atomoxetine with monoamine oxidase inhibitors (MAOIs) is contraindicated. Risk of acute hypertensive episode.

            • procarbazine

              procarbazine increases effects of atomoxetine by pharmacodynamic synergism. Contraindicated. The use of atomoxetine with monoamine oxidase inhibitors (MAOIs) is contraindicated. Risk of acute hypertensive episode.

            • rasagiline

              rasagiline increases effects of atomoxetine by pharmacodynamic synergism. Contraindicated. The use of atomoxetine with monoamine oxidase inhibitors (MAOIs) is contraindicated. Risk of acute hypertensive episode.

            • selegiline

              selegiline increases effects of atomoxetine by pharmacodynamic synergism. Contraindicated. The use of atomoxetine with monoamine oxidase inhibitors (MAOIs) is contraindicated. Risk of acute hypertensive episode.

            • selegiline transdermal

              selegiline transdermal increases effects of atomoxetine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • thioridazine

              atomoxetine and thioridazine both increase QTc interval. Contraindicated.

            • tranylcypromine

              tranylcypromine increases effects of atomoxetine by pharmacodynamic synergism. Contraindicated. The use of atomoxetine with monoamine oxidase inhibitors (MAOIs) is contraindicated. Risk of acute hypertensive episode.

            Serious - Use Alternative (71)

            • amiodarone

              atomoxetine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.

            • arsenic trioxide

              atomoxetine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.

            • artemether/lumefantrine

              atomoxetine and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

            • asenapine

              atomoxetine and asenapine both increase QTc interval. Avoid or Use Alternate Drug.

            • azithromycin

              atomoxetine and azithromycin both increase QTc interval. Avoid or Use Alternate Drug.

            • bedaquiline

              atomoxetine and bedaquiline both increase QTc interval. Avoid or Use Alternate Drug.

            • buprenorphine

              atomoxetine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

            • chloroquine

              atomoxetine and chloroquine both increase QTc interval. Avoid or Use Alternate Drug.

            • chlorpromazine

              atomoxetine and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.

            • clarithromycin

              atomoxetine and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.

            • crizotinib

              atomoxetine and crizotinib both increase QTc interval. Avoid or Use Alternate Drug.

            • dacomitinib

              dacomitinib will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

            • desflurane

              desflurane and atomoxetine both increase QTc interval. Avoid or Use Alternate Drug.

            • disopyramide

              atomoxetine and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.

            • dofetilide

              atomoxetine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.

            • droperidol

              atomoxetine and droperidol both increase QTc interval. Avoid or Use Alternate Drug.

            • encorafenib

              atomoxetine and encorafenib both increase QTc interval. Avoid or Use Alternate Drug.

            • entrectinib

              atomoxetine and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin base

              atomoxetine and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin ethylsuccinate

              atomoxetine and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin lactobionate

              atomoxetine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin stearate

              atomoxetine and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.

            • fexinidazole

              fexinidazole and atomoxetine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

            • flecainide

              atomoxetine and flecainide both increase QTc interval. Avoid or Use Alternate Drug.

            • fluoxetine

              atomoxetine and fluoxetine both increase QTc interval. Avoid or Use Alternate Drug.

            • foscarnet

              atomoxetine and foscarnet both increase QTc interval. Avoid or Use Alternate Drug.

            • givosiran

              givosiran will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

            • glasdegib

              atomoxetine and glasdegib both increase QTc interval. Avoid or Use Alternate Drug.

            • hydroxychloroquine sulfate

              atomoxetine and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.

            • ibutilide

              atomoxetine and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.

            • iloperidone

              atomoxetine and iloperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • inotuzumab

              atomoxetine and inotuzumab both increase QTc interval. Avoid or Use Alternate Drug.

            • iobenguane I 131

              atomoxetine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.

            • isoflurane

              atomoxetine and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • ivosidenib

              atomoxetine and ivosidenib both decrease QTc interval. Avoid or Use Alternate Drug.

            • lefamulin

              lefamulin and atomoxetine both increase QTc interval. Avoid or Use Alternate Drug.

            • lenvatinib

              atomoxetine and lenvatinib both increase QTc interval. Avoid or Use Alternate Drug.

            • lopinavir

              atomoxetine and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.

            • methadone

              atomoxetine and methadone both increase QTc interval. Avoid or Use Alternate Drug.

            • midostaurin

              atomoxetine and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.

            • nilotinib

              atomoxetine and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.

            • ondansetron

              atomoxetine and ondansetron both increase QTc interval. Avoid or Use Alternate Drug.

            • osimertinib

              atomoxetine and osimertinib both increase QTc interval. Avoid or Use Alternate Drug.

            • oxaliplatin

              atomoxetine and oxaliplatin both increase QTc interval. Avoid or Use Alternate Drug.

            • ozanimod

              atomoxetine and ozanimod both increase QTc interval. Avoid or Use Alternate Drug.

            • paliperidone

              atomoxetine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • panobinostat

              atomoxetine and panobinostat both increase QTc interval. Avoid or Use Alternate Drug.

            • pazopanib

              atomoxetine and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.

            • pentamidine

              atomoxetine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • pimavanserin

              atomoxetine and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug.

            • pimozide

              atomoxetine and pimozide both increase QTc interval. Contraindicated.

            • pitolisant

              atomoxetine and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

            • ponesimod

              atomoxetine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

            • procainamide

              atomoxetine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.

            • propafenone

              atomoxetine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.

            • quetiapine

              atomoxetine and quetiapine both increase QTc interval. Avoid or Use Alternate Drug.

            • quinidine

              atomoxetine and quinidine both increase QTc interval. Avoid or Use Alternate Drug.

            • quinine

              atomoxetine and quinine both increase QTc interval. Avoid or Use Alternate Drug.

            • ribociclib

              atomoxetine and ribociclib both increase QTc interval. Avoid or Use Alternate Drug.

            • saquinavir

              atomoxetine and saquinavir both increase QTc interval. Avoid or Use Alternate Drug.

            • selpercatinib

              atomoxetine and selpercatinib both increase QTc interval. Avoid or Use Alternate Drug.

            • sevoflurane

              atomoxetine and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • siponimod

              atomoxetine and siponimod both increase QTc interval. Avoid or Use Alternate Drug.

            • sorafenib

              atomoxetine and sorafenib both increase QTc interval. Avoid or Use Alternate Drug.

            • sotalol

              atomoxetine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • tetrabenazine

              atomoxetine and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • toremifene

              atomoxetine and toremifene both increase QTc interval. Avoid or Use Alternate Drug.

            • trazodone

              atomoxetine and trazodone both increase QTc interval. Avoid or Use Alternate Drug.

            • vandetanib

              atomoxetine and vandetanib both increase QTc interval. Avoid or Use Alternate Drug.

            • vemurafenib

              atomoxetine and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.

            • ziprasidone

              atomoxetine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

            Monitor Closely (118)

            • abiraterone

              abiraterone increases levels of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Reduced initial doses of atomoxetine are recommended with strong CYP2D6 inhibitors.

            • albuterol

              atomoxetine, albuterol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of tachycardia, increased blood pressure.

            • alfuzosin

              atomoxetine and alfuzosin both increase QTc interval. Use Caution/Monitor.

            • amiodarone

              amiodarone will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • amitriptyline

              atomoxetine and amitriptyline both increase QTc interval. Use Caution/Monitor.

            • anagrelide

              atomoxetine and anagrelide both increase QTc interval. Use Caution/Monitor.

            • apomorphine

              atomoxetine and apomorphine both increase QTc interval. Use Caution/Monitor.

            • arformoterol

              arformoterol, atomoxetine. Other (see comment). Use Caution/Monitor. Comment: Exercise caution if beta-agonists and atomoxetine are coadministered. Interaction may be less likely with inhaled beta-agonists versus those given systemically. .

              atomoxetine and arformoterol both increase QTc interval. Use Caution/Monitor.

            • artemether/lumefantrine

              artemether/lumefantrine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • asenapine

              asenapine will increase the level or effect of atomoxetine by Other (see comment). Use Caution/Monitor. Potential for enhanced CNS depression. Monitor closely during conurrent use.

            • bupropion

              bupropion will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • celecoxib

              celecoxib will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • chloroquine

              chloroquine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • cimetidine

              cimetidine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • ciprofloxacin

              atomoxetine and ciprofloxacin both increase QTc interval. Use Caution/Monitor.

            • citalopram

              citalopram increases levels of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Although citalopram is a weak inhibitor of 2D6, the potential for an interaction exists.

              atomoxetine and citalopram both increase QTc interval. Use Caution/Monitor.

            • clomipramine

              clomipramine increases levels of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              atomoxetine and clomipramine both increase QTc interval. Use Caution/Monitor.

            • clozapine

              atomoxetine and clozapine both increase QTc interval. Use Caution/Monitor.

            • darifenacin

              darifenacin will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • dasatinib

              atomoxetine and dasatinib both increase QTc interval. Use Caution/Monitor.

            • degarelix

              atomoxetine and degarelix both increase QTc interval. Use Caution/Monitor.

            • desipramine

              atomoxetine and desipramine both increase QTc interval. Use Caution/Monitor.

            • desvenlafaxine

              desvenlafaxine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mg

            • deutetrabenazine

              atomoxetine and deutetrabenazine both increase QTc interval. Use Caution/Monitor.

            • diphenhydramine

              diphenhydramine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • dobutamine

              atomoxetine, dobutamine. Other (see comment). Use Caution/Monitor. Comment: Due to the potential for increases in blood pressure and heart rate, atomoxetine should be used cautiously with vasopressors such as dobutamine.

            • dolasetron

              atomoxetine and dolasetron both increase QTc interval. Use Caution/Monitor.

            • dopamine

              atomoxetine, dopamine. Other (see comment). Use Caution/Monitor. Comment: Due to the potential for increases in blood pressure and heart rate, atomoxetine should be used cautiously with vasopressors such as dopamine.

            • dronedarone

              dronedarone will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • duloxetine

              duloxetine increases levels of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • eliglustat

              eliglustat increases levels of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.

              atomoxetine and eliglustat both increase QTc interval. Use Caution/Monitor.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

            • ephedrine

              atomoxetine, ephedrine. Other (see comment). Use Caution/Monitor. Comment: Due to the potential for increases in blood pressure and heart rate, atomoxetine should be used cautiously.

            • epinephrine

              atomoxetine, epinephrine. Other (see comment). Use Caution/Monitor. Comment: Due to the potential for increases in blood pressure and heart rate, atomoxetine should be used cautiously with vasopressors such as epinephrine.

            • epinephrine inhaled

              atomoxetine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • escitalopram

              escitalopram increases levels of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              atomoxetine and escitalopram both increase QTc interval. Use Caution/Monitor.

            • esketamine intranasal

              esketamine intranasal, atomoxetine. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Closely monitor blood pressure with concomitant use of esketamine nasal with stimulants. .

            • fedratinib

              fedratinib will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

            • fluconazole

              atomoxetine and fluconazole both increase QTc interval. Use Caution/Monitor.

            • fluoxetine

              fluoxetine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Reduced initial doses of atomoxetine are recommended with strong CYP2D6 inhibitors.

            • fluphenazine

              atomoxetine and fluphenazine both increase QTc interval. Use Caution/Monitor.

            • formoterol

              formoterol, atomoxetine. Other (see comment). Use Caution/Monitor. Comment: Exercise caution if beta-agonists and atomoxetine are coadministered. Interaction may be less likely with inhaled beta-agonists versus those given systemically. .

              atomoxetine and formoterol both increase QTc interval. Use Caution/Monitor.

            • fostemsavir

              atomoxetine and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

            • gemifloxacin

              atomoxetine and gemifloxacin both increase QTc interval. Use Caution/Monitor.

            • gemtuzumab

              atomoxetine and gemtuzumab both increase QTc interval. Use Caution/Monitor.

            • gilteritinib

              atomoxetine and gilteritinib both increase QTc interval. Use Caution/Monitor.

            • goserelin

              atomoxetine and goserelin both increase QTc interval. Use Caution/Monitor.

            • granisetron

              atomoxetine and granisetron both increase QTc interval. Use Caution/Monitor.

            • haloperidol

              haloperidol will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              atomoxetine and haloperidol both increase QTc interval. Use Caution/Monitor.

            • histrelin

              atomoxetine and histrelin both increase QTc interval. Use Caution/Monitor.

            • hydroxyzine

              atomoxetine and hydroxyzine both increase QTc interval. Use Caution/Monitor.

            • imatinib

              imatinib will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • indacaterol, inhaled

              atomoxetine and indacaterol, inhaled both increase QTc interval. Use Caution/Monitor.

            • itraconazole

              atomoxetine and itraconazole both increase QTc interval. Use Caution/Monitor.

            • lapatinib

              atomoxetine and lapatinib both increase QTc interval. Use Caution/Monitor.

            • leuprolide

              atomoxetine and leuprolide both increase QTc interval. Use Caution/Monitor.

            • levalbuterol

              levalbuterol, atomoxetine. Other (see comment). Use Caution/Monitor. Comment: Exercise caution if beta-agonists and atomoxetine are coadministered. Interaction may be less likely with inhaled beta-agonists versus those given systemically. .

              atomoxetine and levalbuterol both increase QTc interval. Use Caution/Monitor.

            • levofloxacin

              atomoxetine and levofloxacin both increase QTc interval. Use Caution/Monitor.

            • lithium

              atomoxetine and lithium both increase QTc interval. Use Caution/Monitor.

            • lofexidine

              atomoxetine and lofexidine both increase QTc interval. Use Caution/Monitor.

            • loperamide

              atomoxetine and loperamide both increase QTc interval. Use Caution/Monitor.

            • lorcaserin

              lorcaserin will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • lumefantrine

              lumefantrine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • lurasidone

              lurasidone, atomoxetine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

            • maprotiline

              atomoxetine and maprotiline both increase QTc interval. Use Caution/Monitor.

            • maraviroc

              maraviroc will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • mefloquine

              atomoxetine and mefloquine both increase QTc interval. Use Caution/Monitor.

            • metaproterenol

              metaproterenol, atomoxetine. Other (see comment). Use Caution/Monitor. Comment: Exercise caution if beta-agonists and atomoxetine are coadministered. Interaction may be less likely with inhaled beta-agonists versus those given systemically. .

            • methylphenidate

              methylphenidate will increase the level or effect of atomoxetine by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • midodrine

              atomoxetine, midodrine. Other (see comment). Use Caution/Monitor. Comment: Due to the potential for increases in blood pressure and heart rate, atomoxetine should be used cautiously with vasopressors such as midodrine.

            • mifepristone

              atomoxetine and mifepristone both increase QTc interval. Use Caution/Monitor.

            • mirabegron

              mirabegron will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • mirtazapine

              atomoxetine and mirtazapine both decrease QTc interval. Use Caution/Monitor.

            • nilotinib

              nilotinib will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • norepinephrine

              atomoxetine, norepinephrine. Other (see comment). Use Caution/Monitor. Comment: Due to the potential for increases in blood pressure and heart rate, atomoxetine should be used cautiously with vasopressors such as norepinephrine.

            • nortriptyline

              atomoxetine and nortriptyline both increase QTc interval. Use Caution/Monitor.

            • octreotide

              atomoxetine and octreotide both increase QTc interval. Use Caution/Monitor.

            • ofloxacin

              atomoxetine and ofloxacin both increase QTc interval. Use Caution/Monitor.

            • olanzapine

              atomoxetine and olanzapine both increase QTc interval. Use Caution/Monitor. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instances

            • olodaterol inhaled

              atomoxetine and olodaterol inhaled both increase QTc interval. Use Caution/Monitor.

            • osilodrostat

              osilodrostat and atomoxetine both increase QTc interval. Use Caution/Monitor.

            • panobinostat

              panobinostat will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Panobinostat can increase the levels and effects of sensitive CYP2D6 substrates or those with a narrow therapeutic index CYP2D6.

            • paroxetine

              paroxetine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Reduced initial doses of atomoxetine are recommended with strong CYP2D6 inhibitors.

            • pasireotide

              atomoxetine and pasireotide both increase QTc interval. Use Caution/Monitor.

            • peginterferon alfa 2b

              peginterferon alfa 2b, atomoxetine. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.

            • perphenazine

              perphenazine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              atomoxetine and perphenazine both increase QTc interval. Use Caution/Monitor.

            • phenylephrine

              atomoxetine, phenylephrine. Other (see comment). Use Caution/Monitor. Comment: Due to the potential for increases in blood pressure and heart rate, atomoxetine should be used cautiously with vasopressors such as phenylephrine.

            • pirbuterol

              pirbuterol, atomoxetine. Other (see comment). Use Caution/Monitor. Comment: Exercise caution if beta-agonists and atomoxetine are coadministered. Interaction may be less likely with inhaled beta-agonists versus those given systemically. .

            • posaconazole

              atomoxetine and posaconazole both increase QTc interval. Use Caution/Monitor.

            • primaquine

              atomoxetine and primaquine both increase QTc interval. Use Caution/Monitor.

            • propafenone

              propafenone will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • protriptyline

              atomoxetine and protriptyline both increase QTc interval. Use Caution/Monitor.

            • quinidine

              quinidine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Reduced initial doses of atomoxetine are recommended with strong CYP2D6 inhibitors.

            • ranolazine

              ranolazine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              atomoxetine and ranolazine both increase QTc interval. Use Caution/Monitor.

            • rilpivirine

              atomoxetine and rilpivirine both increase QTc interval. Use Caution/Monitor.

            • risperidone

              atomoxetine and risperidone both increase QTc interval. Use Caution/Monitor.

            • ritonavir

              ritonavir will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • rolapitant

              rolapitant will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

            • romidepsin

              atomoxetine and romidepsin both increase QTc interval. Use Caution/Monitor.

            • salmeterol

              salmeterol, atomoxetine. Other (see comment). Use Caution/Monitor. Comment: Exercise caution if beta-agonists and atomoxetine are coadministered. Interaction may be less likely with inhaled beta-agonists versus those given systemically. .

            • sertraline

              sertraline will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              atomoxetine and sertraline both increase QTc interval. Use Caution/Monitor.

            • solifenacin

              atomoxetine and solifenacin both increase QTc interval. Use Caution/Monitor.

            • sunitinib

              atomoxetine and sunitinib both increase QTc interval. Use Caution/Monitor.

            • tacrolimus

              atomoxetine and tacrolimus both increase QTc interval. Use Caution/Monitor.

            • telavancin

              atomoxetine and telavancin both increase QTc interval. Use Caution/Monitor.

            • terbinafine

              terbinafine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

            • terbutaline

              terbutaline, atomoxetine. Other (see comment). Use Caution/Monitor. Comment: Exercise caution if beta-agonists and atomoxetine are coadministered. Interaction may be less likely with inhaled beta-agonists versus those given systemically. .

            • thioridazine

              thioridazine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • tipranavir

              tipranavir will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • triclabendazole

              atomoxetine and triclabendazole both increase QTc interval. Use Caution/Monitor.

            • trimipramine

              atomoxetine and trimipramine both increase QTc interval. Use Caution/Monitor.

            • triptorelin

              atomoxetine and triptorelin both increase QTc interval. Use Caution/Monitor.

            • vardenafil

              atomoxetine and vardenafil both increase QTc interval. Use Caution/Monitor.

            • venlafaxine

              venlafaxine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • vilanterol/fluticasone furoate inhaled

              atomoxetine and vilanterol/fluticasone furoate inhaled both increase QTc interval. Use Caution/Monitor.

            • voclosporin

              atomoxetine and voclosporin both increase QTc interval. Use Caution/Monitor.

            • voriconazole

              atomoxetine and voriconazole both increase QTc interval. Use Caution/Monitor.

            • vorinostat

              atomoxetine and vorinostat both increase QTc interval. Use Caution/Monitor.

            Minor (0)

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              Adverse Effects

              >10%

              Xerostomia (dry mouth) (21%)

              Headache (2-19%)

              Abdominal pain (7-18%)

              Decreased appetite (11-16%)

              Insomnia (2-15%)

              Cough (11%)

              Somnolence (11%)

              Vomiting (3-11%)

              1-10%

              Nausea (10%)

              Increases in blood pressure (BP; ≥15-20 mm Hg) and heart rate (HR; ≥20 beats/min) (5-10%)

              Erectile dysfunction (9%)

              Hot flashes (8%)

              Dizziness (5-8%)

              Urinary hesitation or retention (7%)

              Decreased weight (4-7%)

              Depression (4-7%)

              Irritability (<6%)

              Dyspepsia (4%)

              Ejaculation disorder (3%)

              Sinus headache (3%)

              Constipation (2%)

              Dermatitis (2%)

              Menstrual disorder (2%)

              Mood swings (1-2%)

              Postmarketing Reports

              Paresthesia

              Cardiovascular: QT prolongation, syncope

              Peripheral vascular: Raynaud phenomenon

              General: Lethargy

              Neurologic: Hypesthesia, paresthesia in children and adolescents, sensory disturbances, tics

              Psychiatric: Depression and depressed mood, anxiety

              Seizures: Cases include patients with preexisting seizure disorders and those with identified risk factors for seizures, as well as patients with neither history of nor identified risk factors for seizures; exact relation between atomoxetine and seizures is difficult to evaluate because of uncertainty about background risk of seizures in patients with attention-deficit/hyperactivity disorder (ADHD)

              Skin: Hyperhidrosis

              Urogenital: Male pelvic pain, urinary hesitation or retention in children and adolescents

              Musculoskeletal: Rhabdomyolysis

              Alopecia

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              Warnings

              Black Box Warnings

              Atomoxetine use has been associated with increased risk of suicidal ideation in short-term studies in children or adolescents with ADHD; this risk must be balanced against clinical need in patients with ADHD

              Monitor patients closely for suicidal thinking and behavior, clinical worsening, or unusual behavioral changes; families and caregivers should be advised of need for close observation and communication with prescribing healthcare provider

              Average risk of suicidal ideation in patients receiving atomoxetine has been shown to be ~0.4% (5/1357 patients)

              Contraindications

              Hypersensitivity

              Narrow-angle glaucoma

              Administration concomitantly with or within 14 days of monoamine oxidase inhibitor (MAOI) therapy; risk of potentially fatal reaction, including hyperthermia, myoclonus, altered mental status, and neuroleptic malignant syndrome (NMS)-like symptoms

              Pheochromocytoma: Serious reactions, including elevated blood pressure and tachyarrhythmia, have been reported in patients with current or previous pheochromocytoma

              Severe cardiovascular disorders where condition would deteriorate because BP increases by 15-20 mm Hg or HR increases by 20 beats/min; risk is greater in poor CYP2D6 metabolizers

              Cautions

              If drug is given concomitantly with CYP2D6 inhibitor, wait 4 weeks after initiation before adjusting dosage

              Liver injury reported within 120 days of initiation of atomoxetine; patients may present with elevated liver enzymes (>20 × ULN) and jaundice with significantly elevated bilirubin levels (>2 × ULN), followed by recovery upon discontinuance of atomoxetine

              Orthostatic hypotension and syncope reported

              Risk of suicidal thoughts in children and adolescents

              Small risk of allergic reaction

              Use caution in hypertension, tachycardia (see Contraindications)

              Sudden deaths, stroke, and myocardial infarction reported in patients with structural cardiac abnormalities or other serious heart problems taking stimulants at usual doses; patients should have a careful history and physical exam to assess for presence of cardiovascular disease; consider not using atomoxetine in adults with clinically significant cardiac abnormalities

              Patients who develop symptoms such as exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease during stimulant treatment should undergo a prompt cardiac evaluation

              Particular care should be taken in using stimulants to treat ADHD patients with comorbid bipolar disorder because of concern for possible induction of mixed/manic episode in such patients

              Aggressive behavior or hostility is often observed in children and adolescents with ADHD; monitor for the appearance of or worsening of aggressive behavior or hostility

              Monitor growth of children ages 7 to 10 years during treatment with stimulants; may need to interrupt therapy in patients not growing or gaining weight as expected

              Urinary hesitancy or sexual dysfunction may occur

              Rare instances of priapism reported, sometimes necessitating surgical intervention; typically not reported during initiation but often occurring subsequent to dosage increase; immediate medical attention should be sought for abnormally sustained or frequent and painful erections

              Drug can be discontinued without being tapered

              Hypesthesia, paresthesia in children and adolescents, sensory disturbances

              Rare reports of allergic reactions, including anaphylactic reactions, angioneurotic edema, urticaria, and rash

              Use with caution in patietns with bipolar disorder, history of hypertension, hepatic impairment, existing anxiety disorder, history of urinary retention, or tics related to Tourette disorder

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              Pregnancy & Lactation

              Pregnancy

              There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to ADHD medications, during pregnancy; healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for ADHD Medications at 1-866-961-2388 or visiting https://womensmentalhealth.org/adhd-medications

              Available published studies with atomoxetine use in pregnant women are insufficient to establish drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes

              Animal data

              • Some animal reproduction studies of atomoxetine had adverse developmental outcomes; one of 3 studies in pregnant rabbits dosed during organogenesis resulted in decreased live fetuses and an increase in early resorptions, as well as slight increases in the incidences of atypical origin of carotid artery and absent subclavian artery
              • These effects were observed at plasma levels (AUC) 3 times and 0.4 times the human plasma levels in extensive and poor metabolizers receiving the maximum recommended human dose (MRHD), respectively; in rats dosed prior to mating and during organogenesis a decrease in fetal weight (female only) and an increase in the incidence of incomplete ossification of the vertebral arch in fetuses were observed at a dose approximately 5 times the MRHD on a mg/m2 basis
              • In one of 2 studies in which rats were dosed prior to mating through periods of organogenesis and lactation, decreased pup weight and decreased pup survival were observed at doses corresponding to 5-6 times MRHD on a mg/m2 basis; no adverse fetal effects were seen in pregnant rats dosed during the organogenesis period

              Lactation

              There are no data on presence of atomoxetine or its metabolite in human milk, effects on breastfed child, or on milk production; drug is present in animal milk; when a drug is present in animal milk, it is likely that drug will be present in human milk

              Developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from drug or from underlying maternal condition

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Selective inhibition of presynaptic norepinephrine reuptake

              Absorption

              Bioavailability: 63-94%

              Onset: 2-4 wk

              Peak plasma time: 1-2 hr

              Distribution

              Vd: 0.85 L/kg (IV)

              Protein bound: 98%

              Vd: 0.85 L/kg

              Metabolism

              Metabolized in liver by CYP2D6

              Metabolites: 4-Hydroxyatomoxetine (equipotent), N-desmethylatomoxetine (less potent)

              Elimination

              Half-life: 5.2 hr

              Total body clearance: 0.35 L/hr/kg

              Excretion: Urine (80%), feces (17%)

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              Administration

              Administer either as a single daily dose in the morning or as evenly divided doses in the morning and late afternoon/early evening

              Therapy may be discontinued without being tapered

              Do not open capsules; must be swallowed whole with aid of liquids; must not be chewed, divided, or crushed

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Strattera oral
              -
              40 mg capsule
              Strattera oral
              -
              25 mg capsule
              Strattera oral
              -
              10 mg capsule
              Strattera oral
              -
              60 mg capsule
              Strattera oral
              -
              100 mg capsule
              Strattera oral
              -
              80 mg capsule
              Strattera oral
              -
              18 mg capsule
              atomoxetine oral
              -
              100 mg capsule
              atomoxetine oral
              -
              80 mg capsule
              atomoxetine oral
              -
              25 mg capsule
              atomoxetine oral
              -
              40 mg capsule
              atomoxetine oral
              -
              25 mg capsule
              atomoxetine oral
              -
              100 mg capsule
              atomoxetine oral
              -
              80 mg capsule
              atomoxetine oral
              -
              60 mg capsule
              atomoxetine oral
              -
              18 mg capsule
              atomoxetine oral
              -
              10 mg capsule
              atomoxetine oral
              -
              40 mg capsule
              atomoxetine oral
              -
              25 mg capsule
              atomoxetine oral
              -
              10 mg capsule
              atomoxetine oral
              -
              18 mg capsule
              atomoxetine oral
              -
              60 mg capsule
              atomoxetine oral
              -
              40 mg capsule
              atomoxetine oral
              -
              18 mg capsule
              atomoxetine oral
              -
              10 mg capsule
              atomoxetine oral
              -
              100 mg capsule
              atomoxetine oral
              -
              80 mg capsule
              atomoxetine oral
              -
              60 mg capsule
              atomoxetine oral
              -
              60 mg capsule
              atomoxetine oral
              -
              60 mg capsule
              atomoxetine oral
              -
              25 mg capsule
              atomoxetine oral
              -
              40 mg capsule
              atomoxetine oral
              -
              100 mg capsule
              atomoxetine oral
              -
              80 mg capsule
              atomoxetine oral
              -
              40 mg capsule
              atomoxetine oral
              -
              18 mg capsule
              atomoxetine oral
              -
              10 mg capsule
              atomoxetine oral
              -
              100 mg capsule
              atomoxetine oral
              -
              80 mg capsule
              atomoxetine oral
              -
              40 mg capsule
              atomoxetine oral
              -
              25 mg capsule
              atomoxetine oral
              -
              18 mg capsule
              atomoxetine oral
              -
              10 mg capsule
              atomoxetine oral
              -
              60 mg capsule
              atomoxetine oral
              -
              25 mg capsule

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              atomoxetine oral

              ATOMOXETINE - ORAL

              (A-toe-MOX-e-teen)

              COMMON BRAND NAME(S): Strattera

              WARNING: A small number of people (especially children/teenagers) who take atomoxetine for attention-deficit hyperactivity disorder (ADHD) may experience worsening of their condition, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of this medication (especially for children/teenagers).Tell the doctor right away if you notice worsening of your condition/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, hallucinations, delusions, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when you first start this medication or when the dose is changed.

              USES: Atomoxetine is used to treat attention-deficit hyperactivity disorder (ADHD) as part of a total treatment plan, including psychological, social, and other treatments. It may help to increase the ability to pay attention, concentrate, stay focused, and stop fidgeting. It is thought to work by restoring the balance of certain natural substances (neurotransmitters) in the brain.

              HOW TO USE: Read the Medication Guide provided by your pharmacist before you start using atomoxetine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication with or without food as directed by your doctor, usually 1 to 2 times a day. The first dose is usually taken when you wake up in the morning. If a second dose is prescribed, take it as directed by your doctor, usually in the late afternoon/early evening. Taking this medication late in the day may cause trouble sleeping (insomnia).Swallow the capsules whole. Do not crush, chew, or open the capsules. If the capsule is accidentally opened or broken, avoid contact with the powder and wash away any loose powder as soon as possible with water. If the powder gets in your eyes, flush with plenty of water right away and contact your doctor.The dosage is based on your medical condition, response to treatment, and other drugs you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). Do not increase your dose or take this drug more often than directed.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.Tell your doctor if your condition does not improve or if it worsens.

              SIDE EFFECTS: See also Warning section.Stomach upset, nausea, vomiting, constipation, tiredness, loss of appetite/weight loss, dry mouth, dizziness, drowsiness, trouble sleeping, or decrease in sexual ability/desire may occur. In women, menstrual cramps or missed/irregular periods may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.To lessen the chance of dizziness, get up slowly from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.Tell your doctor right away if you have any serious side effects, including: difficulty urinating, unusually fast/irregular heartbeat, fainting, numbness/tingling.Atomoxetine may rarely cause serious (possibly fatal) liver disease. Get medical help right away if you have any symptoms of liver damage, including: dark urine, persistent nausea/vomiting/loss of appetite, stomach/abdominal pain, yellowing eyes/skin.This medication may rarely cause serious problems such as a heart attack or stroke. Get medical help right away if you experience any of the following: chest/jaw/left arm pain, shortness of breath, unusual sweating, weakness on one side of the body, confusion, trouble speaking, sudden vision changes.Rarely, males (including young boys and teens) may have a painful or prolonged erection lasting 4 or more hours while using this medication. Caregivers/parents should also be watchful for this serious side effect in boys. If a painful or prolonged erection occurs, stop using this drug and get medical help right away, or permanent problems could occur. Ask your doctor or pharmacist for more details.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking atomoxetine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: a certain adrenal problem (pheochromocytoma), bladder or prostate problems, glaucoma, heart problems (such as irregular heartbeat, heart failure, previous heart attack, problems with heart structure), family history of heart problems (such as sudden cardiac death, irregular heartbeat), high blood pressure, liver disease, personal/family history of mental/mood disorders (such as bipolar disorder, depression, psychosis, suicidal thoughts), stroke.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).If used for a long time, this drug may affect a child's growth rate, weight, and final adult height. To reduce the risk, the doctor may recommend briefly stopping the medication from time to time. Check the child's weight and height regularly, and consult your doctor or pharmacist for more details.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.Some products have ingredients that could raise your heart rate or blood pressure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products or diet aids).

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: unusually fast heartbeat, severe headache.

              NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as pulse, blood pressure, liver function tests) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.If you have heart problems, your doctor may perform certain heart tests (EKG, echocardiogram) before you start this medication.Keep all regular medical and laboratory appointments.

              MISSED DOSE: If you miss a dose, take it as soon as you remember if it is the same day. If it is the next day, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised September 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
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              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.