Atomoxetine, a Novel Treatment for Attention-Deficit-Hyperactivity Disorder

Alisa K. Christman, Pharm.D.; Joli D. Fermo, Pharm.D.; John S. Markowitz, Pharm.D.


Pharmacotherapy. 2004;24(8) 

In This Article

Potential for Abuse

A comparison of the behavioral effects of atomoxetine versus methylphenidate in those who take recreational drugs was published recently.[38] Drug users subjectively reported the effects of the two agents through the use of a visual analog scale (VAS) assessing behavior, the Addiction Research Center Inventory-Short Form (ACRI), and the Adjective Rating Scale (ARS). The Digit Symbol Substitution Test was used to demonstrate psychomotor performance of patients taking atomoxetine and methylphenidate. The results indicated that patients taking methylphenidate exhibited a significantly higher pleasurable effect and were more stimulated than were patients taking placebo. Patients taking atomoxetine associated the agent with the "bad" or "sick" components of the VAS when compared with placebo (p<0.05). No significant differences were noted between atomoxetine and placebo along the domains of the ACRI and the ARS, whereas patients taking methylphenidate had significantly higher scores than those of patients taking placebo (p<0.05).

These results indicate that atomoxetine does not induce the same subjective effects as methylphenidate. The mechanism of action of atomoxetine differs from stimulants in that it inhibits norepinephrine transporters, whereas stimulants increase levels of dopamine. Therefore, the potential for diversion or abuse with atomoxetine is unlikely compared with stimulants, making atomoxetine a good alternative for patients in whom substance abuse potential is high.

In clinical trials, atomoxetine did not appear to promote the development of new tics or exacerbation of comorbid anxiety. Therefore, in patients who are not able to take stimulants because of contraindications related to tics or anxiety, atomoxetine may be a reasonable alternative. Trials are under way to evaluate the efficacy of atomoxetine in reducing the symptoms of ADHD in patients with comorbid tics or anxiety.