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Original Research

Atomoxetine monotherapy compared with combination therapy for the treatment of ADHD: a retrospective chart review study

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References

Papers of special note have been highlighted as:• of interest

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• This article describes results from a claims database examining the prevalence and predictors of combination therapy for the treatment of ADHD in Medicaid and commercially insured populations.

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• This article demonstrates the lack of empirical data to support or oppose polypharmacy in psychiatric disorders, including ADHD, and suggests a conservative approach until further research can be carried out.

  • Treuer T, Ss G, Mendez L, et al. A systematic review of combination therapy with stimulants and atomoxetine for attention-deficit/hyperactivity disorder, including patient characteristics, treatment strategies, effectiveness, and tolerability. J Child Adol Psychop. 2013;23:179–193.

• This literature review article suggests that drug combination may benefit some, but not all, patients who have tried several ADHD medications without success.

  • Pliszka SR. The Texas children’s medication project: revision of the algorithm for pharmacotherapy of attention-deficit/hyperactivity disorder. J Am Acad Child Psy. 2006;45:642–657.
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  • Hammerness P, Georgiopoulos A, Doyle RL, et al. An open study of adjunct OROS-methylphenidate in children who are atomoxetine partial responders: II tolerability and pharmacokinetics. J Child Adol Psychop. 2009;19:493–499.
  • Guy W. ECDEU assessment manual for psychopharmacology. Rockville (MD): US Dept. of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Pscyhopharmacology Research Branch, Division of Extramural Research Programs; 1976.
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  • Bushe CJ, Savill N. Systematic review of atomoxetine data in childhood and adolescent attention-deficit hyperactivity disorder 2009-2011: focus on clinical efficacy and safety. J Psychopharmacol. 2013;28:204–211.

• This comprehensive review article demonstrates how incremental response time to atomoxetine should be considered when comparing treatment options, noting how atomoxetine requires at least 12 weeks for full response to be demonstrated in children/adolescents.

  • Young JL, Sarkis E, Qiao M, et al. Once-daily treatment with atomoxetine in adults with attention-deficit/hyperactivity disorder: a 24-week, randomized, double-blind, placebo controlled trial. Clin Neuropharmacol. 2011;34:51–60.
  • Jaworowski S, Benarroch F, Gross-Tsur V. Concomitant use of atomoxetine and OROS®-methylphenidate in a 10-year old child suffering from attention-deficit/hyperactivity disorder with comorbid bipolar disorder and Tourette syndrome. J Child Adol Psychop. 2006;16:365–370.
  • Agarwal V, Sitholey P. Combination of atomoxetine and methylphenidate in attention deficit/hyperactivity disorder: a case report. J Can Acad Child Adol Psychiatr. 2008;17:3.
  • Niederhofer H. Atomoxetine may improve methylphenidates’ efficacy in treatment of ADHD? Psychiat Danub. 2009;21:330.
  • Clemow DB. Suboptimal dosing of Strattera (atomoxetine) for ADHD patients. Postgrad Med. 2014;126:196–198.

• This article provides commentary on the frequent underdosing of atomoxetine for the treatment of ADHD and how this underdosing may be associated with poor patient outcomes.

  • Lawson KA, Johnsrud M, Hodgkins P, et al. Utilization patterns of stimulants in ADHD in the Medicaid population: a retrospective analysis of data from the Texas Medicaid program. Clin Ther. 2012;34:944–956.
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  • Kelly RP, Yeo KP, Teng CH. et al. Hemodynamic effects of acute administration of atomoxetine and methylphenidate. J Clin Pharmacol. 2005;45:851–855.

• This article describes the results of atomoxetine combination therapy with methylphenidate in regard to cardiovascular effects, showing there was no synergistic increase in heart rate or cardiovascular risk.

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