Eli Lilly, patent expires 2016
Attention Deficit/Hyperactivity Disorder in children and adults
Blocks reuptake of norepinephrine
Supplied in 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, and 100 mg capsules.
Standard dosing for children is to begin with 0.4-0.5 mg/kg QAM or BID, and increase after about a week to a target dose of 1.2 mg/kg. In adults, start with 40 mg QAM, and increase to 40 mg BID or 80 mg QAM after 3-7 days. Maximum recommended dose is 100 mg/day or 1.4 mg/kg, whichever is lower.
Studies have shown that once daily dosing is as effective as BID dosing, but BID dosing is better tolerated in terms of GI side effects.
Decrease dose in hepatic impairment; no dosage reduction required in renal impairment.
Most common are poor appetite, nausea, and sedation. Weight loss has been reported in some trials. In adults, constipation, dry mouth, urinary retention, and sexual dysfunction have been reported.
Severe liver damage has been reported, but this is very rare. There are minor increases in pulse and BP.
Black Box Warning: In clinical trials, SSRIs and SNRIs increased the risk of suicidality in children (from 2% to 4%). No actual suicides occurred in these trials, and none of the trials included MAOIs, but all antidepressants are required to carry this warning anyway.
Metabolized by 2D6, so reduce its dosage when combined with Prozac or Paxil.
It can potentiate the effect of albuterol on increasing pulse and BP, so be cautious about combining the two.
Does not inhibit hepatic metabolism, so does not affect levels of other drugs.
Can be safely combined with stimulants, as it does not increase BP and pulse beyond effects produced by stimulants alone.
Although it is 98% protein bound, it has no effect on levels of coumadin or dilantin.
Contraindicated with MAOIs.
Half-life is 5 hours. Maximum plasma concentration 1-2 hours after ingestion. 98% protein bound.