TORONTO – Children with attention-deficit hyperactivity disorder can be successfully cross-tapered from a stimulant to atomoxetine with significant improvements in their ADHD symptoms, Dr. Humberto Quintana reported in a poster at the joint annual meeting of the American Academy of Child and Adolescent Psychiatry and the Canadian Academy of Child and Adolescent Psychiatry.
Switching from a stimulant to the serotonin norepinephrine reuptake inhibitor atomoxetine also was safe, said Dr. Quintana of the Louisiana State University Health Sciences Center, New Orleans. The study found slight, but statistically significant, increases in blood pressure and heart rate, but the safety findings otherwise were unremarkable.
The study, funded by Eli Lilly & Co.–for whom Dr. Quintana is an investigator–included 62 children aged 6–17 years. Just over half of the children (53%) were switching to atomoxetine because of inadequate response to their current medication; the rest (47%) switched because of adverse events.
Slightly more of the group (52%) were taking methylphenidate at baseline; the rest were taking an amphetamine.
During the first week of the transition period, patients received the full dose of their current medication daily, plus 0.5 mg/kg per day of atomoxetine. During the second week, they received a half-dose of their stimulant each day, plus 1.2 mg/kg per day of atomoxetine. During the final 5 weeks of the study, the patients received 1.2 mg/kg per day of atomoxetine and no stimulant.
At the end of the study, patients experienced a significant decrease in ADHD symptoms as reported by parents on the ADHD Rating Scale. The mean total score decreased from 32 to 22.5, the inattention score decreased from a mean of 17 to a mean of 13.5, and the mean hyperactivity score decreased from 13 to 9.
Most of the children (65.5%) said they preferred atomoxetine over their previous stimulant medication. When surveyed after the study, parents clearly preferred atomoxetine. Parents said they were satisfied with the drug's effect overall, as well as with its effect in both morning and evening hours. They were very satisfied with the drug's ability to “allow the child to be himself” during treatment.
Significant increases in blood pressure and heart rate were found for most of the 62 children; 53 experienced an average increase of 2.4 mm Hg in both diastolic and systolic blood pressure. Fifty-seven children experienced an average increase in heart rate of 9 beats per minute. There were no other ECG changes, including in the QT interval.