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Mental health

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S Banerjee. East Kent Hospitals NHS Trust, School and Child Health, Ramsgate, Kent, UK

Introduction: When drug treatment for attention deficit/hyperactivity disorder (ADHD) is considered appropriate, methylphenidate, atomoxetine and dexamfetamine are recommended, within their licensed indications.1

Aims and Objectives: To evaluate the current practice in the use of atomoxetine in ADHD clinics in East Kent.

Method: An audit of the three ADHD clinics in East Kent Hospitals NHS Trust. Children aged between 6 and 17 years, who presented within the normal course of care and were prescribed atomoxetine, were included in this study.

Results: There were 64 children, predominantly boys (58; 90.62%). 39 (60.94%) children were in secondary school. The mean age was 12 years and 2 months. 32 children had comorbidities. Atomoxetine was used “off-label” in two adolescents with chronic motor tic disorder and in nocturnal enuresis. 31 (48.44%) children were treatment naive. 15 (23.44%) children were on a combination of stimulants and atomoxetine. The reasons for the switch from stimulants to atomoxetine were: stimulants not effective throughout day and night; more emotional; unsettled in the evenings; decreased appetite; increased aggression; disturbed sleep and increased tics. Comorbid conditions were noted in up to a third of patients. The maintenance dose of atomoxetine ranged from 0.4 to 1.8 mg/kg per day. Atomoxetine was stopped in 14 children, including six (9.37%) children due to side-effects, it was not effective in four (6.25%) and four children were non-compliant. Increased aggression was reported in five (7.8%).

Conclusion: Atomoxetine provides a useful alternative to traditional ADHD therapy with stimulants. It appears to be effective in ADHD and comorbid conditions. Increased aggression was an important side effect leading to the discontinuation of atomoxetine. There is a wide variation in the maintenance dose. More clinical experience is needed to define the role of atomoxetine in …

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