High-dose atomoxetine treatment of ADHD in youths with limited response to standard doses

Christopher J Kratochvil, David Michelson, Jeffrey H. Newcorn, Margaret D. Weiss, Joan Busner, Rodney J. Moore, Dustin D. Ruff, Janet Ramsey, Ruth Dickson, Atilla Turgay, Keith E. Saylor, Stephen Luber, Brigette Vaughan, Albert J. Allen

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

OBJECTIVE: To assess the utility and tolerability of higher than standard atomoxetine doses to treat attention-deficit/hyperactivity disorder (ADHD). METHOD: Two randomized, double-blind trials of atomoxetine nonresponders ages 6 to 16 years were conducted comparing continued treatment with same-dose atomoxetine to treatment using greater than standard efficacious doses (study 1: up to 3.0 mg • kg • day; study 2: up to 2.4 mg • kg • day). RESULTS: The primary outcome measure for both studies was mean ADHD Rating Scale (ADHD RS) total score. For study 1 (N = 122), decreases in ADHD RS total scores were not significantly different between treatment groups (mean change [SD]: continued same dose, -8.9 [11.2]; high dose, -9.8 [13.1]; p = .595). Likewise, for study 2 (N = 125), treatment groups did not differ (mean change [SD]: continued same dose, -6.2 [12.2]; high dose, -8.9 [10.0], p =.110). Tolerability was not significantly different between the continued same-dose and high-dose groups. CONCLUSIONS: These studies provide evidence that current dose recommendations are appropriate for most patients, suggesting no systematic advantage to increasing atomoxetine doses beyond current guidelines. In both studies, continued treatment, whether at a higher dose or the previous dose, was associated with improved outcomes in patients who demonstrated incomplete/inadequate response to acute ADHD treatment, although without a placebo arm, we cannot rule out the possibility that expectancy played a role in symptom improvement. Copyright 2007

Original languageEnglish (US)
Pages (from-to)1128-1137
Number of pages10
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume46
Issue number9
DOIs
StatePublished - Sep 1 2007

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Attention Deficit Disorder with Hyperactivity
Therapeutics
Atomoxetine Hydrochloride
Placebos
Outcome Assessment (Health Care)
Guidelines

Keywords

  • Atomoxetine
  • Attention-deficit/hyperactivity disorder
  • Dose

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health

Cite this

High-dose atomoxetine treatment of ADHD in youths with limited response to standard doses. / Kratochvil, Christopher J; Michelson, David; Newcorn, Jeffrey H.; Weiss, Margaret D.; Busner, Joan; Moore, Rodney J.; Ruff, Dustin D.; Ramsey, Janet; Dickson, Ruth; Turgay, Atilla; Saylor, Keith E.; Luber, Stephen; Vaughan, Brigette; Allen, Albert J.

In: Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 46, No. 9, 01.09.2007, p. 1128-1137.

Research output: Contribution to journalArticle

Kratochvil, CJ, Michelson, D, Newcorn, JH, Weiss, MD, Busner, J, Moore, RJ, Ruff, DD, Ramsey, J, Dickson, R, Turgay, A, Saylor, KE, Luber, S, Vaughan, B & Allen, AJ 2007, 'High-dose atomoxetine treatment of ADHD in youths with limited response to standard doses', Journal of the American Academy of Child and Adolescent Psychiatry, vol. 46, no. 9, pp. 1128-1137. https://doi.org/10.1097/chi.0b013e318074eeb3
Kratochvil, Christopher J ; Michelson, David ; Newcorn, Jeffrey H. ; Weiss, Margaret D. ; Busner, Joan ; Moore, Rodney J. ; Ruff, Dustin D. ; Ramsey, Janet ; Dickson, Ruth ; Turgay, Atilla ; Saylor, Keith E. ; Luber, Stephen ; Vaughan, Brigette ; Allen, Albert J. / High-dose atomoxetine treatment of ADHD in youths with limited response to standard doses. In: Journal of the American Academy of Child and Adolescent Psychiatry. 2007 ; Vol. 46, No. 9. pp. 1128-1137.
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N2 - OBJECTIVE: To assess the utility and tolerability of higher than standard atomoxetine doses to treat attention-deficit/hyperactivity disorder (ADHD). METHOD: Two randomized, double-blind trials of atomoxetine nonresponders ages 6 to 16 years were conducted comparing continued treatment with same-dose atomoxetine to treatment using greater than standard efficacious doses (study 1: up to 3.0 mg • kg • day; study 2: up to 2.4 mg • kg • day). RESULTS: The primary outcome measure for both studies was mean ADHD Rating Scale (ADHD RS) total score. For study 1 (N = 122), decreases in ADHD RS total scores were not significantly different between treatment groups (mean change [SD]: continued same dose, -8.9 [11.2]; high dose, -9.8 [13.1]; p = .595). Likewise, for study 2 (N = 125), treatment groups did not differ (mean change [SD]: continued same dose, -6.2 [12.2]; high dose, -8.9 [10.0], p =.110). Tolerability was not significantly different between the continued same-dose and high-dose groups. CONCLUSIONS: These studies provide evidence that current dose recommendations are appropriate for most patients, suggesting no systematic advantage to increasing atomoxetine doses beyond current guidelines. In both studies, continued treatment, whether at a higher dose or the previous dose, was associated with improved outcomes in patients who demonstrated incomplete/inadequate response to acute ADHD treatment, although without a placebo arm, we cannot rule out the possibility that expectancy played a role in symptom improvement. Copyright 2007

AB - OBJECTIVE: To assess the utility and tolerability of higher than standard atomoxetine doses to treat attention-deficit/hyperactivity disorder (ADHD). METHOD: Two randomized, double-blind trials of atomoxetine nonresponders ages 6 to 16 years were conducted comparing continued treatment with same-dose atomoxetine to treatment using greater than standard efficacious doses (study 1: up to 3.0 mg • kg • day; study 2: up to 2.4 mg • kg • day). RESULTS: The primary outcome measure for both studies was mean ADHD Rating Scale (ADHD RS) total score. For study 1 (N = 122), decreases in ADHD RS total scores were not significantly different between treatment groups (mean change [SD]: continued same dose, -8.9 [11.2]; high dose, -9.8 [13.1]; p = .595). Likewise, for study 2 (N = 125), treatment groups did not differ (mean change [SD]: continued same dose, -6.2 [12.2]; high dose, -8.9 [10.0], p =.110). Tolerability was not significantly different between the continued same-dose and high-dose groups. CONCLUSIONS: These studies provide evidence that current dose recommendations are appropriate for most patients, suggesting no systematic advantage to increasing atomoxetine doses beyond current guidelines. In both studies, continued treatment, whether at a higher dose or the previous dose, was associated with improved outcomes in patients who demonstrated incomplete/inadequate response to acute ADHD treatment, although without a placebo arm, we cannot rule out the possibility that expectancy played a role in symptom improvement. Copyright 2007

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