Pharmacological Treatment of Anxiety Disorders

Medication Classification and Guidelines

Atomoxetine is classified as a selective norepinephrine reuptake inhibitor, distinct from serotonin-norepinephrine reuptake inhibitors (SNRIs), according to the American Academy of Child and Adolescent Psychiatry guidelines 1
The effectiveness of atomoxetine for treating anxiety as the primary disorder has not been established, as noted by the American Academy of Child and Adolescent Psychiatry and the AHRQ/Mayo review 1
Atomoxetine may improve executive functions, such as planning and impulse control, in patients with ADHD, as recommended by the American Academy of Child and Adolescent Psychiatry 1, 2

Atomoxetine is approved for the treatment of ADHD in children, adolescents, and adults, with a mechanism of action different from stimulants, making it a non-stimulant option, with a moderate strength of evidence 2, 1
The medication may be beneficial for patients with a risk of substance abuse, comorbid anxiety, comorbid tics, or those who prefer not to take controlled substances, with a high level of evidence supporting its effectiveness 2
Atomoxetine is suitable for patients with a history of substance abuse, as it is not a controlled substance and has no abuse potential, with a high level of evidence 2

For children and adolescents up to 70 kg, the initial dose is 0.5 mg/kg/day, with a target dose of 1.2 mg/kg/day and a maximum dose of 1.4 mg/kg/day or 100 mg/day, according to treatment guidelines 2
For adults and children over 70 kg, the initial dose is 40 mg/day, with a target dose of 80 mg/day and a maximum dose of 100 mg/day, as recommended by clinical practice guidelines 2
Atomoxetine provides 24-hour symptom control, with a once-daily or split-dose administration option, as stated in clinical trials 2

There is a higher risk of suicidal ideation in children and adolescents compared to placebo, requiring close monitoring, especially during the first few months of treatment or with dose changes, with a warning level of high 2
Atomoxetine should be used with caution in patients with preexisting cardiovascular disease, significant cardiac abnormalities, or those who require monitoring for increases in blood pressure and heart rate, as recommended by safety guidelines 2
Approximately 7% of the population are CYP2D6 poor metabolizers, who may have higher plasma levels and longer half-lives, potentially leading to increased adverse effects, with a high level of evidence 2

The most frequently reported adverse effects include gastrointestinal symptoms, decreased appetite, fatigue, and somnolence, with a common level of occurrence 2
Some selective serotonin reuptake inhibitors can elevate serum atomoxetine levels, requiring careful consideration of drug interactions, as stated in pharmacology guidelines 2