Publications

Published: 6 June 2014

Suicidal ideation and behaviour with atomoxetine (Strattera)

Prescriber Update 35(2)
6 June 2014

Key Messages

  • Patients initiated on atomoxetine should be closely monitored for the emergence of suicidal thoughts or behaviours.
  • Families and caregivers of patients being treated with atomoxetine should be informed to look out for changes in behaviour, especially depression, agitation and irritability as these may indicate the emergence of suicidal thoughts and behaviours.
  • Medical advice should be sought immediately if changes in behaviour are seen.
  • Atomoxetine therapy may need to be discontinued if suicidal thoughts or behaviours emerge.

 

Atomoxetine is indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children six years of age and older and adults. Suicidal ideation is a known adverse effect, that is discussed in the data sheet and was seen in children and adolescents treated with atomoxetine during clinical trials1.

The Centre for Adverse Reactions Monitoring (CARM) has received a report of suicidal ideation in a patient taking atomoxetine. The patient experienced gradual onset of symptoms over the first six weeks of treatment, starting with tearfulness and increasing to self-harming and suicidal ideation. The patient recovered after atomoxetine was stopped.

Suicidal ideation was observed in clinical trials in children and adolescents (5/357 in the Strattera group compared to 0/851 in the placebo group). There was one report of suicidal behaviour in the Strattera group. All patients being treated with Strattera should be observed for emergence of suicidal thoughts or behaviours, especially during the initial few months of treatment or at times of dose change.

Families and caregivers of children and adolescents being treated with Strattera should be informed of the need to monitor these patients for emergence of suicidal thoughts or behaviours that may include signs of agitation, irritability or unusual changes of behaviour. If any of these symptoms develop, medical advice should be sought immediately.

References

  1. Eli Lilly and Company (NZ) Limited. 2013. Strattera Data Sheet. 6 August 2013. URL: www.medsafe.govt.nz/profs/Datasheet/s/Stratteracap.pdf (accessed 1 May 2014).