Question:
Is Atomoxetine recommended for teenagers with DS? Is there any medical evidence for cognition improvement? Or adverse side effect?
Answer:
- Atomoxetine is used to treat attention deficit hyperactivity disorder (ADHD) in teenagers with Down syndrome (DS).
- We could find no evidence for cognitive improvement associated with using atomoxetine in people with DS.
- There is limited information regarding side effects specifically in teens with DS.
Atomoxetine (Strattera) is approved by the US Food and Drug Administration (FDA) for ADHD. It is approved for children (6 years of age and older) and adults. While the exact mechanism of action is unknown, it does selectively inhibit norepinephrine reuptake. By inhibiting (or blocking) the reuptake of norepinephrine in the brain cells, the norepinephrine will have greater effect.
Norepinephrine, also called noradrenaline, is a stimulant. Most other medications to treat ADHD are stimulants. However, unlike other medications for ADHD, atomoxetine is not a stimulant itself. Instead, it increases the effect of the norepinephrine that is already present. Atomoxetine is considered a “non-stimulant” treatment for ADHD.
Atomoxetine is used for people, including teenagers, with and without Down syndrome (DS) to treat ADHD.
Assessment
When assessing an individual with DS for ADHD, it is important to assess for other problems that may mimic or contribute to the symptoms of ADHD. Treatment would be expected to be more successful if those other conditions are treated if present. The University of Iowa has a nice article describing this issue.
Treatment
When deciding on treatment, it is important to look at possible behavioral treatments as well as medication. The Centers for Disease Control has some good information on treating ADHD, but it is not specific to DS.
A study that is assessing treatment for ADHD in children with DS is listed on the ClinicalTrials.gov website. One of the investigators of that study gives more information on ADHD and Down syndrome in this webinar.
Side effects
As with most medications, the list of potential side effects from atomoxetine is long. We did not find any studies describing side effects specifically in people with DS. In our limited experience with the medication in our patients with DS, it has been well-tolerated.
A review article that reported on the findings of 11 papers on the use of atomoxetine in children with intellectual disabilities concluded:
- More study is needed in people with intellectual disabilities (there are only limited study data at this time).
- The limited studies available suggest clinical improvement when children with an intellectual disability and ADHD use atomoxetine; but the studies did not clearly prove that.
- The effect on co-occurring behavioral and cognitive symptoms was less consistent.
- Decreased appetite, nausea, and irritability were the most common side effects.
- Irritability occurred more commonly in people with an intellectual disability than in typically developing individuals (which is also found with stimulant medications for ADHD).
Additionally, atomoxetine is presently being studied as a possible treatment for sleep apnea in children with mosaic DS. Information from LuMind IDSC Foundation can be found at this link. Information from the ClinicalTrials.gov website can be found here.