Mixed reactions as ADHD drug made cheaper

[apothecary]

http://www.smh.com.au/news/national/mixed-...5971265509.html

CHILDREN with behavioural problems will be given greater access to a controversial drug from July after it was listed on the Pharmaceutical Benefits Scheme.

Strattera, used to treat attention deficit hyperactivity disorder, has been linked to serious side-effects, including explosive mood swings and erratic behaviour.

The Therapeutic Goods Administration has received 32 reports of suspected adverse reactions associated with the drug's use. They include one child's attempt to open the door of a moving car and a 12-year-old girl who ripped out her fingernails during an aggressive outburst.

But some doctors and ADHD support groups have welcomed the listing, saying it will make one of the few non-stimulant alternatives to usual therapies, such as Ritalin, more widely available.

About 18,000 people are expected to take Strattera in the first financial year of its listing on the PBS, and it will cost the Federal Government $101.2 million over three years.

Professor Florence Levy, an ADHD specialist at the University of NSW, said Strattera worked by regulating levels of the neurotransmitter chemical norepinephrine in the brain.

Several of her patients had responded well to trials of the drug but had been unable to continue due to its cost. "It was so very expensive but people have wanted to trial it," she said. "It is good to have an alternative to stimulant medication because some kids don't respond well to stimulants."

Strattera, also known as atomoxetine, costs $113.40 a month. Its listing on the PBS will bring this down to $30.70, or as little as $4.90 for those with a concession.

Paul Hitchins, head of the Child Development Unit at the Children's Hospital at Westmead, said more options for treatment of ADHD and associated disorders were always welcome.

He said adverse drug reports should be taken seriously, but the anecdotal reports were not always able to be proved. "A doctor might report what they think is an association, but that doesn't mean there is actually any causal association between the drug and its side effects," Dr Hitchins said.

The head of psychological medicine at Adelaide's Women's and Children's Hospital, Jon Jureidini, said he feared there would be more reports of side effects when Strattera was made widely available on the PBS.

"We are very bad at monitoring the side effects of drugs, and I think that patients should try to take old drugs rather than new drugs, because we know more about them," Dr Jureidini said.

Drugs for children with behavioural problems were being over-prescribed, when doctors should be looking for non-drug alternatives, he said.

The Therapeutic Goods Administration said its review of the drug in November had found low numbers of reported adverse reactions. A spokeswoman said this was possibly due to low usage, as it was not at that time subsidised. It was still being monitored, she said.

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Here are some of the 'anecdotal adverse reactions' from wikipedia:

http://en.wikipedia.org/wiki/Atomoxetine

The most common side effect in adults is drowsiness. This can be counteracted in some patients by measures as simple as a cup of coffee, or breathing exercises, while others become exhausted after a short while after taking the pills, and can sleep for up to 10+ hours. Some patients tend to feel lightheaded, dizzy, or "buzzed" as a minor side effect along with the drowsiness. To diminish these side effects, which can interfere with daytime work, study, etc., dosing time is sometimes changed to just before bed; as Strattera is long-acting, it does not "wear off" overnight. Mild hallucinations can be experienced under high doses (300mg).

Also very common is digestive discomfort, such as heartburn. The most common side effects in children and adolescents (and, after drowsiness, in adults) are upset stomach, nausea, and vomiting. The medication's tendency to decrease appetite may contribute to this problem, as taking Strattera on an empty stomach is usually discouraged; it can also be a problem in itself, in the form of hunger pangs. Consumption of dairy products can cause further upset.

A significant minority of adult male patients taking Strattera suffer minor to severe sexual side effects, including erectile dysfunction, retrograde ejaculation, painful orgasm, and the decoupling of orgasm from ejaculation, wherein ejaculation takes place up to ten seconds before or after orgasm.

Two confirmed cases of liver injury have been reported by Eli Lilly and Company out of approximately two million prescriptions written. In both cases upon discontinuation of atomoxetine, patients' liver functions returned to normal.

[apothecary]

Oh and the action of Atomoxetine is 'selective norepinephrine reuptake inhibitor'.

[Salviador]

Strattera is great for getting rid of intrusive thoughts in psychotic patients... Medication is good, just tends to get over used and maintained in use amongst those who don't necessarily benefit from it.

[occidentalis]

Does anyone else think that the term 'side effects' is an extremely problematic one?