Pharmacotherapy with atomoxetine for US children and adolescents

Atomoxetine, a non-stimulant medication, was approved for treatment of Attention Deficit/ Hyperactivity Disorder (ADHD) in 2002. However, there is a paucity of recent practice-based national data on the use of atomoxetine. This article compares the use of atomoxetine with that of stimulant medications in outpatient treatment of U.S. children and adolescents, and examines the predictors of atomoxetine use in this population.

The 2003-2004 National Ambulatory Medical Care Survey and the outpatient department portion of the 2003-2004 National Hospital Ambulatory Medical Care Survey were used to determine the utilization of atomoxetine and stimulants in youth<20 years. Bivariate analyses were used to examine the use of atomoxetine relative to that of stimulant medications in children and adolescents (n=1,133). Multiple logistic regression analysis was applied to visits involving youths with ADHD to examine predictors of atomoxetine use (n=1,361).

An estimated 14.51 million visits involving psychotropic agents resulted in prescription of atomoxetine and stimulants during the years 2003 and 2004. The percentage of visits for atomoxetine, as a proportion of all psychotropic visits, was nearly 10% (versus 40% for stimulants). Analyses of visits involving atomoxetine and stimulants revealed age- and region-based differences in the use of atomoxetine. Among children with ADHD, approximately 15% of outpatient visits resulted in prescription of atomoxetine; and stimulant medications were prescribed in nearly 61% of these visits. Examination of predictors of ADHD treatments (atomoxetine vs. stimulants) revealed no variations in the use of atomoxetine across sex, race, psychiatric comorbidity, primary care status, and metropolitan location. However, atomoxetine was preferred in 10-to-14 year old children, and in patients with private insurance. Physicians in the Northeast region were less likely to prescribe atomoxetine than physicians in the South.

Although stimulant drugs remain the most frequently prescribed class of psychotropic medications for ADHD in children and adolescents, atomoxetine has emerged as the leading stimulant alternative. Preferential use of atomoxetine in age group 10-to-14 years needs to be further evaluated. Additionally, the role of several factors, including patient preferences, physician-related factors, and psychiatric comorbidity warrant further investigation. Data on differential safety and efficacy of atomoxetine and stimulants are needed to optimize pharmacotherapy in children.