Drug Interactions: Atomoxetine & Antidepressants
Let’s begin by answering this question first:
This question is more directed toward drug-drug interactions and the role of Cytochrome P450:
Atomoxetine is metabolized by CYP2D6, so we should avoid medications inhibiting CYP2D6.
CYP2D6 inhibitors are classified into following three categories:
(A) Strong inhibitors: one that causes a > 5-fold increase in the plasma AUC values or more than 80% decrease in clearance.
- Bupropion,
- Fluoxetine and
- Paroxetine
(B) Moderate inhibitors: one that causes a > 2-fold increase in the plasma AUC values or 50-80% decrease in clearance.
- Sertraline,
- Duloxetine
(C) Weak inhibitors: one that causes a > 1.25-fold but < 2-fold increase in the plasma AUC values or 20-50% decrease in clearance.
- Cimetidine,
- Amidoarone.
Based on this information, Sertraline is the best option available
Interaction Between Atomoxetine and Bupropion:
An open-label, non-randomized, two-period, sequential clinical trial was conducted (reference 3). They found:
- the effect of bupropion on CYP2D6 activity was responsible for an increased systemic exposure to atomoxetine (5.1-fold) and also for a decreased exposure to its main metabolite 4-hydroxyatomoxetine-O-glucuronide (1.5-fold)
References:
- Drug Interactions Flockhart Table ™ (Table)
- Atomoxetine package insert. (PDF)
- J Pharm Pharm Sci. 2016 Apr-Jun;19(2):198-207. (PubMed PMID: 27518170)
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