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A systematic review of combination therapy with stimulants and atomoxetine for attention-deficit/hyperactivity disorder, including patient characteristics, treatment strategies, effectiveness, and tolerability.

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A systematic review of combination therapy with stimulants and atomoxetine for attention-deficit/hyperactivity disorder, including patient characteristics, treatment strategies, effectiveness, and tolerability.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Treuer, Tamás Gau, Susan Shur-Fen Méndez, Luis Montgomery, William Monk, Julie A. Altin, Murat Wu, Shenghu Lin, Chaucer C. H. Dueñas, Héctor J.
Description	Country affiliation: Hungary Author Affiliation: Treuer T ( Neuroscience Research, Eli Lilly and Company, Budapest, Hungary. treuert@lilly.com)
Abstract	OBJECTIVE: The purpose of this article was to systematically review the literature on stimulant and atomoxetine combination therapy, in particular: 1) Characteristics of patients with attention-deficit/hyperactivity disorder (ADHD) given combination therapy, 2) treatment strategies used, 3) efficacy and effectiveness, and 4) safety and tolerability. METHODS: Literature databases (MEDLINE(®), EMBASE, Cochrane Central Register of Controlled Trials, Science Citation Index Expanded, and SciVerse Scopus) were systematically searched using prespecified criteria. Publications describing stimulant and atomoxetine combination therapy in patients with ADHD or healthy volunteers were selected for review. Exclusion criteria were comorbid psychosis, bipolar disorder, epilepsy, or other psychiatric/neurologic diseases that could confound ADHD symptom assessment, or other concomitant medication(s) to treat ADHD symptoms. RESULTS: Of the 16 publications included for review, 14 reported findings from 3 prospective studies (4 publications), 7 retrospective studies, and 3 narrative reviews/medication algorithms of patients with ADHD. The other two publications reported findings from two prospective studies of healthy volunteers. The main reason for prescribing combination therapy was inadequate response to previous treatment. In the studies of patients with ADHD, if reported, 1) most patients were children/adolescents and male, and had a combined ADHD subtype; 2) methylphenidate was most often used in combination with atomoxetine for treatment augmentation or switch; 3) ADHD symptom control was improved in some, but not all, patients; and 4) there were no serious adverse events. CONCLUSIONS: Published evidence of the off-label use of stimulant and atomoxetine combination therapy is limited because of the small number of publications, heterogeneous study designs (there was only one prospective, randomized controlled trial), small sample sizes, and geographic bias. Existing evidence suggests, but does not confirm, that this drug combination may benefit some, but not all, patients who have tried several ADHD medications without success.
File Format	HTM / HTML
ISSN	10445463
e-ISSN	15578992
DOI	10.1089/cap.2012.0093
Journal	Journal of Child and Adolescent Psychopharmacology
Issue Number	3
Volume Number	23
Language	English
Publisher	Mary Ann Liebert
Publisher Date	2013-04-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Pediatrics Adrenergic Uptake Inhibitors Therapeutic Use Attention Deficit Disorder With Hyperactivity Drug Therapy Central Nervous System Stimulants Propylamines Administration & Dosage Adverse Effects Atomoxetine Hydrochloride Drug Therapy, Combination Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Pharmacology (medical) Pediatrics, Perinatology and Child Health Psychiatry and Mental Health

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A systematic review of combination therapy with stimulants and atomoxetine for attention-deficit/hyperactivity disorder, including patient characteristics, treatment strategies, effectiveness, and tolerability.