Attention-deficit/hyperactivity disorder ADHD

Karen is a 7 year old girl who has been started on atomoxetine 18mng once daily for Attention-deficit/hyperactivity disorder, which is under the recommended starting dose of 0.5mg/kg/day. After just 1 week, her parents report that she is not eating, complains of stomach pain almost everyday, is having trouble sleeping, and is “really crunky.” Her teacher says she never seen anything like it; that Karen is acutally worse on her ADHD medication. A careful review reveals that Karen is taking her medication just as prescribed. She is not on any other prescribed, over-the-counter, or herbal medications. The PMHNP considers that:

A. These are common in the first wees of therapy and the dose should be increased to a therapeutic regimen

B. Karen may be a poor metabolizer of CYP2D6 medications and will need a change of therapy

C. Behavioral modalities should be started as optimal management of Attention-deficit/hyperactivity disorderis multimodal

D. Fuoxetine should be added to the regimen as it has demonstrated effecacy with coincident anxiety.

Biederman, J. (2005). Attention-deficit/hyperactivity disorder: a selective overview. Biological psychiatry, 57(11), 1215-1220.