Atomoxetine is often used in ADHD when other agents have been ineffective or are contraindicated. We report prescribing pattern, effectiveness and adverse drug effects associated with atomoxetine (ATX) in a Paediatric Neurodevelopmental Clinic. Naturalistic data are valuable to complement RCT data.

Retrospective case note review of ADHD subjects treated with ATX for any length from a single clinic. Data analysis includes co-morbidity, indications, dose, side effects, and response to treatment (CGI)

150 case notes reviewed. (Males 126, Females 24) .Mean age 12.3 yrs. (range 6.5 to 20.3 yrs) and dose 1.3mg/kg/day. Mean duration treatment 45 weeks (range 1 - 144).

Oppositional /Conduct problems 129(86%), Sleep Problems 100(67%), Learning Difficulty 55(51%), Internalising Symptoms 46(31%), Pervasive Developmental Disorder 32 (21%), Tics/Tourette's 19(13%), Epilepsy 9(6%). Main reasons for ATX initiation -full day cover 150(100%), sleep problems 97(65%), inadequate response or side effects with other medications 78(52%), parental preference 53(35%), internalising symptoms 31(21%), pervasive developmental disorder 31(21%), appetite/growth concerns 20(13%), tics/Tourette's 20(13%). CGI in those > 6 weeks treatment (n=129) - 25(19.4%) CGI-I, 33(25.6%) CGI-I 2, 18(12.4%) CGI-I 3, 47(36.4%) CGI-I 4, 8(6.4%) CGI-I 5. Adverse reactions reported include:-GI symptoms 21 patients, aggression 11, worsening ADHD 6, cold extremities/acrocyanosis 3, self harm 2, somnolence 2, palpitations/labile blood pressure 2.

Atomoxetine is a useful treatment in ADHD for many subjects including those with treatment failure, adverse effects or contraindications associated with other agents. This naturalistic data also demonstrates the importance of parental preference in treatment choice.