Evidence-based Pharmaceutical Research Progress of Atomoxetine for Individualized Dose Adjustment in Childhood Attention Deficit Hyperactivity Disorder

OBJECTIVE To explore the evidence-based pharmacological research progress on individualized dose adjustment of atomoxetine in children with attention deficit hyperactivity disorder(ADHD).

METHODS  A search was conducted on the PubMed database using the keywords "atomoxetine" "therapeutic drug monitoring" "CYP2D6" and "children" to retrieve relevant clinical studies. The search period spaned from the inception of the database to August 2024. A technical framework was designed to evaluate the clinical implementation of therapeutic drug monitoring(TDM) for atomoxetine, conduct a systematic and comprehensive analysis of previous studies, and to summarize the findings to address the framework questions.

RESULTS Current evidence showed significant variability in atomoxetine plasma concentrations among individuals. While peak concentration of atomoxetine was a key monitoring parameter linked to its effectiveness, research on its correlation with tolerability was very limited.

CONCLUSION There is currently a gap between research and support for implementing individualized dose targets in clinical practice. While the evidence supporting the necessity of TDM for atomoxetine is limited, accumulating evidence suggests that implementing TDM and CYP2D6 genotyping in children with ADHD can be a way to achieve precise use of atomoxetine, thereby improving the level of rational drug utilization.